NP · South Carolina
Collaborative Practice Agreement for Nurse Practitioners in South Carolina
Yes, a written physician agreement is required. South Carolina calls it a Written Practice Agreement.
SC removed the word 'supervision' from its Nurse Practice Act in 2018, but NPs still require a written practice agreement to practice or prescribe — no experience-based independence pathway exists today. A pending bill (S.45/H.3580) would create a 2,000-clinical-hour pathway to full practice authority; not yet law.
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
Available remotely (no on-site requirement)
§40-33-34: the collaborating physician must be 'readily available for consultation' and must practice within SC's geographic boundaries. No mile/minute radius or on-site standard is codified.
Supervision ratio
Up to 6 at a time (combined across provider types)
Same combined cap as `pa` — §40-47-195(D)(1)(c) counts NP, CNM, and CNS practice agreements together with PA scope-of-practice guidelines toward one physician's shared limit of 6.
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Separate prescribing terms required · controlled substances permitted
§40-33-34: Schedule III–V if listed in the practice agreement; Schedule II nonnarcotic capped at a 30-day supply per prescription; Schedule II narcotic capped at a 5-day initial supply, with any further prescription requiring written physician agreement (exempt for hospice, palliative-care, or long-term-care patients). Requires 45 contact hours of pharmacotherapeutics education (15 on controlled substances if reciprocating from another state) and 20 CE hours every 2 years to renew (2 of which on controlled-substance prescribing).
Written agreement
Required
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Corporation under Title 33, Chapter 19 for nursing services, or a physician-owned entity per SC's common-law CPOM doctrine (see `pa` entry).
Legal sources for these rules (3)
- S.C. Code § 40-33-34 — Performance of Medical Acts; Qualifications; Practice Agreements; Prescriptive Authorization; Anesthesia Care; Definitionssecondary
- S.C. Code § 40-47-195 — Supervising Physicians; Scope of Practice Guidelines (combined 6-provider cap)
- 2025-2026 S.C. Bill S.45/H.3580 — proposed APRN full-practice-authority pathway (pending, not enacted)
What a collaborating physician costs here
Typical monthly cost in South Carolina
$500 – $700
Estimate for one Nurse Practitioner. This state's rules add a restrictive-tier premium.
About South Carolina's rules
A physician may not hold practice agreements/scope-of-practice guidelines with more than a COMBINED 6 full-time-equivalent PA+NP+CNM+CNS at once (§40-47-195(D)(1)(c)) — a single shared cap, not four separate ones. A widely-repeated '3 PA' cap was repealed in 2019 (Act 32). SC remains restricted-practice for APRNs; a 2,000-hour full-practice-authority bill (S.45/H.3580) is pending, not yet law.
Other clinicians in South Carolina: see the state overview.