Time and Distance to Care
California Health & Wellness (CHW) must follow travel time and distance standards for your care. The standards help to make sure you are able to get care without having to travel too long or too far from where you live. Travel time and distance standards vary by county. The table below shows this travel time and distance standard.
| PROVIDER TYPE | TIME AND DISTANCE TO CARE FROM MEMBERS RESIDENCE WITHIN |
|---|---|
| Primary Care (Adult and Pediatric) and Obstetrics/Gynecology (OB/GYN) Primary Care | 10 miles or 30 minutes |
| Specialty Care1 and Mental Health (non-psychiatry) Outpatient Service (Adult and Pediatric) | Placer County: 30 miles or 60 minutes Amador, Butte, Sutter, El Dorado, Nevada, Yuba Counties: 45 miles or 75 minutes Alpine, Calaveras, Colusa, Glenn, Imperial, Inyo, Mariposa, Mono, Plumas, Sierra, Tehama, Tuolumne Counties: 60 miles or 90 minutes |
| Hospitals | 15 miles or 30 minutes |
| Pharmacy | 10 miles or 30 minutes |
1ADULT AND PEDIATRIC SPECIALITY CARE
- Cardiology/Interventional Cardiology
- Dermatology
- Endocrinology
- ENT/Otolaryngology
- Gastroenterology
- General Surgery
- Hematology
- HIV/AIDS Specialists/Infectious Diseases
- Nephrology
- Neurology
- Obstetrics/Gynecology (OB/GYN) - Adult
- Oncology
- Ophthalmology
- Orthopedic Surgery
- Physical Medicine and Rehabilitation
- Psychiatry
- Pulmonology
If CHW cannot provide care to you within the travel standards, a new one may be used. It's called an alternative access standard. If you need care from a provider (or other provider) that’s far from where you live, you can call Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) for help. Member Services can help find a doctor closer to you.
If CHW cannot find a closer doctor, you can request for CHW to arrange transportation to see the doctor that's far from where you live. Note: "Far" means you cannot get to a doctor (or other provider) within the CHW travel time and distance standards for your county – despite any alternative access standard CHW may use for your ZIP code.
Select a county below to see the alternate access travel time and distance standards.
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95223 | HIV AIDS/Infectious Disease | Adult | 100 | 75 | 1/17/2020 |
| 95223 | HIV AIDS/Infectious Disease | Pediatric | 100 | 75 | 1/17/2020 |
| 95223 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 95223 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 95223 | Primary Care Provider | Adult | 35 | 35 | 1/17/2020 |
| 95223 | Primary Care Provider | Pediatric | 35 | 35 | 1/17/2020 |
| 96120 | HIV AIDS/Infectious Disease | Adult | 125 | 95 | 1/17/2020 |
| 96120 | HIV AIDS/Infectious Disease | Pediatric | 125 | 95 | 1/17/2020 |
| 96120 | Hospital | Not Applicable | 40 | 40 | 1/17/2020 |
| 96120 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 85 | 80 | 1/17/2020 |
| 96120 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96120 | Primary Care Provider | Adult | 40 | 40 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95629 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 45 | 1/17/2020 |
| 95640 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 45 | 1/17/2020 |
| 95642 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95665 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95666 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| 95669 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 45 | 1/17/2020 |
| 95685 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 45 | 1/17/2020 |
| 95689 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95941 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 30 | 1/17/2020 |
| 95942 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95223 | Hospital | Not Applicable | 40 | 40 | 1/17/2020 |
| 95223 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95223 | Pharmacy | Not Applicable | 35 | 35 | 1/17/2020 |
| 95232 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95236 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95245 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| 95246 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| 95249 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95252 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| 95255 | Hospital | Not Applicable | 40 | 40 | 1/17/2020 |
| 95255 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 45 | 1/17/2020 |
| 95257 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95912 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 55 | 1/17/2020 |
