Under TEFRA, direction allows a physician to supervise up to how many CRNAs?

• A. Up to four CRNAs.
• B. Up to two CRNAs.
• C. Up to six CRNAs.
• D. Unlimited CRNAs.

Answer: (A)

The main idea here is how TEFRA defines supervision of CRNAs under the direction model. When a physician provides direction for anesthesia services, there is a specific limit to how many CRNAs can be supervised at one time. Under TEFRA, a physician may supervise up to four CRNAs. This means the physician must be readily available to give direction and assist as needed during the anesthesia service, even though the physician does not need to be in the room for every moment. The four-CRNA limit is designed to balance effective oversight with practical workflow and is a Medicare-related standard often emphasized in professional liability and practice-setting guidelines. The other options don’t fit the established limit: supervision is not unlimited, and typical practice recognizes four as the maximum. In some settings or jurisdictions, different rules may apply, but the TEFRA direction framework most commonly cited supports the up-to-four limit.