Texas CDL Medical Card Requirements and Renewal: DOT Physical Steps

To keep a Texas CDL active, you need a valid medical examiner’s certificate — commonly called a DOT medical card — on file with the Texas Department of Public Safety at all times. The Texas CDL medical card requirements start with a DOT physical performed by a provider on the FMCSA National Registry of Certified Medical Examiners, and the results now travel electronically from the examiner to DPS through the federal National Registry II system.¹ If the card lapses, DPS automatically downgrades your CDL to a standard Class C license, and getting it back can mean retaking both the knowledge and skills exams.

Self-Certify Your Driving Type First

Before a medical card can do you any good, DPS needs to know what kind of commercial driving you do. Federal rules require every CDL or commercial learner’s permit holder to pick one of four categories:²

Non-Excepted Interstate: driving across state lines; medical certificate required at all times.
Excepted Interstate: driving across state lines only for federally exempt operations, such as certain government vehicles or farm equipment; no medical certificate required.
Non-Excepted Intrastate: driving only within Texas; must meet state medical standards and file a certificate.
Excepted Intrastate: driving only within Texas under state-exempt operations; no filing required.

Most drivers hauling freight or passengers fall into a non-excepted category and need the card. Certifying as excepted when your actual duties don’t qualify can end a trip at a roadside inspection and trigger enforcement. When you’re unsure, pick the category that requires the filing. An unnecessary certificate on file costs you nothing; a missing required one costs you your CDL.

Getting the DOT Physical

Your exam has to come from a provider listed on the FMCSA National Registry.³ A physical from your family doctor doesn’t count unless that doctor is on the registry. You can search for nearby examiners at the National Registry website.⁴ Most private clinics charge somewhere between $90 and $150.

Show up with the Medical Examination Report Form (MCSA-5875) already filled out. It’s a multi-page health history covering everything from heart conditions to seizure history, and the driver is responsible for completing the personal information and health history sections before the appointment.⁵ Bring a complete list of your medications with dosages and prescribing doctors. If you use corrective lenses or a hearing aid, bring the actual devices, because the examiner will test you with them. If you have a heart condition, sleep disorder, or other ongoing issue, gather specialist records first. The examiner can’t clear what they can’t evaluate.

Take the health history seriously. It’s a legal document. Deliberately falsifying or omitting a disqualifying condition can void the certificate and expose you to a civil penalty of up to $10,000 per violation under federal law.⁶ The physical itself often reveals conditions drivers didn’t disclose.

What Gets Tested

Each test has a defined pass/fail threshold under 49 CFR 391.41.⁷ For vision, you need at least 20/40 acuity in each eye (with or without lenses), at least 20/40 binocular acuity, a horizontal field of at least 70 degrees in each eye, and the ability to distinguish standard traffic signal colors. For hearing, you must perceive a forced whisper from at least five feet in your better ear, with or without a hearing aid; if tested with an audiometer, average loss in the better ear can’t exceed 40 decibels at 500, 1,000, and 2,000 Hz. The examiner also checks blood pressure, takes a urine sample to screen for conditions like diabetes, and runs a general exam covering heart, lungs, musculoskeletal, and neurological function.

How Long Your Card Lasts

A standard medical certificate is valid for up to 24 months from the date of the exam.⁸ Certain health findings shorten that. Blood pressure is where drivers most often end up with a shorter card than they expected, and the federal advisory criteria set the tiers:⁹

Below 140/90: full two-year certificate.
Stage 1 (140–159 / 90–99): one-year certificate. If it exceeds 140/90 at the next annual check but stays below 160/100, the examiner can issue a one-time three-month card.
Stage 2 (160–179 / 100–109): one-time three-month certificate to start or adjust medication. Once you’re at 140/90 or below with treatment tolerated, a one-year certificate can follow.
Stage 3 (180+ / 110+): disqualified until blood pressure drops to 140/90 or below with well-tolerated treatment; six-month certificates with rechecks every six months after that.

If your blood pressure tends to run high, getting it managed before the appointment can be the difference between a two-year card and a three-month card.

Insulin-treated diabetes has its own paperwork. Your treating clinician must complete the ITDM Assessment Form (MCSA-5870) confirming a stable insulin regimen and controlled blood sugar, and you have to deliver that form to the certified medical examiner within 45 days of the clinician’s signature.¹⁰ Miss the 45-day window and you start over.

