What is the TCPA?
The Telephone Consumer Protection Act (TCPA) is a 1991 federal law, codified at 47 U.S.C. 227, that restricts automated and prerecorded calls, including text messages, to phones without the recipient's consent, and lets consumers sue for violations. For a practice that texts patients, it is the main federal law that decides whether an automated message may be sent at all. This entry defines the law and its vocabulary; our TCPA and patient texting guide covers the healthcare rules in depth.
- The TCPA is a federal statute (47 U.S.C. 227) enforced by the FCC through rules at 47 CFR 64.1200, and by private lawsuits.
- Text messages count as calls under the TCPA.
- The core rule: automated or prerecorded calls and texts to cell phones need the recipient's prior express consent, and marketing needs prior express written consent.
- Damages are set by statute at $500 per violation, up to $1,500 if willful or knowing, so volume turns small errors into large exposure.
Where the TCPA came from
Congress passed the TCPA in 1991, when the complaint was dinner-time robocalls and junk faxes. The law gave the Federal Communications Commission authority to write rules, and it gave individuals the right to sue. Over three decades the FCC and the courts have applied it to newer technology, and today it is one of the most litigated consumer protection laws in the country.
The FCC has long treated a text message as a "call" for TCPA purposes, and the Supreme Court described that as undisputed in a 2016 decision. So when this entry says "call," read it as "call or text."
The key terms, defined
Most TCPA questions turn on a handful of terms. Knowing them makes vendor conversations and legal advice much easier to follow.
- Automatic telephone dialing system (ATDS). Equipment that can store or produce numbers using a random or sequential number generator, and dial them. In Facebook v. Duguid (2021), the Supreme Court read this definition narrowly. Many modern messaging platforms fall outside it, but state laws can be broader.
- Artificial or prerecorded voice. A recorded or synthesized voice message. Calls using one face the same consent rules as autodialed calls.
- Prior express consent. Permission given before the call. For informational calls, such as appointment reminders, the FCC has said providing your number in a relevant context can be enough. See our entry on express consent for texts.
- Prior express written consent. A signed written agreement (electronic signatures count) required for automated telemarketing. Defined in 47 CFR 64.1200(f).
- Telemarketing. A call or text meant to encourage buying or investing in goods or services.
- Revocation. Withdrawing consent. Under FCC rules effective April 11, 2025, consumers may revoke by any reasonable means, and replies such as STOP must be honored within ten business days at most.
Why it matters to an independent practice
Practices rarely think of themselves as telemarketers, and most of what they send is not telemarketing. But the TCPA does not care about intent. It cares about whether a message was automated, whether it went to a cell phone and whether the sender can show consent.
The reason this matters is the damages math. The statute sets $500 per violation, and a court may triple that to $1,500 for willful or knowing violations. Every text is its own potential violation. Consider an illustrative case: a practice adds a promotional message to its reminder stream and sends it to 2,000 patients who only ever agreed to appointment texts. At $500 each, the theoretical exposure is $1,000,000, before anyone argues about willfulness. Real outcomes vary widely, but that arithmetic is why plaintiffs' lawyers watch this area closely.
How practices handle it day to day
A practice does not need a lawyer on staff to stay on the right side of the TCPA. It needs a few habits that are easy to check:
- Collect the mobile number from the patient at intake, with a short line saying it will be used for appointment texts.
- Separate care messages from anything promotional. Reminders, confirmations and offers of earlier times are care-related. Promotions for elective services need their own written consent.
- Make STOP work everywhere. Every automated message should say how to opt out, and an opt-out on any channel should stop all automated texts to that number. Our STOP handling guide has sample wording.
- Keep records. Note when and how each number and consent were collected, and keep opt-outs with dates.
- Mind the state layer. Several states have their own texting laws, some stricter than the TCPA.
Common misunderstandings
- "We're HIPAA compliant, so we're TCPA compliant." They are separate laws. HIPAA governs patient information. The TCPA governs whether you may call or text a number at all.
- "Our software isn't an autodialer, so the TCPA doesn't apply." The ATDS question is contested, prerecorded voice rules apply regardless, and state laws may define autodialers more broadly. Build consent practices that hold up either way.
- "The FCC said it's fine." Since McLaughlin Chiropractic Associates v. McKesson (2025), federal courts are not bound by the FCC's interpretations in enforcement cases. Helpful FCC rulings still carry weight, but not automatically.
- "A patient who texts STOP can still get reminders." Treat STOP as stopping all automated texts to that number, and reach the patient by phone if something important comes up.
TCPA, HIPAA and carrier rules: three different gates
It helps to picture three gates every patient text must pass. HIPAA asks whether you may use the patient's information this way. The TCPA asks whether you may send an automated message to this number. The wireless carriers ask whether your sender is registered and your recipients opted in, which is where 10DLC and toll-free verification come in. A message that clears one gate can still fail another, so a good texting program is designed for all three at once.
Care-related texts, STOP on every message
DocsMD sends patients care-related messages only: the practice name, times and numbered choices, never the patient's name or the reason for the visit. STOP is honored on every message, and most replies are numbered menus that never reach an AI model. It is a revenue recovery engine, not a marketing blaster.
Questions
Does the TCPA apply to text messages?
Yes. The FCC treats texts as calls under the TCPA, and the Supreme Court has described that as undisputed.
Who enforces the TCPA?
The FCC writes and enforces the rules, state attorneys general can sue, and individuals can bring private lawsuits for statutory damages.
Do appointment reminders need written consent?
Generally no. Informational messages such as reminders need prior express consent, which a patient can give by providing their number for that purpose. Prior express written consent is required for automated telemarketing.
What are TCPA damages?
Under 47 U.S.C. 227(b)(3), $500 per violation, which a court may increase up to $1,500 if the violation was willful or knowing.
Is this legal advice?
No. It is a plain-English overview. Have counsel review your consent wording and texting program.