Collaborating Physician Texas: Requirements & Cost (2026)

A Texas clinic using an advanced practice registered nurse (APRN) or physician assistant (PA) generally needs physician delegation when the practitioner will prescribe or order drugs and devices. In most non-facility settings, the central document is a Prescriptive Authority Agreement, commonly called a PAA.

The PAA is only part of the setup. The physician must also register the delegation with the Texas Medical Board (TMB), the parties must conduct documented quality-assurance meetings, and the physician must remain within the applicable seven-full-time-equivalent limit.

Texas does not currently offer an experience-based pathway that eventually removes these prescriptive-delegation requirements for nurse practitioners. However, the exact documentation can differ in hospital and long-term-care facility-based practices.

This guide explains the requirements, common costs, and practical steps for finding a collaborating physician in Texas.

Texas Requirements at a Glance

Issue	General Texas rule
Core agreement	A PAA is generally required when a physician delegates prescriptive authority to an APRN or PA outside an eligible facility-based protocol arrangement.
Registration	Physicians must register supervised APRNs and PAs with the TMB before the delegates begin working for them. Scope, approval, or termination changes should be updated within 30 days.
Ratio	In most settings, one physician may enter PAAs with no more than seven APRNs and PAs, or the equivalent of seven full-time practitioners, combined.
Ratio exceptions	The statutory PAA ratio does not apply in qualifying medically underserved practices or hospital facility-based practices.
PAA review	The agreement and amendments must be reviewed, dated, and signed at least annually.
Quality meetings	For a PAA executed on or after September 1, 2019, documented meetings must occur at least monthly.
Chart review	Chart review is required, but Texas does not prescribe a universal number or percentage. The parties set an appropriate number in the PAA.
Distance	Texas law does not establish a mileage limit, but the physician must still provide adequate supervision.

These are prescriptive-delegation rules, not a complete description of every law that may govern a clinic. Ownership, telemedicine, controlled substances, facility licensing, service-specific standards, and professional scope must also be considered.

Does a Texas NP Need a Collaborating Physician?

Texas is commonly classified as a restricted-practice state for nurse practitioners. For prescribing, the legal structure is more precise: an APRN must have prescriptive authority from the Texas Board of Nursing and delegated authority from a qualified physician under the applicable Texas statutes and rules.

Texas Occupations Code § 157.0512 authorizes a physician to delegate prescribing or ordering drugs and devices to an APRN or PA acting under adequate physician supervision through a PAA. The Texas Medical Board separately requires registration of that delegation.

Accordingly, signing a PAA does not by itself create every authority an APRN needs. Before prescribing begins, confirm:

• the APRN’s active Texas license and role or population focus;
• Texas Board of Nursing prescriptive authority;
• the physician’s eligibility to delegate;
• a signed PAA or other legally permitted facility-based delegation mechanism;
• TMB registration of the delegation; and
• any separate DEA, prescription-monitoring, telemedicine, or service-specific requirements.

The same PAA statute can apply to PAs. Referring to it only as an “NP collaboration agreement” leaves out a substantial part of the Texas framework.

Who Can Serve as a Texas Collaborating Physician?

For online registration, the TMB generally requires a full, active, unrestricted Texas physician license. The Board says a physician may be ineligible for online registration or delegation when the physician:

• is subject to a current board order;
• has reported that they are not actively practicing medicine;
• holds a temporary or faculty temporary license;
• practices under voluntary charity care status; or
• holds a telemedicine, public health, or conceded eminence license.

The physician must be able to provide adequate supervision for the delegated medical acts. Texas does not reduce that obligation to signing a document or attending a monthly call. The clinic should confirm the physician’s clinical competence, availability, capacity, and familiarity with the services being offered.

Before executing the PAA, the physician and APRN or PA must disclose applicable prior disciplinary actions to one another. If a party later receives notice that they are under investigation by the relevant licensing board, that party must immediately notify the other parties to the agreement.

