Collaborative Practice Agreement

A formal written agreement between a physician and a nurse practitioner or physician assistant defining the terms of their professional collaboration, required in some states.

A collaborative practice agreement, or CPA, is a legal document that defines the working relationship between a physician and an advanced practice provider like a nurse practitioner or physician assistant. In states that require CPAs, the NP or PA cannot practice without one. The CPA typically specifies: the scope of services the NP or PA is authorized to provide, prescriptive authority and any limitations on prescribing, protocols for when the NP or PA must consult with or refer to the collaborating physician, the frequency and method of chart review by the physician, how the physician will be available for consultation, and the process for addressing disagreements about patient care. Not all states require CPAs. As of 2026, 28 states and DC grant NPs full practice authority, meaning they can practice independently without a CPA. For PAs, the landscape is shifting toward Optimal Team Practice models that reduce formal supervisory requirements. Check your state's current requirements because these laws change regularly. During credentialing, payers in states that require CPAs will ask for a copy of the agreement. They verify that the collaborating physician is also credentialed with their plan and that the CPA meets state requirements. If your CPA expires or the collaborating physician leaves, you need to execute a new CPA immediately or your ability to practice and bill may be interrupted. A common problem: the collaborating physician changes jobs or retires, and the NP or PA does not update the CPA promptly. The payer discovers during re-credentialing that the listed collaborating physician is no longer available, and the NP's enrollment is suspended until a new CPA is filed. If your state requires a CPA, have a backup plan. Identify a secondary collaborating physician who can step in if your primary collaborator becomes unavailable. Document this backup arrangement in advance so there is no gap in coverage.