CRNA · California
Supervision Agreement for Certified Registered Nurse Anesthetists in California
Yes, a written supervising-physician agreement is required. California does not name a specific instrument.
Structurally different from other APRNs: CRNA anesthesia administration is ORDER-based (a physician/dentist/podiatrist order), not supervision-based — no proximity, ratio, chart-review, or meeting requirement attaches once an order exists. CA opted out of the federal Medicare physician-supervision requirement in 2009 (litigation resolved ~2012), but state law's own order requirement is untouched by that opt-out.
What the supervision must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
No physical/geographic proximity requirement is codified — the model is order-based (a physician need not be present or nearby once the anesthesia order is given), not presence-based.
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 · controlled substances permitted
Exact verb phrasing of §2826.6 (the order-authorization mechanics) differed slightly between two separate research fetches — flag for direct verbatim confirmation before quoting.
Written agreement
Required
California's term is an 'order' — Bus. & Prof. Code §2826.6 (confirmed verbatim), specific to anesthesia, requires the order come from a PHYSICIAN, DENTIST, OR PODIATRIST ONLY. (§2725(b)'s broader general-RN medication-administration authority separately includes clinical psychologist as an ordering provider, but that's a different, non-anesthesia-specific statute — don't import it here; a prior version of this note incorrectly conflated the two.) Not 'standardized procedures' or a 'practice agreement' — the CRNA independently selects/initiates/implements anesthesia once ordered. AB 876 (2025, Ch. 169, eff. 1/1/2026) added clarifying provisions (§§2826, 2826.5-.7) but its own non-expansion clause (§2833.6) states it does not change existing scope — codification/clarification, not new authority.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same nursing-corporation framework as `np` (Bus. & Prof. Code §2775, Corp. Code §13401.5) likely applies, since CRNA is an RN certification, not a separate license — but no CRNA-specific source confirming a real CRNA-owned anesthesia practice was found; this is inferred from the general nursing-corporation statute.
Legal sources for these rules (4)
- Bus. & Prof. Code §2725(b) — General RN/CRNA order-based framework
- Bus. & Prof. Code §§2826, 2826.5, 2826.6, 2826.7, 2827, 2833.6 — Nurse Anesthetists Act (Article 7), as amended by AB 876 (2025)
- AB 876 (2025, Stats. Ch. 169, eff. 1/1/2026) — CRNA codification/clarification; chapter number, effective date, and §§2826/2826.5-.7/2833.6 text confirmed verbatim via direct leginfo fetch in a follow-up pass
- CMS Medicare physician-supervision opt-out (Gov. Schwarzenegger, 2009; litigation concluded ~2012) — SECONDARY SOURCE ONLY (Becker's ASC, Colorado Rural Health Center, CANA); federal Medicare Conditions-of-Participation matter, distinct from CA state law's own order requirement
What a supervising physician costs here
Typical monthly cost in California
$500 – $600
Estimate for one Certified Registered Nurse Anesthetist. Standard-tier state.
About California's rules
California's NPs reach genuine full independence (AB 890/SB 1451, ~6 years total) and CNMs need zero physician involvement for definitionally 'low-risk' pregnancy care — no hours threshold. NPs/PAs may also majority-own their own practice corporations (Corp. Code §13401.5), cutting against the assumption that CA's strict, actively-enforced CPOM regime (2026 AG settlements against Carbon Health, Aspen Dental) blocks all non-physician ownership. CRNA is order-based, not supervision-based. Esthetician laser use is a flat criminal misdemeanor — no delegation pathway exists.
Other clinicians in California: see the state overview.