To get a California fluoroscopy license, a physician needs a current California medical license, an approved application on file with the California Department of Public Health’s Radiologic Health Branch (CDPH-RHB), and a passing score on the fluoroscopy exam administered by the American Registry of Radiologic Technologists (ARRT). The permit is officially called the Supervisor and Operator Permit, and no pre-application coursework is required of physicians. The exam is the gatekeeper.
Who Needs the Permit
Any California-licensed physician who personally operates fluoroscopy equipment, controls radiation exposure during a fluoroscopic procedure, or supervises fluoroscopy technologists or students must hold a Supervisor and Operator Permit.1Legal Information Institute. California Code of Regulations Title 17 30463 – Requirements for Fluoroscopy Permits This covers MDs, DOs, and doctors of podiatric medicine. Chiropractors apply through a separate pathway under the same regulations.2Legal Information Institute. California Code of Regulations Title 17 30466 – Requirements for Licentiate Certificates and Permits
Using fluoroscopy without a valid permit is a misdemeanor in California, carrying fines of up to $5,000 per day, up to 180 days in county jail, or both, with civil penalties and injunctions available to CDPH separately.3California Legislative Information. California Health and Safety Code 107075 – Violations and Penalties
What It Costs and How Long It Takes
The baseline cost for a physician is $577: a $127 non-refundable application fee to CDPH-RHB plus a $450 exam fee paid directly to the ARRT.4California Department of Public Health. California Licentiate Supervisor and Operator Permit(s) Application5The American Registry of Radiologic Technologists. State Licensing Examination Handbooks and Fees Applying for two permit categories at once doubles the application fee to $254. If you also need a temporary permit to practice during the application period, add another $58.
CDPH-RHB mails a decision on your application within 30 days of receiving it.6California Department of Public Health. X-ray Certification and Permitting FAQs Once accepted, you have one year to pass the ARRT exam before the eligibility expires.
Step 1: File the CDPH 8230 Application
The application form is CDPH 8230, “California Licentiate Supervisor and Operator Permit(s) Application,” available from the CDPH-RHB website. Your packet needs three items:
- The completed CDPH 8230 form
- A copy of your current California medical license
- The $127 non-refundable fee ($254 for two categories)
Pay by personal check, cashier’s check, certified check, or money order made out to “CDPH-RHB.” Credit cards are not accepted.4California Department of Public Health. California Licentiate Supervisor and Operator Permit(s) Application
You must provide a Social Security Number or Individual Taxpayer Identification Number on the form. This is mandatory under the California Health and Safety Code and the Family Code and is used for identification and child support enforcement matching.7California Legislative Information. California Health and Safety Code 114870 – Committee Administration and Regulations8California Legislative Information. California Family Code 17520 – Child Support Obligations and License Issuance There is no alternative. Without an SSN or ITIN, the application won’t be processed.
Mail the packet to the Radiologic Health Branch. For USPS:
California Department of Public Health
Radiologic Health Branch, MS 7610
Accounts Receivable and Cashiering Unit
P.O. Box 997414
Sacramento, CA 95899-7414
For FedEx, UPS, or similar express carriers:
California Department of Public Health
Radiologic Health Branch, MS 7610
Accounts Receivable and Cashiering Unit
1500 Capitol Ave., Suite 520, Bldg. 172
Sacramento, CA 95814-5006
If the application is accepted, CDPH-RHB sends a letter of eligibility that lets you schedule the exam. If anything is missing, the letter will say what to fix.
Step 2: Pass the ARRT Fluoroscopy Exam
You have up to one year from your eligibility letter to pass the exam. The ARRT administers it at Pearson VUE testing centers, with over 200 locations nationwide, so you can sit for it outside California.9ARRT. Taking the Exam The $450 fee is paid directly to the ARRT when you schedule.5The American Registry of Radiologic Technologists. State Licensing Examination Handbooks and Fees
The computer-based exam covers radiation physics, the biological effects of radiation, and patient protection techniques for fluoroscopy. Practical content includes selecting technical factors like kVp and mA, pulsed versus continuous fluoroscopy, dose reduction, contrast reactions, pediatric and surgical adaptations, and both fixed and mobile C-arm units. Physicians who have performed fluoroscopy in residency or in another state tend to find the clinical content familiar; the harder areas are physics-based image quality questions and California-specific regulatory items.
If you don’t pass within the one-year eligibility window, your application expires and you’ll need to submit a new CDPH 8230 and pay the $127 fee again. Retake rules within the window vary, so contact CDPH-RHB directly if you fail your first attempt.10ARRT. State Licensing Exam
If You Need to Start Fluoroscopy Before Passing the Exam
California issues a one-time temporary permit for physicians who need to practice fluoroscopy before completing the exam, which commonly comes up for physicians relocating to California or starting a practice that depends on fluoroscopy from day one. It carries the same legal authority as the full permit.11California Department of Public Health. Information Notice Temporary Fluoroscopy Permit for Supervisors and Operators
To qualify you must hold a valid, unrestricted California license as a physician and surgeon or doctor of podiatric medicine; have at least 40 hours of fluoroscopy experience from before you became subject to California’s Radiologic Technology Act, confirmed by a sworn attestation on the application; have a CDPH 8230 on file (so you have to apply for the full permit at the same time); and submit form CDPH 9109 with a $58 non-refundable fee.
The temporary permit lasts up to 12 months. It cannot be renewed, and you can only receive one in your lifetime.12California Department of Public Health. Temporary Fluoroscopy Permit Application for Supervisors and Operators If you haven’t passed the full exam by the time it expires, you lose authorization to use fluoroscopy until you do.
Keeping the Permit Active
The permit renews every two years. In the two years before expiration, you need to complete at least 10 approved continuing education credits, with at least four of those credits specifically addressing radiation safety for clinical uses of fluoroscopy. The remaining six can cover broader radiologic topics.13Legal Information Institute. California Code of Regulations Title 17 30403 – Requirements for Continuing Education
The renewal fee depends on when you file:
- $104 if you renew before your permit expires
- $120 if your permit expired within the past six months
- $224 if your permit expired more than six months ago but less than five years ago
Pay by check or money order to “CDPH-RHB” with the renewal application.14California Department of Public Health. Special Renewal Application Supervisor and Operator Certificate or Permit
A permit that has been expired for more than five years cannot be renewed at all. At that point you have to start over with a new initial application and pass the ARRT exam again. If you stop using fluoroscopy for a stretch, calendar your expiration date before the five-year wall closes behind you.