50-State Guide
Missouri
Last updated June 2026
At a Glance
| Category | Details |
|---|---|
| IMLC Member | No |
| FCVS | Accepted |
| NP Independent Practice | No |
| PA Independent Practice | No |
| Physician-Owned PC Allowed | No |
| Max NPs per Physician | 6 |
| Max PAs per Physician | 6 |
Licensure
| Item | Cost |
|---|---|
| Initial License | $300 |
| Renewal Fee | $260 |
| Renewal Cycle | Biennial |
| Annualized Cost | $130.00 |
| Controlled Substance Registration | Yes ($90/2yr) |
In-State Physician Requirement
Strict: MD must be within 75 miles of site. (CHANGED THEIR LAW ON THIS - telehealth)
APC Supervision
Nurse Practitioners
NPs require physician supervision in Missouri.
- Maximum NPs per physician: 6
Physician Assistants
PAs require physician supervision in Missouri.
- Maximum PAs per physician: 6
Additional Notes
Combined max of 6 (FTE).
CME & Training Requirements
| Requirement | Details |
|---|---|
| Total CME | 50 hours |
| Category 1 Minimum | See board |
| Cycle | Biennial |
| Opioid/Pain Mgmt | Not required |
| Human Trafficking | Required |
| Implicit Bias | Not required |
| Suicide Prevention | Not required |
| DEA MATE Act | 8 hrs one-time (federal) |
| Jurisprudence Exam | Required (embedded in application) |
Fingerprint Requirements
| Detail | Info |
|---|---|
| Required | Yes |
| FBI Check | Yes |
| Method | Ink cards (FD-258) |
| Out-of-State Options | Contact board |
| Timing | With application |
Quirks & Gotchas
Application Requirements
- The board moved to the MOPRO online portal (mopro.mo.gov) starting January 14, 2025. Paper applications still exist but MOPRO is the primary path. You must create a MOPRO account first - there is no shortcut.
- Jurisprudence exam is embedded in the application itself**, not a standalone proctored exam. It is 20 true/false questions on Missouri law and regs. Passing score is 75% (15/20 correct). Easy but mandatory - a wrong answer does not auto-fail you; you need to score below 75% to fail. Many physicians miss this is even a requirement because it is baked into the form rather than administered separately.
- FCVS (Federation Credentials Verification Service) is strongly recommended** but not strictly mandatory for all applicants. The board requires primary source verification of all credentials. If you go without FCVS, each institution (medical school, residency program, boards) must send documents directly to Missouri. FSMB explicitly warns: submit the FCVS application before the UA (Uniform Application) to prevent the UA from expiring while credentials are still gathering.
- Application expiration trap:** Any file sitting incomplete for one year is discarded and the fee is forfeited. Applications pending over 3 months trigger a board request for updated information. Start credential gathering before submitting the application.
Fees
- Initial application fee: $102** (some sources cite $75 for the processing-only portion; the total board fee appears to be $102).
- FCVS profile fee: ~$375** (separate FSMB charge, not paid to Missouri but effectively mandatory for most applicants). Add individual institution fees on top.
- IMLC route fee: $700** to the Compact plus the standard Missouri license fee - significantly more expensive than a direct application if Missouri is your only target state.
- No criminal background check fee listed separately** by the board - but fingerprinting through Missouri State Highway Patrol-approved services runs approximately $15-$50 and is paid directly to that vendor, not the board. Easy to overlook in budgeting.
- Renewal fee is paid biennially; licenses expire January 31 of the renewal year regardless of when you originally licensed. If you license in November, you are renewing in less than 3 months.
Fingerprints & Background Check
- Fingerprinting is required** for new applicants. Acceptable methods: FD-258 hard-copy fingerprint cards OR electronic fingerprinting through Missouri State Highway Patrol-approved services.
- Results must go directly to the board from the processing agency - applicants cannot hand-carry results.
- One notable finding from medicallicensuregroup.com: they describe the background check as “not required by the Missouri Medical Board” for standard licensure (meaning no separate criminal history form beyond the fingerprint-based FBI/state check). This is potentially misleading - fingerprinting effectively IS the background check. Do not skip it.
IMG-Specific Requirements
- International medical graduates (IMGs) must have 3 years of ACGME/AOA/RCPSC-accredited U.S. or Canadian postgraduate training (vs. 1 year for U.S./Canadian graduates).
- A valid ECFMG certificate is required for IMGs.