| 95932 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95957 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95970 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95979 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 95979 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 80 | 70 | 1/17/2020 |
| 95979 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 95979 | Primary Care Provider | Adult | 45 | 40 | 1/17/2020 |
| 95979 | Primary Care Provider | Pediatric | 45 | 40 | 1/17/2020 |
| 95987 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95614 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 40 | 1/17/2020 |
| 95619 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95623 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95629 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95633 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95634 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 50 | 1/17/2020 |
| 95635 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95636 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 60 | 1/17/2020 |
| 95651 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 35 | 1/17/2020 |
| 95664 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 30 | 1/17/2020 |
| 95667 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95672 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 25 | 1/17/2020 |
| 95682 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 30 | 1/17/2020 |
| 95684 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 45 | 1/17/2020 |
| 95709 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 45 | 1/17/2020 |
| 95720 | HIV AIDS/Infectious Disease | Adult | 90 | 65 | 1/17/2020 |
| 95720 | HIV AIDS/Infectious Disease | Pediatric | 90 | 65 | 1/17/2020 |
| 95720 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 95726 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 65 | 50 | 1/17/2020 |
| 95735 | HIV AIDS/Infectious Disease | Adult | 95 | 65 | 1/17/2020 |
| 95735 | HIV AIDS/Infectious Disease | Pediatric | 95 | 70 | 1/17/2020 |
| 95735 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 96150 | HIV AIDS/Infectious Disease | Adult | 100 | 75 | 1/17/2020 |
| 96150 | HIV AIDS/Infectious Disease | Pediatric | 100 | 75 | 1/17/2020 |
| 96150 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 85 | 80 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95920 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 30 | 1/17/2020 |
| 95939 | Hospital | Not Applicable | 40 | 35 | 1/17/2020 |
| 95939 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 60 | 1/17/2020 |
| 95939 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 95939 | Primary Care Provider | Adult | 40 | 35 | 1/17/2020 |
| 95939 | Primary Care Provider | Pediatric | 40 | 35 | 1/17/2020 |
| 95943 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 30 | 1/17/2020 |
| 95963 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 95963 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95970 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95988 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 92227 | Endocrinology | Adult | 140 | 110 | 1/17/2020 |
| 92227 | Endocrinology | Pediatric | 140 | 110 | 1/17/2020 |
| 92227 | HIV AIDS/Infectious Disease | Adult | 120 | 110 | 1/17/2020 |
| 92227 | HIV AIDS/Infectious Disease | Pediatric | 145 | 110 | 1/17/2020 |
| 92231 | Endocrinology | Adult | 140 | 110 | 1/17/2020 |
| 92231 | Endocrinology | Pediatric | 140 | 110 | 1/17/2020 |
| 92231 | HIV AIDS/Infectious Disease | Adult | 130 | 110 | 1/17/2020 |
| 92231 | HIV AIDS/Infectious Disease | Pediatric | 155 | 110 | 1/17/2020 |
| 92233 | Endocrinology | Adult | 140 | 110 | 1/17/2020 |
| 92233 | Endocrinology | Pediatric | 140 | 110 | 1/17/2020 |
| 92233 | HIV AIDS/Infectious Disease | Adult | 120 | 110 | 1/17/2020 |
| 92233 | HIV AIDS/Infectious Disease | Pediatric | 140 | 110 | 1/17/2020 |
| 92233 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not applicable | 40 | 40 | 1/17/2020 |
| 92243 | Endocrinology | Adult | 135 | 105 | 1/17/2020 |
| 92243 | Endocrinology | Pediatric | 135 | 105 | 1/17/2020 |
| 92243 | HIV AIDS/Infectious Disease | Adult | 125 | 105 | 1/17/2020 |
| 92243 | HIV AIDS/Infectious Disease | Pediatric | 145 | 105 | 1/17/2020 |
| 92249 | Endocrinology | Adult | 140 | 110 | 1/17/2020 |
| 92249 | Endocrinology | Pediatric | 140 | 110 | 1/17/2020 |
| 92249 | HIV AIDS/Infectious Disease | Adult | 130 | 110 | 1/17/2020 |
| 92249 | HIV AIDS/Infectious Disease | Pediatric | 150 | 110 | 1/17/2020 |
| 92250 | Endocrinology | Adult | 145 | 115 | 1/17/2020 |
| 92250 | Endocrinology | Pediatric | 145 | 115 | 1/17/2020 |
| 92250 | HIV AIDS/Infectious Disease | Adult | 135 | 115 | 1/17/2020 |
| 92250 | HIV AIDS/Infectious Disease | Pediatric | 160 | 115 | 1/17/2020 |
| 92251 | Endocrinology | Adult | 135 | 105 | 1/17/2020 |
