# COMAR Title 10 — Maryland Department of Health

## Subtitle 65 — Board of Massage Therapy Examiners

### Chapter 01 — General Regulations

**Authority:** General Provisions Article, §4-333(c); Health Occupations Article, §§6-101, 6-102, 6-201—6-206, 6-301—6-306, and 6-504; Annotated Code of Maryland

**Administrative History:** Effective date:

**Administrative History:** Regulations .01 and .02 adopted effective January 2, 2017 (43:26 Md. R. 1446)

**Administrative History:** Regulations .01, .05, and .07 recodified from COMAR 10.43.17 to be Regulations .03, .07, and .09 effective January 2, 2017 (43:26 Md. R. 1446)

**Administrative History:** Regulations .02—.04, .06, and .08—.10, amended and recodified from COMAR 10.43.17 to be Regulations .04—.06, .08, and .10—.12 effective January 2, 2017 (43:26 Md. R. 1446)

**Administrative History:** Regulation .04B amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .05B amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .06 amended effective December 31, 2018 (45:26 Md. R. 1247); December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .06F amended effective August 18, 2025 (52:16 Md. R. 847)

**Administrative History:** Regulation .07 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .07A amended effective December 31, 2018 (45:26 Md. R. 1247)

**Administrative History:** Regulation .08 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .09 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .10 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulations .11 and .12 recodified from COMAR 10.43.17 to be Regulations .13 and .14 effective January 2, 2017 (43:26 Md. R. 1446)

**Administrative History:** Regulation .11 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .12 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .13 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .14 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .15 adopted effective April 9, 2018 (45:7 Md. R. 345)

**Administrative History:** Regulation .15 amended effective December 25, 2023 (50:25 Md. R. 1088)

**Administrative History:** Regulation .16 adopted effective December 31, 2018 (45:26 Md. R. 1247)

**Administrative History:** Regulation .16 repealed effective December 25, 2023 (50:25 Md. R. 1088)

#### Regulation .01 Rules of Order.

*COMAR 10.65.01.01*

All proceedings of the Board in regular session shall be governed by Robert’s Rules of Order.

#### Regulation .02 Board Officers, Members, and Staff.

*COMAR 10.65.01.02*

A. The Board shall, as the appointing authority, direct the operation of the staff through the executive director.

B. Board members may not have monetary, pecuniary, or other interest in the affairs of any:

  (1) Staff member; or

  (2) Organization engaged in business with the Board, including:

    (a) Businesses;

    (b) Enterprises; or

    (c) Other for-profit organizations.

C. A Board member or Board staff may not serve for compensation as an instructor in a continuing education course or program under Board cognizance over which that Board member or staff member serves in an approval capacity.

#### Regulation .03 Scope.

*COMAR 10.65.01.03*

Except as specifically provided in this chapter, this chapter does not limit the right of an individual to:

A. Practice a health occupation that the individual is otherwise authorized to practice under the Health Occupations Article, Annotated Code of Maryland; or

B. Advertise an occupation that the individual is otherwise authorized to practice under the Health Occupations Article, Annotated Code of Maryland.

#### Regulation .04 Definitions.

*COMAR 10.65.01.04*

A. In this chapter, the following terms have the meanings indicated.

B. Terms Defined.

  (1) “Board” means the State Board of Massage Therapy Examiners.

  (2) “Custodian of records” means an individual designated by the Board who:

    (a) Is responsible for the security, storage, dissemination, and destruction of records; and

    (b) Complies with:

      (i) General Provisions Article, Title 4, Annotated Code of Maryland;

      (ii) Health Occupations Article, Title 6, Annotated Code of Maryland; and

      (iii) This subtitle.

  (3) “Health care setting” has the meaning stated in Health-Occupations Article,§6101(c), Annotated Code of Maryland.

  (4) “License” means the document issued by the Board to an individual qualified to practice massage therapy.

  (5) “Licensed massage therapist (LMT)” means an individual who is licensed by the Board to practice massage therapy.

  (6) “Licensee” means, unless the context requires otherwise, a licensed massage therapist or a registered massage practitioner authorized by the Board to practice massage therapy.

  (7) Massage Therapy.

    (a) “Massage therapy” means the use of manual techniques on soft tissues of the human body including stroking, kneading, tapping, stretching, compression, vibration, and friction.

