Supervising Physician Cheat Sheet for Missouri
Requirements for Supervising Physician agreements in Missouri, plus a free agreement builder tailored to Missouri law.
Provider supervision requirements in Missouri
Updated 2026-09-03
Provided for educational and research purposes only — this is not legal advice. Laws and regulations change frequently, and this content may contain errors or omissions. Always confirm current requirements with a licensed attorney before relying on this for compliance decisions.
PA/APRN collaboration is governed by nearly-identical §§ 334.104/334.735: a 6-FTE combined ratio cap, 10%/20% chart-review every 14 days, biweekly physician presence, and a 120-hour controlled-substance Rx cap. A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Physician Assistant
Missouri has no independent-practice pathway for PAs — a written collaborative practice arrangement with a physician is mandatory for as long as the PA practices, regardless of experience (§ 334.735).
Proximity
Available remotely (no on-site requirement)
§ 334.735 requires the collaborating physician and PA to 'maintain geographic proximity,' with no numeric mileage in the current statutory text. A pre-2024 75-mile rule was reportedly rescinded by board action (secondary-sourced — not independently confirmed against current rule text; verify before relying on this for compliance decisions). PAs also generally practice 'within the same office facility' as the supervising physician per the statutory definition of supervision, with exceptions for hospital/nursing-home/correctional-facility follow-up exams if reviewed and countersigned.Chart review
10% of charts · As needed (every 14 days)
10% of all charts documenting the PA's care, reviewed at least every 14 days (§ 334.735). Rises to 20% for charts in which the PA prescribed a controlled substance — see prescriptiveAuthority notes.Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Controlled-substance delegation requires the collaborating physician hold an unrestricted federal DEA registration; separate written delegation within the collaborative practice arrangement (§ 334.735).Practice ownership (CPOM)
Licensee-only ownership required — Traditional corporate-practice-of-medicine doctrine; professional corporations under RSMo Chapter 356 generally require shareholders licensed in the relevant profession
Supervision ratio
Up to 6 at a time (combined cap across provider types)
No physician may hold collaborative practice arrangements/supervision agreements with more than 6 full-time-equivalent APRNs, PAs, and/or assistant physicians in any combination concurrently (§§ 334.104, 334.735). Exceptions exist for hospital inpatient care and population-based public health services.Meeting cadence
As needed
The collaborating physician (or another physician named in the arrangement) must be present for sufficient periods of time at least once every 2 weeks to conduct chart review and provide medical direction, except in documented extraordinary circumstances (§ 334.735). No MEETING_FREQUENCIES value maps exactly to 'biweekly' — treat this as the closest available approximation, not a monthly cadence.Written agreement
Required
$650–$950/mo
Estimated PA supervision cost in Missouri
Available Supervising Physicians in Missouri
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