NP · Tennessee
Collaborative Drug Therapy Management for Nurse Practitioners in Tennessee
Yes, a written agreement with a physician is required before you prescribe and adjust drug therapy. Tennessee calls it a Collaborative Practice Agreement.
TN is a restricted-practice state — NPs must hold a Certificate of Fitness from the Board of Nursing and maintain a written Collaborative Management Agreement (CMA) with a physician for as long as they practice. No experience-based independence pathway was found (TCA § 63-7-123).
What the physician relationship must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
On-site presence required
The collaborating physician must make an in-person visit to a remote NP practice site 'once every thirty (30) days'; up to 10 of the required annual visits may occur via HIPAA-compliant electronic means, but the rest must be in person.
Supervision ratio
Not codified — no cap on file
Chart review
20% of charts · Monthly (every 30 days) · countersignature required
The collaborating physician must personally (non-delegable) review at least 20% of the NP's charts every 30 days, with documented findings and feedback, PLUS 100% of controlled-substance charts. Additional review is required within 10 business days when medically indicated, on patient request, for prescriptions outside the formulary/protocol, for controlled-drug prescriptions, or for a temporary-certificate holder.
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Prescriptions must be on preprinted pads displaying both the NP's and the collaborating physician's names.
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation or PLLC — TN's 'single profession per PC' rule means an NP-owned nursing-services PC is a separate entity from a physician-owned medical PC; see the `pa` entry's CPOM note for the general framework.
Sources for the supervision rules (3)
- Tenn. Code Ann. § 63-7-123 — Advanced Practice Nurse Certificate of Fitness; Collaborative Practice
- Tenn. Comp. R. & Regs. Ch. 1000-04 — Advanced Practice Registered Nurses (recodified from the former Ch. 0880-06 joint Board of Nursing/Board of Medical Examiners rule; confirm current chapter number before citing)secondary
- NP Collaborator — Tennessee collaborating-physician requirements (secondary source; cross-checked against a second independent secondary source for the 20%/100%/30-day figures)secondary
What a collaborating physician costs here
Typical monthly cost in Tennessee
$500 – $700
Estimate for one Nurse Practitioner. This state's rules add a restrictive-tier premium.
About Tennessee's rules
TN is a restricted-practice state for NPs — no independence pathway exists. Physicians must personally review ≥20% of an APRN's charts every 30 days (100% of controlled-substance charts) and visit remote practice sites in person every 30 days. TN has an explicit, unambiguous corporate-practice-of-medicine ban (statute, case law, and AG opinions; TCA § 63-6-204) — a professional corporation may practice only a single profession.
Other clinicians in Tennessee: see the state overview.