| 92251 | Endocrinology | Pediatric | 135 | 105 | 1/17/2020 |
| 92251 | HIV AIDS/Infectious Disease | Adult | 120 | 105 | 1/17/2020 |
| 92251 | HIV AIDS/Infectious Disease | Pediatric | 145 | 105 | 1/17/2020 |
| 92257 | Endocrinology | Adult | 125 | 105 | 1/17/2020 |
| 92257 | Endocrinology | Pediatric | 120 | 100 | 1/17/2020 |
| 92257 | HIV AIDS/Infectious Disease | Adult | 105 | 95 | 1/17/2020 |
| 92257 | HIV AIDS/Infectious Disease | Pediatric | 125 | 100 | 1/17/2020 |
| 92257 | Hospital | Not applicable | 45 | 40 | 1/17/2020 |
| 92257 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not applicable | 50 | 45 | 1/17/2020 |
| 92257 | Pharmacy | Not applicable | 35 | 30 | 1/17/2020 |
| 92257 | Primary Care Provider | Adult | 40 | 35 | 1/17/2020 |
| 92274 | Endocrinology | Adult | 100 | 85 | 1/17/2020 |
| 92274 | Endocrinology | Pediatric | 95 | 80 | 1/17/2020 |
| 92274 | HIV AIDS/Infectious Disease | Pediatric | 100 | 85 | 1/17/2020 |
| 92274 | Hospital | Not applicable | 60 | 55 | 1/17/2020 |
| 92274 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not applicable | 65 | 60 | 1/17/2020 |
| 92281 | Endocrinology | Adult | 125 | 105 | 1/17/2020 |
| 92281 | Endocrinology | Pediatric | 125 | 100 | 1/17/2020 |
| 92281 | HIV AIDS/Infectious Disease | Adult | 110 | 100 | 1/17/2020 |
| 92281 | HIV AIDS/Infectious Disease | Pediatric | 130 | 100 | 1/17/2020 |
| 92283 | Endocrinology | Adult | 200 | 126 | 1/17/2020 |
| 92283 | Endocrinology | Pediatric | 200 | 126 | 1/17/2020 |
| 92283 | ENT/Otolaryngology | Pediatric | 150 | 123 | 1/17/2020 |
| 92283 | HIV AIDS/Infectious Disease | Adult | 180 | 107 | 1/17/2020 |
| 92283 | HIV AIDS/Infectious Disease | Pediatric | 205 | 107 | 1/17/2020 |
| 92283 | Hospital | Not applicable | 75 | 65 | 1/17/2020 |
| 92283 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not applicable | 85 | 75 | 1/17/2020 |
| 92283 | Primary Care Provider | Adult | 70 | 65 | 1/17/2020 |
| 92283 | Primary Care Provider | Pediatric | 60 | 55 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 92328 | Cardiology/Interventional Cardiology | Adult | 145 | 135 | 1/17/2020 |
| 92328 | Cardiology/Interventional Cardiology | Pediatric | 145 | 135 | 1/17/2020 |
| 92328 | Dermatology | Adult | 145 | 135 | 1/17/2020 |
| 92328 | Dermatology | Pediatric | 145 | 135 | 1/17/2020 |
| 92328 | Endocrinology | Adult | 144 | 132 | 1/17/2020 |
| 92328 | ENT/Otolaryngology | Adult | 195 | 180 | 1/17/2020 |
| 92328 | ENT/Otolaryngology | Pediatric | 195 | 180 | 1/17/2020 |
| 92328 | Gastroenterology | Adult | 145 | 135 | 1/17/2020 |
| 92328 | Gastroenterology | Pediatric | 145 | 135 | 1/17/2020 |
| 92328 | General Surgery | Adult | 145 | 135 | 1/17/2020 |
| 92328 | General Surgery | Pediatric | 145 | 135 | 1/17/2020 |
| 92328 | Hematology | Adult | 195 | 175 | 1/17/2020 |
| 92328 | Hematology | Pediatric | 195 | 175 | 1/17/2020 |
| 92328 | HIV AIDS/Infectious Disease | Adult | 110 | 100 | 1/17/2020 |
| 92328 | HIV AIDS/Infectious Disease | Pediatric | 110 | 100 | 1/17/2020 |
| 92328 | Hospital | Not Applicable | 100 | 100 | 1/17/2020 |
| 92328 | Mental Health (Out-Patient Services) | Adult | 93.3 | 85.6 | 1/17/2020 |
| 92328 | Mental Health (Out-Patient Services) | Pediatric | 93.3 | 85.6 | 1/17/2020 |
| 92328 | Nephrology | Adult | 170 | 155 | 1/17/2020 |
| 92328 | Nephrology | Pediatric | 185 | 160 | 1/17/2020 |
| 92328 | Neurology | Adult | 185 | 131 | 1/17/2020 |
| 92328 | Neurology | Pediatric | 195 | 131 | 1/17/2020 |
| 92328 | Obstetrics/Gynecology (OB/GYN) | Not Applicable | 145 | 135 | 1/17/2020 |
| 92328 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 165 | 155 | 1/17/2020 |
| 92328 | Oncology | Adult | 280 | 250 | 1/17/2020 |
| 92328 | Oncology | Pediatric | 195 | 175 | 1/17/2020 |
| 92328 | Ophthalmology | Adult | 140 | 130 | 1/17/2020 |
| 92328 | Ophthalmology | Pediatric | 140 | 130 | 1/17/2020 |
| 92328 | Orthopedic Surgery | Adult | 145 | 135 | 1/17/2020 |
| 92328 | Orthopedic Surgery | Pediatric | 145 | 135 | 1/17/2020 |
| 92328 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 92328 | Physical Medicine and Rehabilitation | Adult | 200 | 185 | 1/17/2020 |
| 92328 | Physical Medicine and Rehabilitation | Pediatric | 200 | 185 | 1/17/2020 |
| 92328 | Primary Care Provider | Adult | 85 | 80 | 1/17/2020 |
| 92328 | Primary Care Provider | Pediatric | 105 | 95 | 1/17/2020 |
| 92328 | Psychiatry | Adult | 165 | 155 | 1/17/2020 |
| 92328 | Psychiatry | Pediatric | 170 | 155 | 1/17/2020 |
| 92328 | Pulmonology | Adult | 190 | 160 | 1/17/2020 |
| 92328 | Pulmonology | Pediatric | 195 | 170 | 1/17/2020 |
| 93513 | ENT/Otolaryngology | Adult | 140 | 130 | 1/17/2020 |
| 93513 | ENT/Otolaryngology | Pediatric | 140 | 130 | 1/17/2020 |
