Texas Medical Lien Law for Outpatient Providers (2026)

Texas gives a statutory lien to hospitals and emergency medical services providers, and to physicians only in narrow hospital-based situations. Outpatient practices such as chiropractic, physical therapy, pain management, imaging and surgery centers rely on a letter of protection (LOP) from the patient's attorney. Texas also limits medical damages to amounts "actually paid or incurred," and the Texas Supreme Court has allowed defendants to discover LOP providers' negotiated rates.

At a glance

Question	Answer
Statutory lien for outpatient providers	No. Chapter 55 covers hospitals and EMS providers, and physicians only for emergency hospital care in the first 7 days of hospitalization or when employed by a higher-education institution.
Main law	Tex. Prop. Code ch. 55 (§§ 55.001 to 55.008)
What outpatient providers usually rely on	A letter of protection or contract lien
Notice or filing	Chapter 55 liens: notice filed with the county clerk before money is paid, then mailed to the patient within 5 business days after recording. LOPs: no statutory filing.
Limits on the amount	Hospital liens: the lesser of 100 days of charges, 50% of the recovery, or the jury's hospital-charges award minus a pro rata share of attorney fees. EMS liens: up to $1,000. LOPs: no statutory cap.
Health insurance and billing the patient	A provider that is required or authorized to bill the patient's health plan must do so on time, or it cannot collect from the patient what the plan would have paid. In a represented personal injury case, billing the patient's attorney meets the deadline.
Billed vs. paid in the case	Recovery is limited to amounts "actually paid or incurred" (CPRC § 41.0105). Amounts a provider has no right to be paid are inadmissible (Haygood, 2011). LOP providers' negotiated rates are discoverable (K & L Auto Crushers, 2021).
Recent changes (2023–2026)	SB 30 (2025), which would have limited past medical damages to amounts paid and required LOP disclosure, did not become law.

Is there a lien law for outpatient providers?

Not for outpatient care. Texas Property Code chapter 55 creates these liens:

Hospitals. A hospital has a lien on the cause of action of a person injured in an accident attributed to someone else's negligence, if the person was "admitted to a hospital not later than 72 hours after the accident." The lien extends to hospitals the patient is transferred to for the same injury. (Tex. Prop. Code § 55.002)
EMS providers. Emergency medical services received within 72 hours after the accident, only in counties with a population of 800,000 or less (§ 55.002(c)).
Physicians, narrowly. The hospital's lien may include a physician's reasonable and necessary charges for emergency hospital care in the first seven days of hospitalization. A physician employed by an institution of higher education, whose charges are not in the hospital lien, has a lien on the same terms. (§ 55.004(c), (h))

Chapter 55 does not give a lien to chiropractors, physical therapists, pain management practices, imaging centers or surgery centers (§ 55.001).

A chapter 55 lien attaches to the cause of action, a judgment and settlement proceeds. It does not attach to workers' compensation, FELA or Longshore claims, to the patient's own insurance proceeds other than public liability coverage, or to certain claims against railroads that maintain hospitals (§ 55.003). For a workers' compensation patient, a hospital lien is limited to the amounts due under the workers' compensation system (Daughters of Charity Health Servs. of Waco v. Linnstaedter, 226 S.W.3d 409 (Tex. 2007)).

How a lien is perfected

Chapter 55 liens. The hospital or EMS provider files written notice with the county clerk of the county where services were provided, before money is paid to the injured person. The notice states the patient's name and address, the accident date, the provider's name and location, and the alleged liable party's name if known. The clerk indexes the lien under the patient's name. (§ 55.005)

The provider must then mail notice to the patient or their legal representative no later than the 5th business day after receiving the clerk's notice that the lien was recorded. The notice says the lien attaches to the claim but not to the patient's real property. EMS providers can instead put this notice on the authorization form. Failure to receive the notice does not affect the lien's validity.

A release of a claim the lien attaches to is valid only if the charges were paid in full before the release, the charges were paid to the extent of the money paid to the injured person, or the provider is a party to the release (§ 55.007).

LOPs. No statutory filing or notice requirement applies.

Limits on what the provider is paid

Hospital liens. Under § 55.004(b), the lien may not exceed the lesser of:

charges for the first 100 days of hospitalization;
50% of the recovery; or
if the jury awards hospital charges, that award minus a pro rata share of attorney fees and expenses.

The lien does not cover charges above a "reasonable and regular rate," physician charges paid or accepted under insurance or collectible under an assignment of benefits, or charges barred for late billing under CPRC § 146.003 (§ 55.004(d)).

EMS liens. The provider's charge, up to $1,000, for services within 72 hours of the accident, with the same rate and insurance exclusions (§ 55.004(f) to (g)).