What Must a Texas Prescriptive Authority Agreement Include?

For a PAA executed in 2026, the agreement must be written, signed, and dated. At minimum, it must include:

1. The names, addresses, and professional license numbers of the parties.
2. The nature of the practice and its locations or settings.
3. The types or categories of drugs and devices that may—or may not—be prescribed.
4. A general consultation and referral plan.
5. A plan for patient emergencies.
6. A process for communication and sharing patient-care information.
7. One or more alternate physicians if alternate physician supervision will be used.
8. A prescriptive-authority quality-assurance and improvement plan.
9. Methods for documenting chart review and periodic meetings.

The original draft incorrectly treated an alternate physician as mandatory in every PAA. Texas requires the agreement to identify alternate physicians only when the parties intend to use alternate supervision.

The PAA and any amendments must be reviewed at least annually, dated, and signed by the parties. Each party must retain a copy until the second anniversary of the agreement’s termination. If one of the relevant licensing boards requests the agreement, it must be made available no later than the third business day after the request is received.

TMB Registration and the 30-Day Update Rule

The PAA and the TMB registration are separate requirements.

According to the Texas Medical Board’s prescribing and supervision guidance, physicians must register the APRNs and PAs they supervise before those delegates begin working for them. The Board’s online system is used to register prescriptive authority and file PA supervision notices.

Supervision or delegation approval and termination changes should be updated in the system within 30 days. The TMB also says physicians must report changes to the scope of delegation within 30 days.

Hard-copy forms are no longer routinely accepted, but the TMB expressly recognizes exceptions. For example, an otherwise eligible physician who cannot use the online system may need to contact the registration department. For that reason, “hard copies are never accepted” would be inaccurate.

A sound onboarding checklist should distinguish between:

• executing the PAA;
• registering the relationship before work begins;
• recording the actual start date;
• updating scope, approval, or termination changes within 30 days; and
• retaining confirmation of each submission.

Late updates do not erase potential exposure for the period in which registration information was inaccurate. The specific consequences, however, depend on the facts and any action by the applicable board.

How the Texas 1:7 FTE Limit Works

The commonly cited “1:7 ratio” applies to prescriptive authority agreements. Except for statutory exceptions, the combined number of APRNs and PAs with whom one physician may enter PAAs cannot exceed seven practitioners or the full-time equivalent of seven practitioners.

Important details include:

• APRNs and PAs count together.
• The calculation is based on full-time equivalents, not merely seven names.
• The physician must count relationships across separate non-exempt practices.
• Texas no longer offers a general waiver allowing a physician to exceed the limit.

Under § 157.0512, the ratio does not apply when prescriptive authority is exercised in a practice serving a medically underserved population or in a qualifying hospital facility-based practice. A freestanding clinic does not automatically become facility-based merely because a hospital owns or operates it.

Physicians working with multiple clinics should maintain a current delegation roster showing each practitioner, provider type, FTE allocation, practice setting, start date, termination date, and claimed exception.

Monthly Meetings and Chart Review

A PAA executed on or after September 1, 2019, must provide for documented meetings at least once each month. The meetings must include:

• discussion of patient-care improvement;
• information about patient treatment and care;
• needed changes to care plans; and
• referral issues.

The parties determine how the meetings occur. They may require in-person attendance or use remote methods such as telephone or video conferencing. Working at the same physical location does not remove the monthly-meeting requirement.

Texas also requires chart review as part of the quality-assurance plan. The law does not establish a universal 10% requirement, fixed minimum, or standard number of charts. The physician and delegate determine the number and document it in the PAA.

That discretion is not permission to select an arbitrary token number. The TMB explains that adequate supervision remains required and that the amount of chart review may matter when the quality of supervision is evaluated. Patient complexity, prescribing risk, practitioner experience, volume, time working together, and practice setting should inform the review plan.

Can the Collaboration Be Remote?

Texas law does not specify a mileage limit between the delegating physician and the APRN or PA. The TMB also permits monthly PAA meetings to be conducted remotely for agreements executed on or after September 1, 2019.