| 93513 | Hematology | Adult | 140 | 130 | 1/17/2020 |
| 93513 | Hematology | Pediatric | 140 | 130 | 1/17/2020 |
| 93513 | HIV AIDS/Infectious Disease | Adult | 140 | 120 | 1/17/2020 |
| 93513 | HIV AIDS/Infectious Disease | Pediatric | 135 | 120 | 1/17/2020 |
| 93513 | Hospital | Not Applicable | 50 | 50 | 1/17/2020 |
| 93513 | Nephrology | Adult | 170 | 155 | 1/17/2020 |
| 93513 | Nephrology | Pediatric | 140 | 130 | 1/17/2020 |
| 93513 | Neurology | Adult | 140 | 130 | 1/17/2020 |
| 93513 | Neurology | Pediatric | 140 | 75 | 1/17/2020 |
| 93513 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 150 | 135 | 1/17/2020 |
| 93513 | Oncology | Adult | 200 | 180 | 1/17/2020 |
| 93513 | Oncology | Pediatric | 140 | 130 | 1/17/2020 |
| 93513 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 93513 | Physical Medicine and Rehabilitation | Adult | 140 | 130 | 1/17/2020 |
| 93513 | Physical Medicine and Rehabilitation | Pediatric | 140 | 130 | 1/17/2020 |
| 93513 | Primary Care Provider | Adult | 55 | 50 | 1/17/2020 |
| 93513 | Primary Care Provider | Pediatric | 55 | 50 | 1/17/2020 |
| 93513 | Pulmonology | Adult | 150 | 135 | 1/17/2020 |
| 93513 | Pulmonology | Pediatric | 140 | 125 | 1/17/2020 |
| 93514 | ENT/Otolaryngology | Adult | 100 | 90 | 1/17/2020 |
| 93514 | ENT/Otolaryngology | Pediatric | 100 | 90 | 1/17/2020 |
| 93514 | Hematology | Adult | 100 | 90 | 1/17/2020 |
| 93514 | Hematology | Pediatric | 97 | 89 | 1/17/2020 |
| 93514 | HIV AIDS/Infectious Disease | Adult | 155 | 110 | 1/17/2020 |
| 93514 | HIV AIDS/Infectious Disease | Pediatric | 115 | 110 | 1/17/2020 |
| 93514 | Hospital | Not Applicable | 40 | 35 | 1/17/2020 |
| 93514 | Nephrology | Adult | 145 | 135 | 1/17/2020 |
| 93514 | Nephrology | Pediatric | 100 | 90 | 1/17/2020 |
| 93514 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 135 | 125 | 1/17/2020 |
| 93514 | Oncology | Adult | 190 | 160 | 1/17/2020 |
| 93514 | Oncology | Pediatric | 100 | 90 | 1/17/2020 |
| 93514 | Physical Medicine and Rehabilitation | Adult | 100 | 90 | 1/17/2020 |
| 93514 | Physical Medicine and Rehabilitation | Pediatric | 100 | 90 | 1/17/2020 |
| 93514 | Pulmonology | Adult | 105 | 95 | 1/17/2020 |
| 93514 | Pulmonology | Pediatric | 100 | 90 | 1/17/2020 |
| 93526 | ENT/Otolaryngology | Adult | 145 | 135 | 1/17/2020 |
| 93526 | ENT/Otolaryngology | Pediatric | 145 | 135 | 1/17/2020 |
| 93526 | Hematology | Adult | 145 | 135 | 1/17/2020 |
| 93526 | Hematology | Pediatric | 145 | 135 | 1/17/2020 |
| 93526 | HIV AIDS/Infectious Disease | Adult | 125 | 110 | 1/17/2020 |
| 93526 | HIV AIDS/Infectious Disease | Pediatric | 120 | 110 | 1/17/2020 |
| 93526 | Hospital | Not Applicable | 60 | 35 | 1/17/2020 |
| 93526 | Nephrology | Adult | 165 | 155 | 1/17/2020 |
| 93526 | Nephrology | Pediatric | 145 | 135 | 1/17/2020 |
| 93526 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 150 | 140 | 1/17/2020 |
| 93526 | Oncology | Adult | 220 | 205 | 1/17/2020 |
| 93526 | Oncology | Pediatric | 145 | 135 | 1/17/2020 |
| 93526 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 93526 | Physical Medicine and Rehabilitation | Adult | 145 | 135 | 1/17/2020 |
| 93526 | Physical Medicine and Rehabilitation | Pediatric | 145 | 135 | 1/17/2020 |
| 93526 | Primary Care Provider | Adult | 65 | 33.5 | 1/17/2020 |
| 93526 | Primary Care Provider | Pediatric | 75 | 50 | 1/17/2020 |
| 93526 | Psychiatry | Adult | 120 | 110 | 1/17/2020 |
| 93526 | Psychiatry | Pediatric | 120 | 110 | 1/17/2020 |
| 93526 | Pulmonology | Adult | 145 | 130 | 1/17/2020 |
| 93526 | Pulmonology | Pediatric | 155 | 145 | 1/17/2020 |
| 93527 | Cardiology/Interventional Cardiology | Adult | 91 | 76 | 1/17/2020 |
| 93527 | Cardiology/Interventional Cardiology | Pediatric | 65 | 80 | 1/17/2020 |
| 93527 | Dermatology | Adult | 130 | 120 | 1/17/2020 |
| 93527 | Dermatology | Pediatric | 130 | 120 | 1/17/2020 |
| 93527 | Endocrinology | Adult | 92 | 77 | 1/17/2020 |
| 93527 | Endocrinology | Pediatric | 95 | 80 | 1/17/2020 |
| 93527 | ENT/Otolaryngology | Adult | 145 | 125 | 1/17/2020 |
| 93527 | ENT/Otolaryngology | Pediatric | 145 | 125 | 1/17/2020 |
| 93527 | Gastroenterology | Adult | 95 | 80 | 1/17/2020 |
| 93527 | Gastroenterology | Pediatric | 95 | 80 | 1/17/2020 |
| 93527 | General Surgery | Adult | 95 | 80 | 1/17/2020 |
| 93527 | Hematology | Adult | 150 | 125 | 1/17/2020 |
| 93527 | Hematology | Pediatric | 150 | 125 | 1/17/2020 |
| 93527 | Hospital | Not Applicable | 65 | 60 | 1/17/2020 |
| 93527 | Nephrology | Pediatric | 95 | 80 | 1/17/2020 |
| 93527 | Neurology | Adult | 95 | 80 | 1/17/2020 |
| 93527 | Neurology | Pediatric | 150 | 140 | 1/17/2020 |
| 93527 | Obstetrics/Gynecology (OB/GYN) | Not Applicable | 95 | 90 | 1/17/2020 |