LOPs. No statutory cap. What the case can recover for the bill is limited by CPRC § 41.0105 and by proof that the charges are reasonable.

Lien agreements and letters of protection

The Texas Professional Ethics Committee treats a signed LOP as giving the provider a "matured legal or equitable interest" in the settlement funds (Ethics Op. 681, 2018).

In In re K & L Auto Crushers, LLC, 627 S.W.3d 239 (Tex. 2021), the Texas Supreme Court held it was an abuse of discretion to deny narrowed discovery of LOP providers' negotiated rates with insurers and government payors. Because an LOP gives a provider "a direct financial stake" in the case, the provider loses some of the protection given to disinterested third parties.

Medical expense affidavits under CPRC § 18.001 are central to disputes over LOP bills. In In re Allstate Indemnity Co., 622 S.W.3d 870 (Tex. 2021), the court held that a defendant is not barred from contesting medical expenses at trial for lack of a proper counteraffidavit.

The attorney's duty to pay the provider

Under Ethics Opinion 681, a doctor who treated under a signed LOP has an interest in the settlement funds, and the lawyer must pay the doctor according to that interest. If the client disputes the claim, the lawyer must keep the disputed amount in trust until the dispute is resolved or the funds are interpleaded. That duty survives the lawyer's discharge. A provider without an LOP or assignment has no such interest, and the lawyer follows the client's instructions. The opinion relies on Disciplinary Rule 1.14.

Health insurance, no-fault and billing the patient

Civil Practice and Remedies Code chapter 146 sets billing deadlines for licensed providers whose services a health benefit plan can reimburse (CPRC § 146.002):

When the provider is "required or authorized" to bill the patient's plan directly, it must bill by the contract deadline. With no contract, the deadline is the first day of the 11th month after services.
Medicare, Medicaid and other third-party payors must be billed when federal or state law requires or authorizes it.
If the patient has an attorney on a related personal injury claim, the provider may bill the attorney instead, by the first day of the 11th month after services, unless the patient directs otherwise (§ 146.002(c-1)).

A provider that misses these rules "may not recover from the patient any amount" the patient would have received as plan benefits, or would not otherwise have owed. The same bar protects family members. (§ 146.003) The statute's definition of "health benefit plan" includes auto personal injury protection (PIP) and medical payments coverage (§ 146.001).

Apart from § 146.003, we could not confirm in a primary source whether an LOP provider may bill the patient if the case is lost or the recovery is too small.

Billed vs. paid medical damages

CPRC § 41.0105 says recovery of medical or health care expenses "is limited to the amount actually paid or incurred by or on behalf of the claimant."

Haygood v. De Escabedo, 356 S.W.3d 390 (Tex. 2011) held that recovery is limited to expenses that have been or must be paid by or for the claimant. It excludes amounts a provider bills but "has no right to be paid," and evidence of those amounts is irrelevant and inadmissible.

Recent changes

SB 30 (89th Legislature, 2025) did not become law. It related to recovery of health care damages. Early versions would have limited past medical damages to amounts paid and required disclosure of LOPs. The Senate passed it and the House passed a substitute. The last action, on May 30, 2025, was the appointment of conference committee members. (SB 30 bill history)
HB 2446 (2025), on § 18.001 affidavits, passed the House and was received by the Senate on May 12, 2025, with no enactment shown. (HB 2446 bill history)
HB 4806 (2025), on recovery of damages, was left pending in committee. (HB 4806 bill history)

What this means for your practice

Outpatient practices have no chapter 55 lien in Texas. Under Ethics Opinion 681, a signed LOP is what obligates the attorney to hold or pay your share of a disputed settlement. Without an LOP or assignment, the attorney follows the client's instructions.
Expect your rates to be discovered. After K & L Auto Crushers, defendants can obtain LOP providers' negotiated rates with insurers and government payors.
Watch the chapter 146 deadline. In a represented personal injury case, sending your bill to the patient's attorney by the first day of the 11th month after service meets it, unless the patient directs otherwise.
Missing a required billing deadline can bar you from collecting from the patient what their plan would have paid, and PIP and med-pay coverage count as health benefit plans under the statute.
Keep § 18.001 affidavits accurate and itemized. Recovery is limited to amounts actually paid or incurred, and billed amounts you have no right to collect are inadmissible.

Sources

How we verified: Tex. Prop. Code §§ 55.002 and 55.004 and CPRC § 146.002(c-1) were checked on the official Texas Statutes site (statutes.capitol.texas.gov). Other statute text was read from FindLaw's code pages, current as of January 1, 2026, and bill histories from Texas Legislature Online. Research current as of November 12, 2026.