CRNAs are trained and licensed to provide the full range of anesthesia care: general anesthesia, regional anesthesia, sedation, and the pre- and post-anesthesia care around them. What a given CRNA may do in a given job depends on three layers: state law, federal payment rules, and the policies of the facility where they work.
This page explains each layer and how they stack.
Key points
- Scope stacks in three layers: state law, Medicare rules, facility policy.
- 27 states plus DC and Guam have opted out of federal supervision.
- Facility policy can narrow your scope but never expand it.
- CRNAs are the primary anesthesia providers in most rural US hospitals.
What CRNAs are trained to do
The AANA's Scope of Nurse Anesthesia Practice describes the profession's full scope. It includes:
- Pre-anesthesia assessment and developing the anesthetic plan
- Obtaining informed consent for anesthesia
- Inducing, maintaining, and emerging patients from general anesthesia
- Regional anesthesia: spinals, epidurals, and peripheral nerve blocks
- Sedation and monitored anesthesia care (MAC)
- Airway management, including intubation and emergency airway care
- Placing invasive lines such as arterial and central lines
- Ordering and administering anesthetic and adjunct drugs, fluids, and blood products
- Post-anesthesia care and discharge decisions
- Acute and chronic pain management services
Every CRNA completes a doctoral program and passes the NBCRNA National Certification Examination before practicing. See /how-many-years-does-it-take-to-become-a-nurse-anesthetist/ for the training path and /nce-exam/ for the exam.
Training in scope does not automatically mean authority to use it everywhere. That is where the layers come in.
Layer 1: State law
Each state defines APRN and CRNA practice through its nurse practice act and board of nursing rules. States differ on:
- Whether CRNAs need physician supervision, collaboration, or neither
- Whether the supervising or collaborating physician must be an anesthesiologist, or can be the operating surgeon or dentist
- Prescriptive authority, which is separate from giving drugs in the OR (see /crna-prescriptive-authority/)
- Specific procedures, such as chronic pain management
Your state board of nursing is the authoritative source. Find yours through /board-of-nursing/. Note that the Nurse Licensure Compact covers RN licenses only; CRNA authority requires licensure in each state of practice. See /nursing-compact-states/ and /aprn-compact/.
Layer 2: Federal payment rules and opt-out states
Medicare's hospital Conditions of Participation (42 CFR 482.52) require that a CRNA administering anesthesia be supervised by the operating practitioner or an anesthesiologist, unless the state has opted out of that requirement.
As of September 2026, 27 states plus the District of Columbia and Guam have opted out, with Utah and Wyoming opting out in part. Vermont and Ohio opted out in July 2026 and DC in September 2026. Full list and details at /crna-opt-out-states/.
Two points people often get wrong:
- The opt-out affects Medicare payment conditions, and the supervision it removes is the operating practitioner's, since the rule never required an anesthesiologist specifically.
- A state that has not opted out can still allow broad CRNA practice under state law. The CoP supervision requirement is a billing condition, and the "supervising" surgeon is not directing the anesthetic.
Layer 3: Facility policy
Facilities can restrict practice below what state and federal law allow, and most do in some way. Medical staff bylaws, credentialing, and privileging decide what you may actually do in that building: which blocks, which lines, which patient populations, whether you take OB or trauma.
Facility policy can narrow your scope. It cannot expand it beyond state law. This is why two CRNAs in the same state can have very different jobs, and why case mix and privileges are key interview questions. See /crna-job-interview-questions/.
Supervision vs collaboration vs independent practice
These words get used loosely. In practice:
- Supervision means a physician is formally responsible for oversight of the anesthesia care. In most care team models, that physician is an anesthesiologist who medically directs or supervises several rooms.
- Collaboration means a defined working relationship with a physician, often the surgeon, without moment-to-moment direction. Many states use collaboration language.
- Independent practice means the CRNA provides anesthesia without a required physician relationship for anesthesia decisions. The surgeon still decides the surgery; the CRNA owns the anesthetic.
Independent practice is common in rural hospitals, many ASCs, and office settings, and CRNAs are the primary anesthesia providers in most rural US hospitals. Billing under the QZ modifier (CRNA non-medically directed) is widespread even in states without an opt-out, because the opt-out and billing modifiers answer different questions.
If independent work is your goal, weigh state environment, facility culture, and your own experience level together. New grads should build a foundation first; see /new-grad-crna-first-job/. Experienced CRNAs comparing markets can start with /crna-salary-by-state/ and /best-crna-jobs/, and 1099-minded readers should see /1099-crna/.
Can CRNAs practice without an anesthesiologist?
Yes, where state law and facility policy allow it. Many hospitals and ASCs run CRNA-only anesthesia, with the operating practitioner relationship satisfying any supervision rules that apply.
Can CRNAs intubate, place central lines, and do blocks?
All are within the professional scope described by the AANA. Whether you may do them in a specific job depends on state rules and, most often, facility privileging.
Does scope of practice affect pay?
Often, yes. Independent and rural roles frequently pay more because the CRNA carries the full anesthetic responsibility. See /crna-salary/ and /crna-contract-negotiation/.
This page is general information, and scope questions in a specific situation belong to your state board of nursing and facility counsel.