Does Texas Require a DME License?

No. Texas does not have a general license for durable medical equipment suppliers that sell or rent to patients. The Texas Department of State Health Services (DSHS) licenses device manufacturers and distributors, and its rule defines a distributor as a business that moves devices from the manufacturer "to the person who makes final delivery or sale to the ultimate user" (25 Tex. Admin. Code 229.433(8)). A supplier that is itself the one selling to the patient sits at the end of that chain, outside the distributor license.

Several online 50-state lists say Texas requires a DME supplier license. We read the Texas rules and did not find one. That does not mean nothing in Texas applies to you; it means the licenses that apply are tied to what you do and what you sell.

What does the Texas device distributor license cover?

The DSHS rules at 25 Tex. Admin. Code 229.431 to 229.444 license device distributors and manufacturers. The key definitions in 229.433:

• A distributor "furthers the marketing of a finished domestic or imported device from the original place of manufacture to the person who makes final delivery or sale to the ultimate user." The term includes an importer or own-label distributor, and excludes anyone who repackages or relabels.
• A manufacturer "manufactures, fabricates, assembles, or processes a finished device," and the term "includes a person who repackages or relabels a finished device."

The exemptions in 229.434(a) include intracompany sales and "distribution from a place of business located outside the State of Texas." So an out-of-state business shipping devices into Texas is exempt from the distributor license even if it would otherwise be a distributor.

When could a Texas supplier still need a DSHS license?

Three situations deserve a careful look:

1. You sell to other suppliers, not just patients. A Texas business that wholesales devices to other retailers is doing what the distributor definition describes.
2. You repackage or relabel. Breaking cases of supplies into private-label kits, or relabeling, falls under the manufacturer definition in 229.433(17), which "includes a person who repackages or relabels a finished device."
3. Other laws apply anyway. The exemption section says it "does not exempt a person from other applicable provisions of the Texas Food, Drug, and Cosmetic Act ... the Texas Dangerous Drug Act ... or the rules" adopted under them (229.434(c)). Drugs and prescription-only items are governed separately.

Do orthotics and prosthetics need a Texas license?

Yes, for the practice. Texas Occupations Code chapter 605 says a person "may not practice, attempt to practice, or offer to practice orthotics or prosthetics ... unless the person holds a license under this chapter" (605.251). Facilities are accredited too: the Texas Department of Licensing and Regulation issues accreditation to orthotic or prosthetic facilities, and "An orthotic or prosthetic facility must be under the on-site direction of an orthotist or prosthetist licensed by the department in the discipline for which accreditation is sought" (605.260(a), (c)). The statute defines orthotics around measuring, designing, fabricating, fitting, adjusting or servicing an orthosis under a practitioner's order (605.002). If your Texas location fits or adjusts braces, read chapter 605 before you open. More in O&P practitioner and facility licensing.

Does Texas Medicaid add anything?

A possible surety bond. Under 1 Tex. Admin. Code 352.15, HHSC may require a surety bond "for each enrolled location" when a provider or type of provider "has been identified by federal or state agencies to have a significant history of, or potential for, fraud, waste, or abuse." The bond must be "no less than $50,000," name HHSC as obligee, and come from a surety licensed by the Texas Department of Insurance with a Treasury certificate of authority. HHSC "will not reimburse a provider for items or services furnished during a period in which the provider does not have a current surety bond." This is separate from Medicare's own bond, and we do not sell bonds; your licensed surety agent issues them. See Texas Medicaid's surety bond.

Is there anything to list for Texas in PECOS?

The CMS-855S asks each location to list the states it serves and to "submit all required licenses for the products and services being provided." Where Texas law requires no license for what you supply, there is no Texas supplier license to attach. Any product or practice license that does apply, such as an orthotics and prosthetics license, belongs on the application. For Round 2028 competitive bidding, CBIC's rule is the same: every license a state requires for the product category must be current in PECOS by the close of the bid window. See getting your state licenses into PECOS.

One accreditation note for Texas suppliers: the Board of Certification/Accreditation (BOC) said in January 2026 that its restrictions on new accreditation and reaccreditation of suppliers in Texas, California, Florida and New York remain in place.

Why do the 50-state lists get Texas wrong?

Most likely because they see a DSHS "device distributor" license and assume it covers every supplier. The definitions say otherwise, and an out-of-state supplier is exempt from it on the face of 229.434(a)(2). It is a good example of why we cite the rule for every state and mark a state "being confirmed" rather than copying an aggregator. The full verified list is in DME license requirements by state and on the Texas state page.

Where can we help a Texas supplier?

A $149 DMEPOS Readiness Review maps your products against Texas and every other state you ship to, so you pay for licenses only where the law requires them (pricing). For the states that do require one, our State DME License service is $699 per state ($899 for California, Florida, Georgia and Alabama). Your owner or an officer signs each application and pays the state.