| 93527 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 85 | 80 | 1/17/2020 |
| 93527 | Oncology | Adult | 140 | 200 | 1/17/2020 |
| 93527 | Oncology | Pediatric | 150 | 125 | 1/17/2020 |
| 93527 | Orthopedic Surgery | Adult | 240 | 200 | 1/17/2020 |
| 93527 | Orthopedic Surgery | Pediatric | 130 | 120 | 1/17/2020 |
| 93527 | Physical Medicine and Rehabilitation | Adult | 150 | 140 | 1/17/2020 |
| 93527 | Physical Medicine and Rehabilitation | Pediatric | 150 | 140 | 1/17/2020 |
| 93527 | Psychiatry | Pediatric | 95 | 80 | 1/17/2020 |
| 93527 | Pulmonology | Adult | 95 | 80 | 1/17/2020 |
| 93527 | Pulmonology | Pediatric | 150 | 125 | 1/17/2020 |
| 93545 | Cardiology/Interventional Cardiology | Adult | 105 | 90 | 1/17/2020 |
| 93545 | Cardiology/Interventional Cardiology | Pediatric | 100 | 87 | 1/17/2020 |
| 93545 | Dermatology | Adult | 125 | 115 | 1/17/2020 |
| 93545 | Dermatology | Pediatric | 125 | 115 | 1/17/2020 |
| 93545 | Endocrinology | Adult | 105 | 90 | 1/17/2020 |
| 93545 | Endocrinology | Pediatric | 105 | 90 | 1/17/2020 |
| 93545 | ENT/Otolaryngology | Adult | 145 | 130 | 1/17/2020 |
| 93545 | ENT/Otolaryngology | Pediatric | 145 | 130 | 1/17/2020 |
| 93545 | Gastroenterology | Adult | 105 | 90 | 1/17/2020 |
| 93545 | Gastroenterology | Pediatric | 105 | 90 | 1/17/2020 |
| 93545 | General Surgery | Adult | 105 | 90 | 1/17/2020 |
| 93545 | General Surgery | Pediatric | 105 | 90 | 1/17/2020 |
| 93545 | Hematology | Adult | 145 | 130 | 1/17/2020 |
| 93545 | Hematology | Pediatric | 145 | 130 | 1/17/2020 |
| 93545 | Hospital | Not Applicable | 65 | 60 | 1/17/2020 |
| 93545 | Nephrology | Adult | 120 | 110 | 1/17/2020 |
| 93545 | Nephrology | Pediatric | 130 | 110 | 1/17/2020 |
| 93545 | Neurology | Adult | 130 | 110 | 1/17/2020 |
| 93545 | Neurology | Pediatric | 145 | 122 | 1/17/2020 |
| 93545 | Obstetrics/Gynecology (OB/GYN) | Not Applicable | 100 | 95 | 1/17/2020 |
| 93545 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 120 | 110 | 1/17/2020 |
| 93545 | Oncology | Adult | 250 | 215 | 1/17/2020 |
| 93545 | Oncology | Pediatric | 145 | 130 | 1/17/2020 |
| 93545 | Orthopedic Surgery | Adult | 125 | 115 | 1/17/2020 |
| 93545 | Orthopedic Surgery | Pediatric | 125 | 115 | 1/17/2020 |
| 93545 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 93545 | Physical Medicine and Rehabilitation | Adult | 145 | 135 | 1/17/2020 |
| 93545 | Physical Medicine and Rehabilitation | Pediatric | 145 | 135 | 1/17/2020 |
| 93545 | Primary Care Provider | Adult | 45 | 40 | 1/17/2020 |
| 93545 | Primary Care Provider | Pediatric | 75 | 70 | 1/17/2020 |
| 93545 | Psychiatry | Adult | 120 | 110 | 1/17/2020 |
| 93545 | Psychiatry | Pediatric | 125 | 110 | 1/17/2020 |
| 93545 | Pulmonology | Adult | 135 | 115 | 1/17/2020 |
| 93545 | Pulmonology | Pediatric | 145 | 130 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 93623 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 75 | 70 | 1/17/2020 |
| 93623 | Oncology | Adult | 100 | 90 | 1/17/2020 |
| 93653 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 93653 | Oncology | Adult | 95 | 85 | 1/17/2020 |
| 95306 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 55 | 1/17/2020 |
| 95311 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95325 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95338 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 95338 | Oncology | Adult | 95 | 85 | 1/17/2020 |
| 95345 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 95369 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95389 | HIV AIDS/Infectious Disease | Adult | 95 | 70 | 1/17/2020 |
| 95389 | Hospital | Not Applicable | 40 | 40 | 1/17/2020 |
| 95389 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 60 | 1/17/2020 |
| 95389 | Pharmacy | Not Applicable | 35 | 35 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 93512 | ENT/Otolaryngology | Adult | 120 | 110 | 1/17/2020 |
| 93512 | ENT/Otolaryngology | Pediatric | 120 | 110 | 1/17/2020 |
| 93512 | Hematology | Adult | 120 | 110 | 1/17/2020 |
| 93512 | Hematology | Pediatric | 120 | 110 | 1/17/2020 |
| 93512 | HIV AIDS/Infectious Disease | Adult | 12 | 67 | 1/17/2020 |
| 93512 | HIV AIDS/Infectious Disease | Pediatric | 155 | 67 | 1/17/2020 |
| 93512 | Hospital | Not Applicable | 45 | 40 | 1/17/2020 |
| 93512 | Nephrology | Adult | 125 | 115 | 1/17/2020 |
| 93512 | Nephrology | Pediatric | 120 | 110 | 1/17/2020 |
| 93512 | Neurology | Adult | 100 | 65 | 1/17/2020 |
| 93512 | Neurology | Pediatric | 120 | 65 | 1/17/2020 |
| 93512 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 120 | 110 | 1/17/2020 |
| 93512 | Oncology | Adult | 140 | 130 | 1/17/2020 |
