Does a Certified Registered Nurse Anesthetist need a written agreement with a physician in Indiana?

Q: Does a Certified Registered Nurse Anesthetist need a written agreement with a physician in Indiana?

Not in every case. Not required — and this 'no' is stricter than it looks, not looser. Indiana exempts CRNAs from IC 25-23-1-19.4's practice-agreement requirement entirely (§ 19.4(a)) but replaces it with a materially heavier operational constraint: physician direction AND immediate physical presence for every anesthesia administration (IC 25-23-1-30(a); mirrored as an exclusion from the Medical Practice Act at IC 25-22.5-1-2(a)(13)). There is no written document to procure, but there is a physician who must be in the room.

CRNA · Indiana

Collaborative Practice Agreement for Certified Registered Nurse Anesthetists in Indiana

Not unconditionally. Indiana does not name a specific instrument.

Practice authoritySupervision required

Written agreementNo agreement required

What Indiana calls itNo named instrument

Research date2026-08-21

Indiana's anesthesia model is neither an agreement nor an order — it is a physical-presence mandate. IC 25-23-1-30(a): a CRNA 'may administer anesthesia if the certified registered nurse anesthetist acts under the direction of and in the immediate presence of a physician.' CRNAs are expressly carved OUT of the APRN collaboration and prescriptive-authority statutes (IC 25-23-1-19.4(a), -19.5(a)), so no practice agreement, chart review, or board filing applies.

What the collaboration 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

IC 25-23-1-30(a) requires the physician's 'immediate presence' — the strictest proximity standard recorded anywhere in this dataset, and stricter than Texas's § 157.058 order-based model, which requires only a general anesthesia order and no physical presence. Note that the statute says 'a physician,' not 'an anesthesiologist.' SEPARATE AND DISTINCT: Indiana has NOT opted out of the federal Medicare condition of participation requiring physician supervision of CRNAs (AANA state page, secondary). Those are two independent requirements — the federal one governs Medicare reimbursement for hospitals/CAHs/ASCs, the state one governs the CRNA's own licensure. Do not treat Indiana's non-opt-out as the source of the state-law rule, or vice versa.

Supervision ratio

Not codified — no cap on file

Chart review

Not codified — left to the agreement

Meeting cadence

Not codified — left to the agreement

Prescriptive authority

Covered by the practice agreement · no controlled-substance authority

CRNAs are excluded from the APRN prescriptive-authority program by IC 25-23-1-19.5(a), and IC 25-23-1-30(b) confirms that nothing in the chapter requires a CRNA to obtain prescriptive authority in order to administer anesthesia. Coded controlledSubstancesAllowed=False for PRESCRIBING specifically; administering anesthesia agents (including scheduled drugs) under physician direction and immediate presence is a separate act and is authorized by § 30(a). AANA's Indiana page also reports no CRNA prescriptive authority (secondary, corroborating).

Written agreement

Not required

Not required — and this 'no' is stricter than it looks, not looser. Indiana exempts CRNAs from IC 25-23-1-19.4's practice-agreement requirement entirely (§ 19.4(a)) but replaces it with a materially heavier operational constraint: physician direction AND immediate physical presence for every anesthesia administration (IC 25-23-1-30(a); mirrored as an exclusion from the Medical Practice Act at IC 25-22.5-1-2(a)(13)). There is no written document to procure, but there is a physician who must be in the room.

Practice ownership (corporate practice of medicine)

Licensee-only ownership required — Same as the general `np` entry — a CRNA is a registered nurse in a specialty role under IC 25-23-1-1(b)(4), so the same inferred IC 25-22.5-1-2(a)(22)(G) reading applies. Note that this ownership analysis does not loosen § 25-23-1-30(a): owning the entity does not relieve the immediate-presence requirement for the anesthesia itself.

This analysis governs entity ownership only. It does not extend to any service outside the APRN's own scope — notably delegated medical-aesthetic procedures, which stay under the delegating physician's control via IC 25-22.5-1-2(a)(20) regardless of who owns the entity (see the `esthetician` entry).

Legal sources for these rules (4)

What a collaborating physician costs here

Typical monthly cost in Indiana

$500 – $600

Estimate for one Certified Registered Nurse Anesthetist. This state's proximity rules add a small premium.

About Indiana's rules

Indiana requires a career-long collaborative practice agreement for every APRN role except CRNAs (IC 25-23-1-19.4(c)); APRN prescribers additionally face a codified 5%-of-charts random-sampling review (848 IAC 5-1-1). CRNAs instead face a stricter rule — physician direction and immediate presence (IC 25-23-1-30). Widely repeated reports that Indiana enacted full practice authority in 2026 are unsupported: HB 1116, HB 1129 and SB 60 all failed. Indiana's corporate-practice doctrine is comparatively permissive.

Other clinicians in Indiana: see the state overview.