How to Become a Medical Assistant in Maryland

Who can apply

• Maryland has no state license for medical assistants. Under COMAR 10.32.12, a medical assistant is an "assistant": someone a licensed physician delegates routine technical acts to.
• You must be "trained", meaning you have the knowledge, skills and abilities the delegating physician judges you need for each delegated act (COMAR 10.32.12.02).
• To take x-rays in a physician's office without a radiographer license, you must register with the Board of Physicians as a Limited X-Ray Machine Operator (LXMO). This requires a fingerprint-based criminal history records check (COMAR 10.32.14.03).

Step by step

1. Finish a medical assistant program or get on-the-job training. Maryland does not require a specific program; the delegating physician decides whether you are trained for each task.
2. Optional: earn a national certification (CMA, RMA, CCMA or NCMA). Maryland does not require one.
3. If your job includes x-rays, get at least 6 months of clinical care experience. Complete a limited scope x-ray program: at least 115 didactic hours and 480 clinical hours under a certified radiologic technologist, with 5 competencies in each body area.
4. Pass the ARRT Limited Scope of Practice in Radiography exam with 75% or higher, submit fingerprints, and apply for LXMO registration with the Board of Physicians ($65).
5. Work under the supervision level COMAR 10.32.12.04 requires for each task: without on-site supervision, with on-site supervision, or with direct supervision.

Training and exam

Training: Maryland has no state-mandated medical assistant program. The delegating physician must decide that you are trained for each act (COMAR 10.32.12.02). For x-ray work, LXMO registration requires at least 6 months of clinical care experience. You also need a limited scope x-ray program with at least 115 hours of didactic training taught by a certified radiologic technologist, at least 480 hours of clinical training under a certified radiologic technologist's direct supervision, and at least five competencies in each body area (COMAR 10.32.14.03).

Exam: Maryland has no state exam for medical assistants, and national certification exams are voluntary. LXMO registration requires a score of 75% or higher on the ARRT Examination for Limited Scope of Practice in Radiography, or a passing result on another exam the Board approves. The Board charges $10 to apply to take this exam.

What it costs in Maryland

Fixed amounts are set by the state. Items marked “your quote” are priced by private sellers, so enter what you’re quoted.

Good to know in Maryland

What a medical assistant can do in Maryland: At sites other than the health care facilities covered by Health-General Article 19-114 and 19-3B-01(b) (for example, a physician's office), COMAR 10.32.12.04 lists tasks by supervision level. Without on-site supervision, a physician may delegate: preparing patients for exams, history interviews, phlebotomy and specimen collection, CLIA-permitted lab tests, TB skin tests, ECGs, basic pulmonary function tests, visual field tests, sending prescriptions to a pharmacy, and preparing and giving oral drugs. With on-site supervision (the physician on site and immediately available): intradermal, subcutaneous and intramuscular injections (including small amounts of local anesthetic) and starting a peripheral IV line. With direct supervision (the physician present with the patient): injecting IV drugs or contrast.

What a medical assistant cannot do: A physician may not delegate physical exams, any anesthetic or conscious sedation beyond topical or small amounts of local anesthetic, starting any treatment on your own (except CPR), giving medical advice without consulting a physician, or physical therapy. A physician may also not delegate acts limited by law to licensed, certified or registered professionals. An assistant who acts beyond these rules may be treated as practicing medicine without a license (COMAR 10.32.12.04-.05). A physician may not require you to perform a delegated act, and you may not delegate an act to anyone else.

X-ray: A registered LXMO may take x-rays in a physician's office only of the chest, spine, upper extremities and lower extremities. The LXMO works under the immediately available supervision of a licensed physician or licensed radiologic technologist. LXMOs may not do CT, fluoroscopy, invasive radiology, mammography, nuclear medicine, radiation therapy or xerography. They must wear a badge reading "Limited X-Ray Machine Operator" (COMAR 10.32.14.05-.06; rules effective August 18, 2025).

Letting your LXMO registration lapse: If you do not renew, your registration expires and you may no longer take x-rays. The Board may fine you up to $1,000 and your employer up to $5,000 for practicing after expiration, and up to $100 per missing continuing education hour (COMAR 10.32.14.03).

Sources

• COMAR 10.32.12.02 - Definitions (Delegation of Acts by a Licensed Physician)
• COMAR 10.32.12.04 - Scope of Delegation to an Assistant
• COMAR 10.32.12.05 - Prohibited Conduct and Penalties
• COMAR 10.32.14 - Unlicensed Limited X-Ray Machine Operator
• COMAR 10.32.14.03 - LXMO Application, Renewal, and Reinstatement
• COMAR 10.32.14.06 - LXMO Scope of Practice
• COMAR 10.32.14.09 - LXMO Fees