Clinical Nurse Specialist 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 A pre-2024 numeric 75-mile proximity rule was reportedly rescinded by both boards — current text uses an undefined 'geographic proximity' standard; verify with counsel before relying on any specific mileage figure.
Clinical Nurse Specialist
CNS is not a distinct licensure category — Missouri's unified APRN statute (§ 335.016) lists 'Certified Clinical Nurse Specialist' as one of four national-certification sub-types under the single APRN license. No CNS-specific supervision statute was found; treated identically to general NP under § 334.104.
Proximity
Available remotely (no on-site requirement)
Same undefined 'geographic proximity' standard as general NP (§ 334.104).Chart review
10% of charts · As needed (every 14 days)
Same 10%/20% structure as general NP.Prescriptive authority
Separate prescribing terms required · controlled substances permitted
Same Schedule III-V/hydrocodone framework, 120-hour cap, ≥1,000-hour threshold for the controlled-substance certificate as general NP.Practice ownership (CPOM)
Licensee-only ownership required — Same as the general `np` entry — no CNS-specific ownership rule found.
Supervision ratio
Up to 6 at a time (combined cap across provider types)
Same 6-FTE combined cap as general NP/PA.Meeting cadence
As needed
Same biweekly-presence standard as general NP.Written agreement
Required
$650–$950/mo
Estimated CNS supervision cost in Missouri
Available Supervising Physicians in Missouri
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