| 93512 | Oncology | Pediatric | 120 | 110 | 1/17/2020 |
| 93512 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 93512 | Physical Medicine and Rehabilitation | Adult | 120 | 110 | 1/17/2020 |
| 93512 | Physical Medicine and Rehabilitation | Pediatric | 120 | 110 | 1/17/2020 |
| 93512 | Primary Care Provider | Adult | 45 | 40 | 1/17/2020 |
| 93512 | Primary Care Provider | Pediatric | 45 | 40 | 1/17/2020 |
| 93512 | Pulmonology | Adult | 100 | 90 | 1/17/2020 |
| 93512 | Pulmonology | Pediatric | 100 | 90 | 1/17/2020 |
| 93514 | ENT/Otolaryngology | Adult | 115 | 110 | 1/17/2020 |
| 93514 | ENT/Otolaryngology | Pediatric | 115 | 110 | 1/17/2020 |
| 93514 | Hematology | Adult | 115 | 110 | 1/17/2020 |
| 93514 | Hematology | Pediatric | 115 | 110 | 1/17/2020 |
| 93514 | HIV AIDS/Infectious Disease | Adult | 155 | 110 | 1/17/2020 |
| 93514 | HIV AIDS/Infectious Disease | Pediatric | 115 | 110 | 1/17/2020 |
| 93514 | Hospital | Not Applicable | 35 | 32 | 1/17/2020 |
| 93514 | Nephrology | Adult | 145 | 95 | 1/17/2020 |
| 93514 | Nephrology | Pediatric | 115 | 95 | 1/17/2020 |
| 93514 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 135 | 120 | 1/17/2020 |
| 93514 | Oncology | Pediatric | 115 | 105 | 1/17/2020 |
| 93514 | Pharmacy | Not Applicable | 35 | 35 | 1/17/2020 |
| 93514 | Physical Medicine and Rehabilitation | Adult | 115 | 110 | 1/17/2020 |
| 93514 | Physical Medicine and Rehabilitation | Pediatric | 115 | 110 | 1/17/2020 |
| 93514 | Primary Care Provider | Adult | 35 | 35 | 1/17/2020 |
| 93514 | Primary Care Provider | Pediatric | 35 | 35 | 1/17/2020 |
| 93514 | Pulmonology | Adult | 100 | 95 | 1/17/2020 |
| 93514 | Pulmonology | Pediatric | 100 | 95 | 1/17/2020 |
| 93517 | Hematology | Pediatric | 95 | 85 | 1/17/2020 |
| 93517 | HIV AIDS/Infectious Disease | Adult | 150 | 120 | 1/17/2020 |
| 93517 | HIV AIDS/Infectious Disease | Pediatric | 125 | 115 | 1/17/2020 |
| 93517 | Hospital | Not Applicable | 60 | 55 | 1/17/2020 |
| 93517 | Neurology | Pediatric | 95 | 85 | 1/17/2020 |
| 93517 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 95 | 85 | 1/17/2020 |
| 93517 | Oncology | Adult | 95 | 85 | 1/17/2020 |
| 93517 | Oncology | Pediatric | 95 | 85 | 1/17/2020 |
| 93517 | Pharmacy | Not Applicable | 45 | 45 | 1/17/2020 |
| 93517 | Primary Care Provider | Adult | 60 | 55 | 1/17/2020 |
| 93517 | Primary Care Provider | Pediatric | 60 | 55 | 1/17/2020 |
| 93517 | Pulmonology | Pediatric | 100 | 90 | 1/17/2020 |
| 93546 | ENT/Otolaryngology | Adult | 95 | 90 | 1/17/2020 |
| 93546 | ENT/Otolaryngology | Pediatric | 95 | 90 | 1/17/2020 |
| 93546 | Hematology | Adult | 95 | 90 | 1/17/2020 |
| 93546 | Hematology | Pediatric | 95 | 90 | 1/17/2020 |
| 93546 | HIV AIDS/Infectious Disease | Adult | 125 | 90 | 1/17/2020 |
| 93546 | HIV AIDS/Infectious Disease | Pediatric | 95 | 90 | 1/17/2020 |
| 93546 | Nephrology | Adult | 120 | 110 | 1/17/2020 |
| 93546 | Nephrology | Pediatric | 95 | 90 | 1/17/2020 |
| 93546 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 110 | 105 | 1/17/2020 |
| 93546 | Oncology | Adult | 135 | 125 | 1/17/2020 |
| 93546 | Oncology | Pediatric | 100 | 90 | 1/17/2020 |
| 93546 | Physical Medicine and Rehabilitation | Adult | 95 | 90 | 1/17/2020 |
| 93546 | Physical Medicine and Rehabilitation | Pediatric | 95 | 90 | 1/17/2020 |
| 96107 | HIV AIDS/Infectious Disease | Adult | 125 | 105 | 1/17/2020 |
| 96107 | HIV AIDS/Infectious Disease | Pediatric | 125 | 105 | 1/17/2020 |
| 96107 | Hospital | Not Applicable | 60 | 55 | 1/17/2020 |
| 96107 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 85 | 80 | 1/17/2020 |
| 96107 | Pharmacy | Not Applicable | 55 | 50 | 1/17/2020 |
| 96107 | Primary Care Provider | Adult | 60 | 30 | 1/17/2020 |
| 96107 | Primary Care Provider | Pediatric | 40 | 30 | 1/17/2020 |
| 96133 | HIV AIDS/Infectious Disease | Adult | 130 | 105 | 1/17/2020 |
| 96133 | HIV AIDS/Infectious Disease | Pediatric | 130 | 105 | 1/17/2020 |
| 96133 | Hospital | Not Applicable | 55 | 50 | 1/17/2020 |
| 96133 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 90 | 80 | 1/17/2020 |
| 96133 | Pharmacy | Not Applicable | 40 | 40 | 1/17/2020 |
| 96133 | Primary Care Provider | Adult | 55 | 22 | 1/17/2020 |
| 96133 | Primary Care Provider | Pediatric | 40 | 22 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95602 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 95945 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 95946 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95949 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 45 | 1/17/2020 |
| 95959 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95960 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95975 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| 95977 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 96161 | HIV AIDS/Infectious Disease | Adult | 95 | 85 | 1/17/2020 |