Medications on Schedules II through V, such as prescription opioids, benzodiazepines, or certain ADHD medications, are only allowed when a licensed prescribing practitioner familiar with your history confirms in writing that the medication won’t impair your ability to drive safely.⁷ The medical examiner still has final say. Schedule I substances are prohibited outright.

How Your Card Reaches Texas DPS

This process changed in 2025 and 2026. Under National Registry II, your certified medical examiner is required to submit exam results electronically to FMCSA by midnight of the calendar day after your exam, and FMCSA passes the data to Texas DPS automatically.¹ You no longer fax, mail, or email your certificate to DPS in most cases.

As of April 10, 2026, Texas no longer accepts paper medical certificates. Everything runs through the electronic system. FMCSA has issued temporary waivers allowing drivers to carry paper certificates as proof of certification for up to 60 days after issuance while states finalize their electronic connections, and it recommends that examiners keep issuing paper copies as backup until further notice.¹¹

After the exam, verify that your record updated correctly using the Texas DPS License Eligibility tool online. Allow up to 10 business days for processing.¹ If your certificate doesn’t appear or the dates are off, contact the examiner first, since the data originates from their NRII submission. Keep your paper copy until the electronic record checks out.

When to Renew

Texas DPS sends a courtesy notice roughly 60 days before your certificate expires.¹ Treat it as a reminder, not a starting gun. Renewal is the same process as the original card: schedule a DOT physical with a registered examiner, complete the exam, and let the electronic transmission update your DPS record with a new expiration date. Drivers on shorter certificates cycle through this frequently, which is all the more reason to keep a calendar alert well ahead of each expiration.

What Happens If Your Card Lapses

If your certificate expires and no new one reaches DPS, the system automatically downgrades your CDL to a regular Class C driver license. You lose all commercial driving privileges immediately.¹ Driving a commercial vehicle on a downgraded license exposes you to citations and puts your carrier’s operating authority at risk.

Recovery depends on how quickly you act. If you submit a valid medical certificate within 12 months, your license hasn’t expired, and your record is otherwise in good standing, Texas can restore your previous CDL status — including endorsements and restrictions — without requiring you to retake the knowledge and skills exams. Transaction fees apply, and restoring a CDL currently costs up to $97.¹² Wait longer than 12 months, or let your underlying license expire by more than two years, and you’ll face the full CDL testing process from scratch.¹

If You Can’t Pass the Physical

Interstate drivers who can’t meet the hearing or seizure-free standards can apply to FMCSA for an exemption. The application requires medical records, employment history, driving experience, and motor vehicle records, and FMCSA has up to 180 days to decide.¹³ Apply early if you think you’ll need it. Drivers with a missing or impaired limb can pursue a Skill Performance Evaluation certificate by demonstrating safe operation of their specific vehicle type.¹⁴ FMCSA has also updated its vision and insulin-treated diabetes standards, so many drivers who previously needed individual exemptions may now qualify under the standard certification process with appropriate documentation.

One boundary worth naming: FMCSA exemption programs only cover interstate commerce. If you drive exclusively within Texas, FMCSA cannot grant a variance, and you’d need to work through state requirements instead.

1
Department of Public Safety. Commercial Driver License (CDL) Medical Certification Requirement
2
eCFR. 49 CFR 383.71 – Driver Application and Certification Procedures
3
Federal Motor Carrier Safety Administration. National Registry of Certified Medical Examiners
4
FMCSA National Registry. National Registry of Certified Medical Examiners
5
Federal Motor Carrier Safety Administration. Medical Examination Report Form MCSA-5875
6
Office of the Law Revision Counsel. 49 USC 521 – Civil Penalties
7
eCFR. 49 CFR 391.41 – Physical Qualifications for Drivers
8
eCFR. 49 CFR 391.45 – Persons Who Must Be Medically Examined and Certified
9
eCFR. Appendix A to Part 391 – Medical Advisory Criteria
10
Federal Motor Carrier Safety Administration. Insulin-Treated Diabetes Mellitus Assessment Form, MCSA-5870
11
FMCSA National Registry. NRII Learning Center
12
Department of Public Safety. Commercial Driver License (CDL) Frequently Asked Question
13
Federal Motor Carrier Safety Administration. Driver Exemptions
14
Federal Motor Carrier Safety Administration. Skill Performance Evaluation Certificate Program