- FCVS does not verify international (non-ACGME/AOA/RCPSC) GME training. All international residency training goes in the “Additional Activities” section of the UA only - no primary source verification pathway exists through FCVS for it.
Other Gotchas
- 3-attempt limit** on each USMLE Step (I, II, III).
- 7-year time limit** to complete all three Steps, starting from the date of the first successful Step passage - not from when you started attempting. A gap year between Steps could bite you.
CME & Mandatory Training
- 50 hours every 2-year cycle**, renewable January 31 of even years.
- Acceptable credit types: AMA PRA Category 1, AOA Category 1-A or 2-A, or AAFP Prescribed. Category 2/non-prescribed credits do not count toward the 50-hour requirement.
- Alternative pathway:** 40 hours suffice if all credits are AMA Category 1 or AOA Category 1-A AND each activity includes a post-test completion. This is obscure and rarely advertised.
- No state-mandated topic-specific CME** for physicians (no mandatory opioid prescribing hours, no implicit bias, no human trafficking, no suicide prevention required by Missouri state board at this time). This is actually notable - Missouri is one of the less prescriptive states.
- DEA MATE Act caveat (federal, not state):** Any DEA-registered physician must complete a one-time 8-hour training on opioid/substance use disorder treatment as part of DEA registration/renewal (effective June 27, 2023). This is not a Missouri board requirement but catches people off guard at DEA renewal.
- Physicians receiving initial licensure within the current renewal cycle are exempt from CME for that cycle only.
Timeline
- Official board estimate: minimum 6 weeks once application is complete, fee paid, and in queue.
- Real-world average: 8-12 weeks for a complete, clean application.
- FCVS processing adds time upstream - budget 4-6 weeks for FCVS alone if credentials are straightforward; more if any institution is slow to respond.
- Total realistic timeline from starting the process: 3-5 months for most physicians.
Telehealth (Recent Changes)
- SB 79 (2025):** The most recent update. Removed the requirement that on-site clinical staff be available at originating sites for telehealth delivery (with limited exceptions for new provider relationships). This is a meaningful operational loosening.
- Licensing:** The patient’s location defines “place of service.” You must hold an active Missouri license to treat patients located in Missouri - no exceptions for virtual-only, subscription, or DTC models.
- Out-of-state exceptions** are narrow: emergency/disaster relief (no charge permitted), episodic irregular consultation with a Missouri-licensed physician, or informal unpaid consultation. Regular telehealth practice = full Missouri license required.
- Controlled substance prescribing via telehealth:** Requires EPCS (electronic prescribing of controlled substances) with two-factor authentication, mandatory PDMP check, and heightened documentation for opioids, benzodiazepines, stimulants, and MAT. Questionnaire-only or messaging-only evaluation is explicitly insufficient as a basis for prescribing.
- Audio-only coverage (Medicaid): Missouri Medicaid covers audio-only telehealth; bill with the FQ modifier** (effective July 1, 2022) for equivalent reimbursement. Private insurers cannot deny coverage solely because service was delivered via telehealth.
Other Gotchas
- License expiration is January 31** regardless of original issue date. A physician licensed in December effectively has a ~6-week first cycle.
- Inactive status exists** but requires a formal application to reinstate. CME requirements during inactive periods and reinstatement conditions are not clearly published online - confirm directly with the board.
- Limited license** types exist (e.g., for residents, locum tenens situations) and do not automatically convert to full unrestricted licenses. Separate application required.
- Associate Physician license** (Missouri-specific category) does not count toward or transition into a full physician license without meeting all standard requirements independently.
- SPEX/COMVEX** examinations are only required if restoring a license after disciplinary action or by specific board order - not standard.
- The board’s own website (pr.mo.gov) has a broken/unverifiable SSL certificate as of mid-2025, which can cause confusion when trying to access forms directly. Forms are still accessible via HTTP fallback but many browsers will block them. Plan to use the MOPRO portal instead of downloading PDFs directly.
- Board phone: (573) 751-0098 | Email: licensure@pr.mo.gov - worth a direct call to confirm any requirement that seems ambiguous online, particularly around supplemental forms the board may request case-by-case.
Researched from state board websites and regulatory sources. Verify with the board directly before applying.
Resources
- Missouri State Board of Registration for the Healing Arts
- FSMB State Licensure Directory
- Interstate Medical Licensure Compact
Sources
Data compiled from state medical board websites, FSMB, and regulatory filings. Last updated June 2026.
Have a correction or update? Let us know.