Commercial Driver License (CDL) Medical Certification FAQs

When you:

• Apply for a CDL or CLP;
• Renew a CDL or CLP;
• Apply for a higher class of CDL or CLP;
• Apply for a new endorsement on a CDL or CLP;
• Transfer a CDL from another state; or
• Have been issued an updated Medical Examiner’s Certificate

…you will be required to self-certify to a single type of commercial operation as part of your driver license application. Based on that self-certification, electronic verification of a qualified medical examiner’s certificate in the National Registry will be initiated. If the medical certificate indicates a state issued medial variance requirement, you may be required to present the MoDOT issued SPE or waiver approval notice. to obtain or retain your CDL or CLP.

To comply with the requirements for medical certification, it is important to know how you are using the CMV. To help you decide, follow these steps:

Step 1: Do you, or will you, use a CDL to operate a CMV in interstate commerce or intrastate commerce?

Interstate commerce is when you drive a CMV:

• From one state to another state or a foreign country;
• Between two places within a state, but during part of the trip, the CMV crosses into another state or foreign country; or
• Between two places within a state, but the cargo is part of a trip that began or will end in another state or foreign country.

Intrastate Commerce is when you drive a CMV within a state and you do not meet any of the descriptions above for interstate commerce.

If you operate in both intrastate commerce and interstate commerce, you must choose interstate commerce.

Step 2: Once you decide you operate or will operate in interstate commerce or intrastate commerce, you must decide whether you operate (or expect to operate) in a non-excepted or excepted status. This decision will tell you to which of the four types of commerce you must self-certify.

Interstate Commerce:

You operate in excepted interstate commerce when you drive a CMV in interstate commerce only for the following excepted activities:

• To transport school children and/or school staff between home and school;
• As federal, state or local government employees;
• To transport human corpses or sick or injured persons;
• Fire truck or rescue vehicle drivers during emergencies and other related activities;
• Primarily in the transportation of propane winter heating fuel when responding to an emergency condition requiring immediate response such as damage to a propane gas system after a storm or flooding;
• In response to a pipeline emergency condition requiring immediate response such as a pipeline leak or rupture;
• In custom harvesting on a farm or to transport farm machinery and supplies used in the custom harvesting operation to and from a farm or to transport custom harvested crops to storage or market;
• Beekeeper in the seasonal transportation of bees;
• Controlled and operated by a farmer, but is not a combination vehicle (power unit and towed unit), and is used to transport agricultural products, farm machinery or farm supplies (no placardable hazardous materials) to and from a farm and within 150 air-miles of the farm;
• As a private motor carrier of passengers for non-business purposes; or
• To transport migrant workers.

If you answered yes to one or more of the above activities as the only operation in which you drive, you operate in excepted interstate commerce and do not need a federal medical examiner’s certificate.

If you answered no to all of the above activities, you operate in non-excepted interstate commerce and are required to provide a current medical examiner’s certificate (49 CFR 391.45) to the Department. Most CDL holders who drive CMVs in interstate commerce are non-excepted interstate commerce drivers.

If you operate in both excepted interstate commerce and non-excepted interstate commerce, you must choose non-excepted interstate commerce to be qualified to operate in both types of interstate commerce.

Intrastate Commerce:

You operate in excepted intrastate commerce when you drive a CMV only in intrastate commerce activities for which Missouri has determined do not require you to meet the state’s medical certification requirements.

You operate in non-excepted intrastate commerce when you drive a CMV only in intrastate commerce and are required to meet the state medical certification requirements.

If you operate in both excepted intrastate commerce and non-excepted intrastate commerce, you must choose non-excepted intrastate commerce.

Step 3: Provide the Department with your self-certification of your operating status. If you self-certify to non-excepted interstate, or non-excepted intrastate, the Department must be able to request the medical examiner certificate information directly from the National Registry and post the information to your transaction and driver record.

If your medical examiner's certificate is only valid with a skills performance evaluation variance or waiver/exemption waiver granted by the Federal Motor Carrier Safety Administration (FMCSA) or the Missouri Department of Transportation (MoDOT), you are also required to provide a copy of that variance or waiver/exemption document to the Department.

As of June 23, 2025, drivers meeting qualification requirements and who have the medical examiner certificate information posted to their driver record as defined per provisions of 49 CFR 383 and 391, will no longer be required to carry the physical card while operating. Any documentation of a medical variance if appliable must be maintained.

If you are a current CDL holder, with a self-certification status of non-excepted interstate or non-excepted intrastate that has not changed and have been issued a qualified medical examiner certificate, the medical examiner will post the information to the National Registry. Once posted to the registry the information will be electronically transmitted and posted to your Missouri commercial driver record. No further action is required unless you are otherwise due for renewal of your commercial driver license. Note: The Department will update variance information received from FMCSA or MoDOT if a current medical certification is on file, however if the MoDOT variance approval has not been received you may be required to submit a copy of the approved variance to the Department.

The Department will notify you that you are no longer medically certified to operate a CMV. If the updated medical certificate and variance information, when applicable, is not updated within sixty days of expiration of the prior certificate or waiver, the Department will downgrade your license to remove all CDL privileges.

No. You must be examined by a medical professional listed on the National Registry of Certified Medical Examiners. Only medical examiners that have completed the required training and testing for Federal Motor Carrier Safety Administration (FMCSA) physical qualification standards will be added to the registry. The registry is maintained by FMCSA, and inquiries regarding participation in the registry must be submitted through that agency.

If the medical examiner's certificate has expired, you must obtain a new one and provide it to the Department. If the variance (waiver) has expired, you must renew it with FMCSA and it must be provided to the Department. Retesting for the CDL may not be required unless you voluntarily downgrade your license by applying for non-commercial license or let your CDL license remain expired for more than six months.

Commercial drivers have the following options for submitting a medical certificate update request:

Apply in person at any Missouri contract license office. Must present current commercial driver license or noncommercial driver license and commercial learners permit and notify the clerk of your request to change your self-certification status. When your self-certification status changes to a non-excepted category the Department will complete an inquiry to the National Registry to verify you have a qualified medical examiner certificate and any applicable variance information on file. Once confirmed the information will be posted to your Missouri driver record. If the change in self-certification may require adding or removing of restrictions such as a K-Interstate Only or V-Variance, a new license transaction must be completed.

No. A medical certificate posted for a driver with a self-certification status of excepted interstate or excepted intrastate on their commercial record, will not be automatically posted. If your status has changed and you now operate in a non-excepted category and must maintain a medical certificate, you are required to apply in person to update your self-certification and have the information available in the registry posted to your driver record.

The Department will send a courtesy notice to make drivers who had claimed to be excepted aware that a medical examiner certificate was posted for them and steps required to change their status if required.

Yes. The Department will not receive or post updates automatically for:

• Commercial drivers or permit holders whose driver record indicate a self-certification status of excepted interstate or excepted intrastate. ( For details on certification types go to https://dor.mo.gov/driver-license/issuance/commercial/medical-certification-requirements.html )
• Drivers without a valid Missouri commercial driver license or commercial learner’s permit.
• Drivers whose commercial credential is expired.