    (b) “Massage therapy” includes massage, myotherapy, and synonyms or derivatives of these terms, with or without the aid of:

      (i) Cold packs;

      (ii) Nonlegend topical applications; or

      (iii) Heat limited to hot packs and heating pads.

    (c) “Massage therapy” does not include the:

      (i) Diagnosis of illness, disease, or injury;

      (ii) Adjustment, manipulation, or mobilization of any of the articulations of the osseous structures of the body or spine; or

      (iii) Laying on of hands, consisting of pressure or movement, with the exception of such techniques described in §B(7)(a) of this regulation on a fully clothed individual to specifically affect the electromagnetic energy or energetic field of the human body.

  (8) “Massage therapy education program” means a course of study that prepares individuals in subjects related to the knowledge, techniques, skills, and abilities used in the practice of massage therapy.

  (9) “Practice massage therapy” means to engage professionally and for compensation in massage therapy.

  (10) “Registered massage practitioner (RMP) or registrant” means an individual who is registered by the Board to practice massage therapy in a setting that is not a health care setting.

  (11) “Registration” means, unless the context requires otherwise, a document issued by the Board to practice massage therapy in a setting that is not a health care setting.

  (12) “Research” means a curriculum component that systematically investigates and validates massage therapy techniques based on sources and data to provide successful outcomes for clients.

  (13) “State Board of Massage Therapy Examiners Jurisprudence Examination” means the test developed by the Board to assess an applicant’s knowledge of the statute and regulations governing massage therapy in the State.

#### Regulation .05 Licensure or Registration Required; Exceptions.

*COMAR 10.65.01.05*

An individual shall be licensed by the Board in order to practice massage therapy, and shall be registered by the Board in order to practice massage therapy in a setting that is not a health care setting, except for the following:

A. A student enrolled in an approved education program as determined by the Board while performing massage therapy in the program;

B. An individual who:

  (1) Practices massage therapy in a recognized jurisdiction with an active license or registration in good standing;

  (2) Is seeking to practice in Maryland exclusively with a visiting organization for not more than 7 consecutive days and not to exceed 30 days per calendar year; and

  (3) Submits a timely request for approval to participate in an event by application at least 10 days prior to the event in accordance with Board procedures;

C. A family member performing massage therapy on another family member;

D. An athletic trainer while functioning in the scope of the athletic trainer's professional capacity;

E. An individual employed by the federal government to practice massage therapy while practicing within the scope of the individual's employment; or

F. A licensed cosmetologist or esthetician who:

  (1) Operates a beauty salon;

  (2) Has obtained a permit from the State Board of Cosmetology as required under Business Occupations and Professions Article, §5-501, Annotated Code of Maryland; and

  (3) Limits their practice to:

    (a) Being within the scope of a license issued by the State Board of Cosmetology; and

    (b) The application and removal of skin products, not including massage therapy.

#### Regulation .06 Application for Licensure or Registration.

*COMAR 10.65.01.06*

A. An applicant for a license to practice massage therapy shall:

  (1) Complete the application provided by the Board;

  (2) Pay the application fee as specified in COMAR 10.65.07;

  (3) Submit one recent 2 inch by 2 inch passport type photograph on a solid white background of the applicant;

  (4) Submit a completed criminal background check;

  (5) Provide evidence that the applicant is:

    (a) Of good moral character; and

    (b) 18 years old or older;

  (6) Pass the State Board of Massage Therapy Examiners Jurisprudence Examination, which is administered by the Board, with a score of at least 75 percent;

  (7) Have sent directly to the Board by the administering authority proof of having passed a Board-approved examination;

  (8) Have copies of official transcripts sent directly to the Board by an institution of postsecondary education, as defined in Education Article, §10-101, Annotated Code of Maryland, and approved by the Maryland Higher Education Commission, from which the applicant graduated that documents completion of a program of at least 750 contact hours of massage therapy education in a curriculum that is:

    (a) Approved by the Board;

    (b) Endorsed by:

      (i) The Commission on Massage Therapy Accreditation (COMTA); or

      (ii) An equivalent entity that accredits both institutions of postsecondary education and programs offering instruction in massage therapy; and

    (c) Accredited by an institutional accreditation agency recognized by the United States Department of Education;

  (9) Provide documentation of having satisfactorily completed the requirements listed in Regulation .07 of this chapter;

  (10) Provide documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level; and

  (11) Have verification of status sent directly to the Board by the issuing state, if certified, licensed, or registered to practice massage therapy in another state.

