Texting patients under the TCPA: the three consent tiers in 47 CFR 64.1200, and where the reminder exemption ends

What it says#

The Telephone Consumer Protection Act, 47 U.S.C. 227, makes it unlawful to make a call using an automatic telephone dialing system or an artificial or prerecorded voice to a cellular number without the prior express consent of the called party, other than for emergencies. The FCC's implementing rule, 47 CFR 64.1200, carries that prohibition at paragraph (a)(1)(iii) and treats text messages as calls; the exemption paragraph says so in terms: "the term 'call' includes a text message, including a short message service (SMS) call." The statute gives the person called a private right of action for actual loss or $500 per violation, whichever is greater, and lets a court treble that to $1,500 for a willful or knowing violation.

The rule then sorts messages by content. Paragraph (a)(2) says an autodialed or prerecorded call that "includes or introduces an advertisement or constitutes telemarketing" needs the prior express written consent of the called party, with two exceptions: a call by or for a tax-exempt nonprofit, and "a call that delivers a 'health care' message made by, or on behalf of, a 'covered entity' or its 'business associate,' as those terms are defined in the HIPAA Privacy Rule." An advertisement is "any material advertising the commercial availability or quality of any property, goods, or services." Telemarketing is a call or message "for the purpose of encouraging the purchase or rental of, or investment in, property, goods, or services." Prior express written consent, in paragraph (f)(9), is "an agreement, in writing, bearing the signature of the person called that clearly authorizes the seller to deliver or cause to be delivered to the person called advertisements or telemarketing messages using an automatic telephone dialing system or an artificial or prerecorded voice, and the telephone number to which the signatory authorizes such advertisements or telemarketing messages to be delivered." The agreement must disclose that the person is authorizing such calls and "is not required to sign the agreement (directly or indirectly), or agree to enter into such an agreement as a condition of purchasing any property, goods, or services." An electronic signature counts.

Paragraph (a)(9)(iv) is the exemption a dental office lives on. Calls "made by, or on behalf of, healthcare providers, which include hospitals, emergency care centers, medical physician or service offices, poison control centers, and other healthcare professionals" are exempt from the consent requirement provided all of the following are met: sent only to the wireless number the patient provided; state the provider's name and contact information; "strictly limited to" appointment and exam confirmations and reminders, wellness checkups, hospital pre-registration instructions, pre-operative instructions, lab results, post-discharge follow-up intended to prevent readmission, prescription notifications, and home healthcare instructions; no telemarketing, solicitation or advertising, and no accounting, billing, debt-collection or other financial content; HIPAA-compliant; concise, generally one minute or less for voice or 160 characters or less for text; "only one message (whether by voice call or text message) per day to each patient, up to a maximum of three voice calls or text messages combined per week to each patient"; an easy opt-out in each message, with STOP as the exclusive means for texts; and opt-outs honored immediately. The lead-in adds that the exemption holds only if the message is not charged to the patient or counted against plan limits.

Paragraphs (a)(10) through (a)(12), adopted in the FCC's February 2024 TCPA Consent Order, govern revocation. A called party may revoke consent "by using any reasonable method to clearly express a desire not to receive further calls or text messages." Replying "stop," "quit," "end," "revoke," "opt out," "cancel," or "unsubscribe" is a reasonable means per se; other words count if a reasonable person would read them as a revocation; the sender may not designate an exclusive means; and the request must be honored within a reasonable time not to exceed ten business days. Revocation by other means, such as a voicemail or email, creates a rebuttable presumption that consent was revoked. A single confirmation text is allowed if it contains no marketing and is sent within five minutes. These took effect April 11, 2025, except that the FCC's Consumer and Governmental Affairs Bureau has waived, first to April 11, 2026 and now to January 31, 2027, the requirement that a revocation sent in response to one type of message stop all unrelated robocalls and robotexts from the same sender, while the Commission considers changing it.

Who it applies to#

Any dental office whose software sends texts or plays recorded calls to patients' cell phones with equipment that meets the rule's definition of an autodialer, "equipment which has the capacity to store or produce telephone numbers to be called using a random or sequential number generator and to dial such numbers." Whether a given vendor's platform meets that definition is a question for the vendor and your attorney; the tiers above are what apply once it does. The healthcare-provider exemption is written for the reminder, the recall notice, the pre-op instruction and the prescription notice. It is not written for the whitening special, the review request tied to a discount, or a balance reminder: the first two are advertising or telemarketing and need the signed agreement, and billing content is excluded from the exemption by name.

The health care message carve-out in (a)(2) sits between the two. A message from a HIPAA covered entity that is a health care message but does not fit the eight conditions, say one that runs past 160 characters or is the fourth that week, still avoids the written-consent requirement; it needs the patient's prior express consent. The FCC's consumer pages on this were unreachable from here; the reading above is from the rule text and the Commission's orders.

What changed#

Two things moved in 2024 and 2025. The revocation rules are new and in force: since April 11, 2025 a patient's "please stop" in any form, not only STOP, must be honored within ten business days, and a sender may not insist on its own channel. The FCC's order notes that a revocation made in response to an exempt informational message is an opt-out that stops all further robocalls and robotexts, though the broadest version of that scope is the piece under waiver until January 31, 2027.

The other change was one that did not happen. In 2023 the FCC rewrote the definition of prior express written consent so that a signature could authorize no more than one identified seller, with calls "logically and topically associated" with the interaction that prompted the consent, effective January 27, 2025. On January 24, 2025 the Eleventh Circuit vacated it in Insurance Marketing Coalition v. FCC, and on August 29, 2025 the Commission restored the 2012 definition in the CFR. The written consent your marketing texts rest on is the one described above, unchanged since 2012.

Where the source is#

The rule text is 47 CFR 64.1200 on eCFR, current as of September 10, 2026, and the statute is 47 U.S.C. 227 on the House Office of the Law Revision Counsel's site. The February 2024 TCPA Consent Order, FCC 24-24, and the two bureau waiver orders, DA 25-312 and DA 26-12, are PDFs on docs.fcc.gov; the Federal Register publication of the revocation rules and the October 2024 effective-date notice are on govinfo, as is the August 2025 document restoring the written-consent definition. The Eleventh Circuit's opinion is on the court's site. The FCC's consumer guides on robocalls and robotexts refused automated requests from this environment and were not read for this entry.