It is nevertheless too broad to say that every Texas collaboration can be “fully remote.” The physician must still provide adequate supervision, and distance may become relevant when the Board evaluates whether supervision was meaningful. The services, patient population, clinic setting, emergency plan, physician availability, telemedicine rules, and any in-person duties must support the arrangement.

A Dallas physician may be able to delegate to a practitioner in El Paso without violating a mileage rule. The parties still need a credible system for consultation, escalation, chart access, quality meetings, coverage, and urgent clinical issues.

Controlled-Substance Prescribing in Texas

A PAA can authorize controlled-substance prescribing only within the limits of Texas and federal law. It is inaccurate to imply that signing the PAA gives unrestricted authority to prescribe all controlled substances.

The TMB’s current guidance explains:

• Authority for Schedule II prescribing may be delegated only in limited circumstances, principally qualifying hospital facility-based care for certain admitted or emergency-department patients, or as part of hospice care for a person with a certified terminal illness.
• In other eligible settings, delegated controlled-substance authority is generally limited to Schedules III through V.
• The physician’s name, address, and telephone number must appear on the prescription drug order. For a controlled substance, the physician’s DEA number must also appear.
• APRNs and PAs must consult the delegating physician before refilling a controlled-substance prescription after the initial 90-day supply, and the consultation must be documented.
• Additional DEA registration, electronic-prescribing, Prescription Monitoring Program, patient-specific, and professional-scope rules may apply.

The PAA should therefore identify the permitted and prohibited drug categories accurately rather than using a broad phrase such as “controlled substances allowed.”

Common Texas Compliance Mistakes

The most common problems are usually failures of implementation rather than missing boilerplate:

• Treating the PAA as the registration. Both the written agreement and required TMB registration must be addressed.
• Beginning work before registration. The physician should register supervised delegates before they begin working for the physician.
• Failing to update changes. Scope, approval, and termination changes should be reported within 30 days.
• Making alternate supervision mandatory by template. Name alternate physicians when they will actually be used and define their role accurately.
• Counting seven people instead of seven FTEs. Track APRNs and PAs together across non-exempt PAAs.
• Assuming a hospital-owned clinic is facility-based. Physical setting and statutory requirements control the classification.
• Using an unsupported 10% chart-review rule. Set and document a risk-appropriate number rather than presenting 10% as Texas law.
• Keeping no meaningful meeting record. Document the date, participants, patient-care topics, referrals, improvement issues, and agreed actions.
• Overstating remote practice. No mileage rule does not eliminate adequate supervision.
• Treating all controlled-substance schedules alike. Schedule II authority is limited to narrow statutory settings.
• Missing annual signatures or record retention. Review and re-sign annually, then retain the agreement for two years after termination.

What Does a Collaborating Physician Cost in Texas?

Texas does not prescribe a monthly collaboration fee. Published 2026 sources show different figures because they measure different things:

• Single Aim Health reports estimated Texas physician compensation of approximately $694 per month, based on 111 Texas data points in its broader dataset.
• NP Collaborator reports a Texas median of approximately $499 per month, based on more than 50 Texas contracts.
• Medical Director Co. advertises Texas services beginning at $799 per month.

These figures are not necessarily comparable. One may represent physician pay, another an all-in contract median, and another a packaged service price. Included agreement drafting, registration assistance, compliance tracking, replacement coverage, platform fees, number of practitioners, specialty, prescribing risk, patient volume, and availability expectations can all change the total.

For planning purposes, approximately $500 to $900 or more per month is a more defensible working range than presenting $499 to $750 as a universal Texas price. Higher-risk, multi-provider, controlled-substance, or high-touch arrangements may exceed that range.

Our collaborating physician fees guide explains what clinics should compare beyond the headline monthly amount.