| 96161 | HIV AIDS/Infectious Disease | Pediatric | 91 | 82 | 1/17/2020 |
| 96161 | Nephrology | Adult | 90 | 80 | 1/17/2020 |
| 96161 | Nephrology | Pediatric | 95 | 85 | 1/17/2020 |
| 96161 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 90 | 85 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95602 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 35 | 1/17/2020 |
| 95603 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 35 | 1/17/2020 |
| 95631 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 55 | 1/17/2020 |
| 95648 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 30 | 1/17/2020 |
| 95658 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 30 | 1/17/2020 |
| 95681 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 30 | 1/17/2020 |
| 95703 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 40 | 1/17/2020 |
| 95713 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 65 | 50 | 1/17/2020 |
| 95722 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 96146 | HIV AIDS/Infectious Disease | Adult | 85 | 75 | 1/17/2020 |
| 96146 | HIV AIDS/Infectious Disease | Pediatric | 82 | 70 | 1/17/2020 |
| 96146 | Nephrology | Adult | 80 | 70 | 1/17/2020 |
| 96146 | Nephrology | Pediatric | 80 | 70 | 1/17/2020 |
| 96146 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 90 | 80 | 1/17/2020 |
| 96161 | HIV AIDS/Infectious Disease | Adult | 95 | 85 | 1/17/2020 |
| 96161 | HIV AIDS/Infectious Disease | Adult | 90 | 85 | 1/17/2020 |
| 96161 | Nephrology | Adult | 90 | 85 | 1/17/2020 |
| 96161 | Nephrology | Pediatric | 95 | 85 | 1/17/2020 |
| 96161 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 90 | 85 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95923 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95934 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95947 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95971 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95981 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 45 | 1/17/2020 |
| 95983 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 95983 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 96020 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 50 | 1/17/2020 |
| 96103 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 55 | 1/17/2020 |
| 96105 | HIV AIDS/Infectious Disease | Adult | 105 | 100 | 1/17/2020 |
| 96105 | HIV AIDS/Infectious Disease | Pediatric | 105 | 100 | 1/17/2020 |
| 96105 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 96122 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 96129 | HIV AIDS/Infectious Disease | Adult | 95 | 85 | 1/17/2020 |
| 96129 | HIV AIDS/Infectious Disease | Pediatric | 95 | 85 | 1/17/2020 |
| 96129 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 55 | 1/17/2020 |
| 96137 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95910 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 95910 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95910 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 95922 | Hospital | Not Applicable | 40 | 35 | 1/17/2020 |
| 95922 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| 95922 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 95960 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 96118 | HIV AIDS/Infectious Disease | Adult | 105 | 100 | 1/17/2020 |
| 96118 | HIV AIDS/Infectious Disease | Pediatric | 105 | 100 | 1/17/2020 |
| 96118 | Hospital | Not Applicable | 35 | 35 | 1/17/2020 |
| 96118 | Nephrology | Adult | 95 | 90 | 1/17/2020 |
| 96118 | Nephrology | Pediatric | 95 | 90 | 1/17/2020 |
| 96118 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 80 | 75 | 1/17/2020 |
| 96118 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96118 | Primary Care Provider | Adult | 35 | 35 | 1/17/2020 |
| 96118 | Primary Care Provider | Pediatric | 35 | 35 | 1/17/2020 |
| 96124 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 70 | 65 | 1/17/2020 |
| 96125 | Hospital | Not Applicable | 33 | 30 | 1/17/2020 |
| 96125 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 55 | 1/17/2020 |
| 96125 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96126 | HIV AIDS/Infectious Disease | Adult | 105 | 95 | 1/17/2020 |
| 96126 | HIV AIDS/Infectious Disease | Pediatric | 105 | 95 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95659 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95668 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 25 | 1/17/2020 |
| 95674 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95692 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 30 | 1/17/2020 |