B. On or before September 30, 2024, to be a registered massage practitioner, an applicant shall:

  (1) Complete the application provided by the Board;

  (2) Pay the application fee as specified in COMAR 10.65.07; and

  (3) Submit one recent 2 inch by 2 inch passport type photograph on a solid white background of the applicant;

  (4) Submit a completed criminal background check;

  (5) Provide evidence that the applicant is:

    (a) Of good moral character; and

    (b) 18 years old or older;

  (6) Pass the State Board of Massage Therapy Examiners Jurisprudence Examination, which is administered by the Board, with a score of at least 75 percent;

  (7) Have sent directly to the Board by the administering authority proof of having passed a Board-approved examination;

  (8) Have copies of official transcripts sent directly to the Board by the school from which the applicant graduated that documents completion of a program of at least 600 classroom hours in massage therapy education that is:

    (a) Approved by the Board;

    (b) Endorsed by:

      (i) The Commission on Massage Therapy Accreditation (COMTA); or

      (ii) An equivalent entity that accredits both institutions of postsecondary education and programs offering instruction in massage therapy; and

    (c) Accredited by an institutional accreditation agency recognized by the United States Department of Education;

  (9) Provide documentation of having satisfactorily completed the requirements listed in Regulation .07 of this chapter;

  (10) Provide documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level; and

  (11) Have verification of status sent directly to the Board by the issuing state, if certified, licensed, or registered to practice massage therapy in another state.

C. The Board may not issue a license or registration if the criminal history record information required under Health Occupations Article, §6-303(b), Annotated Code of Maryland, has not been received.

D. On or after October 1, 2024, the Board may not issue an initial registration to practice as a registered massage practitioner.

E. On or before October 31, 2026, on a request made on an application approved by the Board, the Board shall convert the registration of an individual registered by the Board as a registered massage practitioner to a license to practice massage therapy if the individual complies with regulations under this subtitle.

F. Conversion.

  (1) In order for an individual to convert from a registered massage practitioner to a licensed massage therapist, a minimum of one of the following shall be met by the conversion applicant:

    (a) Has held a registration continuously in good standing for a minimum of 10 years preceding the conversion request;

    (b) Attest to the accumulation of 1,000 hours of hands-on experience within the practice of massage therapy over the previous 2 years between:

      (i) Work hours; and

      (ii) Board-approved continuing education hours; or

    (c) Provide documentation verifying a total of 750 hours of massage therapy education which may include:

      (i) Contact hours from a Board-approved program of study of massage therapy; or

      (ii) Board-approved continuing education hours.

  (2) It is the burden of the conversion applicant to demonstrate that the applicant is eligible for conversion.

  (3) The Board:

    (a) May request additional documentation from the conversion applicant to substantiate or clarify the applicant’s conversion application; and

    (b) May not convert the registration of an applicant whose registration has been suspended or revoked.

#### Regulation .07 Required Massage Therapy Education and Training.

*COMAR 10.65.01.07*

A. Classroom Training: LMTs.

  (1) An applicant for a license to practice massage therapy shall provide documentation of having graduated with at least 750 hours of education in a Board-approved program for the study of massage therapy that includes the following areas of content:

    (a) 100 hours in anatomy, physiology, and kinesiology;

    (b) 200 hours in massage therapy theory;

    (c) 50 hours in contraindications to massage therapy and pathology;

    (d) 30 hours in professional ethics;

    (e) 5 hours in health and hygiene;

    (f) 5 hours in research;

    (g) 175 hours in supervised hands-on techniques;

    (h) 50 hours in clinical assessment and documentation;

    (i) 35 hours in professional standards and business practices; and

    (j) 100 hours in supervised clinical experience/practicum.

  (2) Cardiopulmonary resuscitation (CPR) shall be included but does not count towards the 750-hour minimum.

  (3) An applicant may attend more than one training institution, if the applicant graduates from a school requiring satisfactory completion of a minimum of 750 classroom hours in massage therapy education.

B. Classroom Training: RMPs.

  (1) An applicant for a registration to practice massage therapy shall provide documentation of graduation from a Board-approved program of at least 600 hours for the study of massage therapy that includes the following areas of content:

    (a) Anatomy, physiology, and kinesiology;

    (b) Massage therapy theory;

    (c) Contraindications and pathology;

    (d) Professional ethics;

    (e) Health and hygiene;

    (f) Research;

    (g) Supervised hands-on techniques; and

    (h) Clinical assessment and documentation.

