CNS · Virginia
Collaborative Practice Agreement for Clinical Nurse Specialists in Virginia
Not unconditionally. Virginia does not name a specific instrument.
Uniquely among VA provider types, CNS independence turns on prescribing rather than experience/hours. A CNS who does not prescribe controlled substances/devices practices without any written practice agreement from licensure (full independence, subject to general consult/referral duties). A CNS who does prescribe controlled substances/devices must practice under a permanent practice agreement with a physician — unlike NP/PA/CNM, there is no attestation/hours-based exit from that requirement (§ 54.1-2957(J), 18VAC90-30-125).
Independent practice requires: does not prescribe controlled substances or devices.
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
CNS who prescribes controlled substances/devices: Available remotely (no on-site requirement)
No codified mile/minute radius or on-site requirement; agreement need only address availability for routine and urgent consultation.
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
CNS who prescribes controlled substances/devices: Separate prescribing terms required · controlled substances permitted
May prescribe Schedules II–VI per § 54.1-2957.01, but only pursuant to a permanent practice agreement with a physician — no independent-prescribing pathway exists for CNS.
CNS who does not prescribe controlled substances/devices: Covered by the practice agreement · no controlled-substance authority
Practices independently; no prescriptive authority for controlled substances.
Written agreement
Not required
Conditional, not unconditional — shown as 'Not required' for the default/non-prescribing branch, but a CNS who prescribes controlled substances/devices DOES need a permanent practice agreement with a physician, with no attestation/hours-based exit (see Prescriptive Authority below).
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Professional Limited Liability Company (PLLC) under § 13.1-1102 — CNSs, as an APRN category, are eligible independent PLLC owners; no physician ownership required. Alternatively a Professional Corporation under § 13.1-543 with all shares held by licensed/authorized individuals.
This ownership pathway applies regardless of the prescribing/non-prescribing branch above — it governs entity ownership, not clinical practice-agreement status.
Legal sources for these rules (2)
What a collaborating physician costs here
Typical monthly cost in Virginia
$500 – $650
Estimate for one Clinical Nurse Specialist. This state's rules add a restrictive-tier premium.
About Virginia's rules
No provider type below has a codified chart-review percentage, countersignature rule, or numeric proximity radius — all are left to the practice agreement. CPOM (ownership) is governed by Title 13.1's PC/PLLC statutes, which explicitly list APRNs (NP/CRNA/CNM/CNS) as eligible independent owners but do not enumerate PAs — the PA ownership pathway is an inference from that omission, not a confirmed holding. Virginia has no independent corporate-practice-of-medicine common-law doctrine (a 1992 AG opinion, secondary-sourced only).
Other clinicians in Virginia: see the state overview.