| 95953 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| 95957 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 45 | 1/17/2020 |
| 95982 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| 95991 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 40 | 1/17/2020 |
| 95993 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 40 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95942 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 45 | 1/17/2020 |
| 95963 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 25 | 1/17/2020 |
| 96021 | Hospital | Not Applicable | 40 | 35 | 1/17/2020 |
| 96021 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 50 | 40 | 1/17/2020 |
| 96022 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 80 | 65 | 1/17/2020 |
| 96029 | Hospital | Not Applicable | 45 | 40 | 1/17/2020 |
| 96029 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 96035 | Hospital | Not Applicable | 45 | 20 | 1/17/2020 |
| 96035 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 96055 | Hospital | Not Applicable | 45 | 20 | 1/17/2020 |
| 96055 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 40 | 1/17/2020 |
| 96059 | Hospital | Not Applicable | 40 | 40 | 1/17/2020 |
| 96059 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 65 | 50 | 1/17/2020 |
| 96059 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96059 | Primary Care Provider | Adult | 35 | 22 | 1/17/2020 |
| 96059 | Primary Care Provider | Pediatric | 35 | 30 | 1/17/2020 |
| 96061 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 96061 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96075 | Hospital | Not Applicable | 45 | 40 | 1/17/2020 |
| 96075 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 65 | 50 | 1/17/2020 |
| 96075 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 96075 | Primary Care Provider | Adult | 35 | 35 | 1/17/2020 |
| 96075 | Primary Care Provider | Pediatric | 35 | 35 | 1/17/2020 |
| 96076 | Hospital | Not Applicable | 45 | 45 | 1/17/2020 |
| 96076 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 95 | 80 | 1/17/2020 |
| 96076 | Pharmacy | Not Applicable | 35 | 35 | 1/17/2020 |
| 96076 | Primary Care Provider | Adult | 45 | 40 | 1/17/2020 |
| 96076 | Primary Care Provider | Pediatric | 45 | 40 | 1/17/2020 |
| 96080 | Hospital | Not Applicable | 45 | 40 | 1/17/2020 |
| 96080 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 75 | 65 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95314 | Pharmacy | Not Applicable | 35 | 35 | 1/17/2020 |
| 95321 | Hospital | Not Applicable | 35 | 30 | 1/17/2020 |
| 95321 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95335 | HIV AIDS/Infectious Disease | Adult | 100 | 95 | 1/17/2020 |
| 95335 | HIV AIDS/Infectious Disease | Pediatric | 100 | 95 | 1/17/2020 |
| 95335 | Hospital | Not Applicable | 55 | 50 | 1/17/2020 |
| 95335 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 55 | 50 | 1/17/2020 |
| 95335 | Pharmacy | Not Applicable | 40 | 35 | 1/17/2020 |
| 95335 | Primary Care Provider | Adult | 40 | 35 | 1/17/2020 |
| 95335 | Primary Care Provider | Pediatric | 40 | 35 | 1/17/2020 |
| 95346 | Hospital | Not Applicable | 35 | 20 | 1/17/2020 |
| 95346 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| 95364 | HIV AIDS/Infectious Disease | Adult | 105 | 90 | 1/17/2020 |
| 95364 | HIV AIDS/Infectious Disease | Pediatric | 105 | 95 | 1/17/2020 |
| 95364 | Hospital | Not Applicable | 55 | 50 | 1/17/2020 |
| 95364 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 60 | 55 | 1/17/2020 |
| 95364 | Pharmacy | Not Applicable | 35 | 30 | 1/17/2020 |
| 95364 | Primary Care Provider | Adult | 45 | 40 | 1/17/2020 |
| 95364 | Primary Care Provider | Pediatric | 40 | 35 | 1/17/2020 |
| 95389 | HIV AIDS/Infectious Disease | Adult | 115 | 80 | 1/17/2020 |
| 95389 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 65 | 60 | 1/17/2020 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95692 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95903 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95918 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |
| 95922 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 30 | 45 | 1/17/2020 |
| 95935 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 30 | 1/17/2020 |
| 95960 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95961 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 45 | 35 | 1/17/2020 |
| 95962 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 30 | 1/17/2020 |
| 95977 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 40 | 35 | 1/17/2020 |
| 95981 | Obstetrics/Gynecology (OB/GYN) Primary Care | Not Applicable | 35 | 35 | 1/17/2020 |