What to Verify Before Hiring a Texas Physician

Before signing, confirm:

1. The physician holds an eligible Texas license and can register the delegation.
2. The APRN or PA holds the required Texas license and prescriptive authority.
3. The physician has adequate clinical competence and capacity for the services.
4. The PAA includes every required element and matches the actual practice.
5. The physician remains within the seven-FTE limit or documents a valid exception.
6. Registration will be completed before the delegate begins working.
7. Monthly meetings, chart reviews, annual signatures, and 30-day updates have assigned owners.
8. Controlled-substance categories and limitations are stated precisely.
9. Communication, emergency escalation, record access, backup coverage, insurance, payment, and termination expectations are documented.

For a deeper legal overview, read our Texas collaborating physician requirements guide.

How to Find a Collaborating Physician in Texas

Begin by documenting the clinic’s actual requirements. A useful matching brief should include:

• APRN or PA credentials and FTE allocation;
• practice locations and setting classifications;
• patient population and clinical services;
• drug and device categories involved;
• controlled-substance and telemedicine activity;
• expected chart-review volume;
• consultation and response expectations;
• desired start date; and
• any alternate-coverage needs.

Collaborating Physician uses these details to evaluate fit and introduce an eligible Texas physician. Clinics can request a physician match, while physicians interested in Texas opportunities can apply to join the network. There is no platform fee for physicians.

Frequently Asked Questions

Does a Texas NP need a collaborating physician?

An APRN who will prescribe or order drugs and devices generally needs Texas Board of Nursing prescriptive authority plus physician delegation through a PAA or another legally permitted facility-based mechanism. Texas does not currently provide an experience-based transition to unrestricted independent APRN prescribing.

How many NPs can one Texas physician collaborate with?

In most settings, one physician may enter PAAs with a combined maximum of seven APRNs and PAs or seven full-time equivalents. The ratio does not apply to qualifying hospital facility-based practices or practices serving medically underserved populations.

Must the physician live near the Texas clinic?

Texas law does not state a mileage limit. Remote meetings are permitted for PAAs executed on or after September 1, 2019, but the physician must still provide adequate supervision. Distance and the services offered can affect whether the arrangement is workable.

How often must a Texas PAA be reviewed?

The PAA and its amendments must be reviewed, signed, and dated at least annually. Monthly quality-assurance meetings and chart reviews are separate ongoing requirements.

How many charts must the physician review?

Texas does not set one mandatory number or percentage for all practices. The parties establish the number in the PAA, taking account of adequate supervision, patient complexity, prescribing risk, practitioner experience, and the practice setting.

Can a Texas APRN prescribe controlled substances under a PAA?

Yes, within delegated state and federal limits. Schedules III through V may be delegated in eligible settings. Schedule II authority is restricted to narrow hospital facility-based and hospice circumstances. Additional DEA, electronic-prescribing, PMP, consultation, and documentation requirements may apply.

Is an alternate physician required in every PAA?

No. The PAA must designate one or more alternate physicians if alternate physician supervision will be used. The agreement should also explain any alternate physician’s role in supervision and quality meetings.

What happens if the physician misses a 30-day update?

Submitting a late update does not eliminate possible exposure from inaccurate registration information. The consequences depend on the circumstances and any action by the licensing board. Correct the record promptly and obtain Texas healthcare counsel when necessary.

Final Takeaway

Texas compliance depends on more than obtaining a physician’s signature. The clinic needs the correct delegation mechanism, an accurate PAA, advance registration, a current FTE count, meaningful monthly meetings, risk-appropriate chart review, annual signatures, and timely updates.

If your clinic is ready to begin, request a Texas physician match. Matches often occur within 24 to 48 hours, subject to license eligibility, clinical fit, physician availability, and completion of the required setup.

Disclaimer: This article provides general educational information and is not legal or medical advice. Laws, rules, and board procedures change. Verify current requirements with the Texas Legislature, Texas Medical Board, Texas Board of Nursing, Texas State Board of Pharmacy, and qualified Texas healthcare counsel before relying on a particular arrangement.