  (2) Cardiopulmonary resuscitation (CPR) shall be included but does not count towards the 600-hour minimum.

  (3) An applicant may attend more than one training institution, if the applicant graduates from a school requiring satisfactory completion of a minimum of 600 classroom hours in massage therapy education.

C. Education and Training in a Foreign Country.

  (1) The Board may grant a license or registration to practice massage therapy to an applicant who completed an educational program in a foreign country if the applicant:

    (a) Can demonstrate through a Board-approved certifying agency that the applicant's education and training were substantially equivalent to the requirements of §A of this regulation through a Board-approved certifying agency; and

    (b) Meets the examination and other requirements of this chapter.

  (2) The Board may interview an applicant under this section to determine whether the applicant's education and training meet the requirements of this chapter.

  (3) An applicant shall arrange and pay for the professional translation into English of all documentation required under this chapter if the documentation is in a language other than English.

#### Regulation .08 Licensure.

*COMAR 10.65.01.08*

A. The Board shall:

  (1) Issue a license to an approved applicant that:

    (a) Is not valid for more than 2 years, and

    (b) Expires on the date set by the Board; or

  (2) Notify an applicant not approved for licensure by letter which specifies the reason or reasons for disapproval.

B. The licensee shall notify the Board of any change in the legal name or address of the licensee, in writing, within 60 days after the change occurs.

C. The Board may not issue a license if the criminal history records information required under Health Occupations Article, §6–303(b), Annotated Code of Maryland, has not been received.

D. Display of License. A licensee shall display the license and any current renewal license conspicuously in the space where the licensee is engaged in practice, including in any temporary space or in any exhibit location.

#### Regulation .09 Registration.

*COMAR 10.65.01.09*

A. The Board shall:

  (1) Issue an initial registration until September 30, 2024, to an approved applicant that:

    (a) Is not valid for more than 2 years; and

    (b) Expires on the date set by the Board; or

  (2) Notify an applicant not approved for registration, by a letter which specifies the reason or reasons for disapproval.

B. The registrant shall notify the Board, in writing, of any change in the legal name or address of the registrant within 60 days after the change occurs.

C. The Board may not issue a registration if the criminal history records information required under Health Occupations Article, §3–302.1, Annotated Code of Maryland, has not been received.

D. Display of Registration. A registrant shall display the registration and any current renewal registration conspicuously in the space where the registrant is engaged in practice, including in any temporary space or in any exhibit location.

#### Regulation .10 Renewals.

*COMAR 10.65.01.10*

A. The Board shall send each licensee a renewal notice that states the:

  (1) Date on which the current license or registration expires;

  (2) Latest date by which the renewal application and documentation can be received by the Board in order for the renewal license or registration to be issued before the current license or registration expires; and

  (3) Amount of the renewal fee as specified in COMAR 10.65.07.

B. At least 30 days before the current license or registration expires, the Board shall send the renewal notice by electronic means or first-class mail to the last known electronic or physical address of the licensee.

C. Late Renewal. A late fee in addition to a renewal fee shall be applied as specified in COMAR 10.65.07, if the request is received by the Board within 30 days of the expiration date of the license or registration.

D. Licensees shall satisfactorily complete the minimum continuing education requirements set forth under COMAR 10.65.05.

#### Regulation .11 Reinstatement.

*COMAR 10.65.01.11*

A. The Board shall reinstate an individual whose license or registration has expired if the individual:

  (1) Meets the renewal requirements of this chapter and Health Occupations Article, §6-306, Annotated Code of Maryland;

  (2) Pays the late and reinstatement fees as specified in COMAR 10.65.07, if the request is received by the Board more than 30 days after the expiration date of the license or registration; and

  (3) Satisfactorily completes the minimum continuing education requirements set forth under COMAR 10.65.05.

B. A licensed massage therapist who fails to apply for licensure reinstatement within 5 years after the expiration date of the license shall meet the requirements in effect at the time of the request in order to be licensed to practice massage therapy.

C. Except as otherwise provided in this chapter, a registered massage practitioner who fails to apply for registration reinstatement within 5 years after the expiration date of the registration shall meet the requirements in effect at the time of the request in order to be registered to practice massage therapy in a setting that is not a health care setting.

#### Regulation .12 Inactive Status.

*COMAR 10.65.01.12*

A. In accordance with Health Occupations Article, §6-306, Annotated Code of Maryland, a request by an active licensee or registrant to transfer a license or registration to inactive status shall be granted upon receipt of the:

  (1) Completed Board-approved inactive status application; and

  (2) Payment of the required, non-refundable, biennial inactive status fee set forth in COMAR 10.65.07.

B. An individual:

  (1) May apply for inactive status only if the individual’s license or registration is still active at the time the inactive status application request is made;

  (2) Shall renew and pay the biennial inactive status fee during each renewal period; and

  (3) On inactive status is not authorized to and may not practice massage therapy.

C. Within 5 calendar years after being placed on inactive status, an individual seeking to be reactivated shall be required, as a condition of reactivation, to submit:

  (1) Proof of having completed the required CEUs of which shall have been obtained within the 2-year period immediately preceding the application for reactivation; and

  (2) Documentation of current CPR requirements at the designated level.

D. If an individual on inactive status seeks to be reactivated beyond the required 5-year period and conditions set forth under §C of this regulation, the individual shall be required to:

  (1) Submit a new application;

  (2) Pay the non-refundable fee set forth in COMAR 10.65.07;

  (3) Submit to a criminal history records check in accordance with Health Occupations Article, §6-303, Annotated Code of Maryland;

  (4) Pass the Jurisprudence Examination required by the Board with a score of at least 75 percent; and

  (5) Possess documentation of current certification of qualification in CPR, at a minimum at the Basic Life Support (BLS) level.

#### Regulation .13 Duplicate Licenses and Registrations.

*COMAR 10.65.01.13*

A. The Board shall issue a duplicate license or registration to a licensee if:

  (1) The licensee has a change of name, loses or damages the original, or practices in multiple locations; and

    (a) Makes the request to the Board in writing;

    (b) Provides appropriate legal documentation of the change;

    (c) Pays the fee as specified in COMAR 10.65.07; and

    (d) Surrenders the current license or registration;

  (2) The Board, as a result of its error, issues an incorrect license or registration and the licensee:

    (a) Notifies the Board in writing within 6 weeks of receipt of the incorrect license or registration; and

    (b) Surrenders the incorrect license or registration; or

  (3) The licensee does not receive the license or registration within 2 weeks of issuance and the licensee provides a notarized statement to the Board attesting to the non-receipt of the license or registration within 30 days of the date the license or registration was issued by the Board.

B. The requirements in §A of this regulation do not apply if the non-receipt was due to the licensee’s failure to change the licensee’s address of record with the Board.

#### Regulation .14 Penalties.

*COMAR 10.65.01.14*

If a licensee fails to notify the Board of a change of name or address within the time required in Regulations .08B and .09B of this chapter, subject to the hearing provisions of Health Occupations Article, §6–309, Annotated Code of Maryland, the Board may impose an administrative penalty of $100.

#### Regulation .15 Compelling Public Purpose Disclosure.

*COMAR 10.65.01.15*

A. The custodian of records for the Board may find that a compelling public purpose warrants disclosure of information in an application, certification, licensing, or investigative file, regardless of whether there has been a request for the information, if the information concerns:

  (1) Possible criminal activity and the disclosure is to a federal, state, or local law enforcement or prosecutorial official or authority;

  (2) A possible violation of law and the disclosure is to a federal, state, or local authority that has jurisdiction over the individual whose conduct may be a violation, and the information disclosed is limited to information relevant to the possible violation by that individual; or

  (3) Conduct by an individual that the Board reasonably believes may pose a risk to the public health, safety, or welfare, and the disclosure is to:

    (a) A law enforcement authority;

    (b) An administrative official;

    (c) An Agency that regulates the individual; or

    (d) A hospital or other health care facility where the individual has privileges.

B. Other Disclosures. This regulation does not prohibit or limit the ability of the custodian of records for the Board to disclose:

  (1) General licensing information as provided in General Provisions Article, §4-333(c), Annotated Code of Maryland; or

  (2) Any information that the Board may otherwise disclose by law.

#### Regulation .16 Board Approval of Educational Programs.

*COMAR 10.65.01.16*

A. The Board may approve any program of studies provided by an accredited State educational institution for:

  (1) Licensed massage therapists; and

  (2) Registered massage practitioners.

B. The Board shall:

  (1) Maintain a list of educational institutions in this State that currently provide an approved licensed massage therapist or registered massage practitioner program;

  (2) Set standards for approval of programs licensing massage therapists or registered massage practitioners at educational institutions in this State; and

  (3) Survey approved massage therapy programs and schools as necessary.