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 and 30 minutes |
| Specialty Care1 and Mental Health (non-psychiatry) Outpatient Service (Adult and Pediatric) | Placer County: 30 miles and 60 minutes Amador, Butte, Sutter, El Dorado, Nevada, Yuba Counties: 45 miles and 75 minutes Alpine, Calaveras, Colusa, Glenn, Imperial, Inyo, Mariposa, Mono, Plumas, Sierra, Tehama, Tuolumne Counties: 60 miles and 90 minutes |
| Hospitals | 15 miles and 30 minutes |
| Pharmacy | 10 miles and 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 your zip code and provider type are listed, CHW must help you find an appointment. You have a right to call Member Services at 1-877-658-0305 (For TTY, contact California Relay by dialing 711 and provide the 1-877-658-0305 number) to get help with finding an appointment to a closer specialist.
If CHW cannot find you an appointment with a closer specialist, CHW will arrange transportation to see the specialist.
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 Specialists/Infectious Diseases | Adult | 220 | 179 | 2/8/2021 |
| 95223 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 221 | 187 | 2/8/2021 |
| 95223 | Primary Care Provider | Adult | 180 | 145 | 2/8/2021 |
| 95223 | Primary Care Provider | Pediatric | 180 | 145 | 2/8/2021 |
| 95223 | Pharmacy | Not applicable | 34 | 31 | 2/8/2021 |
| 96120 | Cardiology/Interventional Cardiology | Pediatric | 68 | 65 | 2/8/2021 |
| 96120 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 180 | 136 | 2/8/2021 |
| 96120 | Nephrology | Adult | 67 | 65 | 2/8/2021 |
| 96120 | Nephrology | Pediatric | 222 | 137 | 2/8/2021 |
| 96120 | Psychiatry | Adult | 77 | 70 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95629 | Hospital | Not applicable | 17 | 20 | 2/8/2021 |
| 95629 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95640 | Hospital | Not applicable | 19 | 20 | 2/8/2021 |
| 95640 | Primary Care Provider | Adult | 14 | 15 | 2/8/2021 |
| 95640 | Primary Care Provider | Pediatric | 14 | 15 | 2/8/2021 |
| 95642 | HIV/AIDS Specialists/Infectious Diseases | Adult | 64 | 50 | 2/8/2021 |
| 95665 | HIV/AIDS Specialists/Infectious Diseases | Adult | 68 | 50 | 2/8/2021 |
| 95669 | Hospital | Not applicable | 23 | 25 | 2/8/2021 |
| 95669 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95689 | HIV/AIDS Specialists/Infectious Diseases | Adult | 67 | 50 | 2/8/2021 |
| 95689 | Hospital | Not applicable | 25 | 25 | 2/8/2021 |
| 95689 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95901 | Primary Care Provider | Adult | 14 | 15 | 2/8/2021 |
| 95901 | Pharmacy | Not applicable | 22 | 20 | 2/8/2021 |
| 95914 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 95914 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95916 | Hospital | Not applicable | 22 | 25 | 2/8/2021 |
| 95916 | Primary Care Provider | Adult | 19 | 20 | 2/8/2021 |
| 95916 | Primary Care Provider | Pediatric | 19 | 20 | 2/8/2021 |
| 95916 | Pharmacy | Not applicable | 107 | 59 | 2/8/2021 |
| 95917 | Primary Care Provider | Adult | 16 | 15 | 2/8/2021 |
| 95917 | Primary Care Provider | Pediatric | 16 | 15 | 2/8/2021 |
| 95917 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95917 | Physical Medicine and Rehabilitation | Pediatric | 55 | 55 | 2/8/2021 |
| 95926 | Physical Medicine and Rehabilitation | Pediatric | 95 | 70 | 2/8/2021 |
| 95928 | Physical Medicine and Rehabilitation | Pediatric | 136 | 89 | 2/8/2021 |
| 95930 | Hospital | Not applicable | 28 | 30 | 2/8/2021 |
| 95930 | Primary Care Provider | Adult | 17 | 20 | 2/8/2021 |
| 95930 | Primary Care Provider | Pediatric | 17 | 20 | 2/8/2021 |
| 95930 | Pharmacy | Not applicable | 52 | 48 | 2/8/2021 |
| 95938 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95938 | Primary Care Provider | Pediatric | 12 | 15 | 2/8/2021 |
| 95941 | Hospital | Not applicable | 35 | 30 | 2/8/2021 |
| 95941 | Primary Care Provider | Adult | 21 | 20 | 2/8/2021 |
| 95941 | Primary Care Provider | Pediatric | 21 | 20 | 2/8/2021 |
| 95941 | Pharmacy | Not applicable | 30 | 30 | 2/8/2021 |
| 95942 | Hospital | Not applicable | 30 | 30 | 2/8/2021 |
| 95942 | Primary Care Provider | Adult | 26 | 25 | 2/8/2021 |
| 95942 | Primary Care Provider | Pediatric | 83 | 50 | 2/8/2021 |
| 95942 | Pharmacy | Not applicable | 30 | 25 | 2/8/2021 |
| 95942 | Physical Medicine and Rehabilitation | Pediatric | 69 | 65 | 2/8/2021 |
| 95954 | Hospital | Not applicable | 24 | 25 | 2/8/2021 |
| 95954 | Physical Medicine and Rehabilitation | Pediatric | 64 | 60 | 2/8/2021 |
| 95965 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95965 | Primary Care Provider | Pediatric | 12 | 15 | 2/8/2021 |
| 95965 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95965 | Physical Medicine and Rehabilitation | Pediatric | 168 | 121 | 2/8/2021 |
| 95966 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95969 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 95969 | Physical Medicine and Rehabilitation | Pediatric | 168 | 121 | 2/8/2021 |
| 95973 | Hospital | Not applicable | 22 | 20 | 2/8/2021 |
| 95973 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 95973 | Primary Care Provider | Pediatric | 71 | 32 | 2/8/2021 |
| 95973 | Physical Medicine and Rehabilitation | Pediatric | 161 | 126 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95222 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 95 | 75 | 2/8/2021 |
| 95223 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 221 | 187 | 2/8/2021 |
| 95223 | Hospital | Not applicable | 121 | 78 | 2/8/2021 |
| 95223 | Primary Care Provider | Adult | 35 | 35 | 2/8/2021 |
| 95223 | Primary Care Provider | Pediatric | 180 | 145 | 2/8/2021 |
| 95223 | Pharmacy | Not applicable | 193 | 154 | 2/8/2021 |
| 95228 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 82 | 75 | 2/8/2021 |
| 95228 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 95228 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95230 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 80 | 65 | 2/8/2021 |
| 95230 | Pharmacy | Not applicable | 14 | 15 | 2/8/2021 |
| 95236 | Pharmacy | Not applicable | 12 | 13 | 2/8/2021 |
| 95245 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 95245 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95245 | Primary Care Provider | Pediatric | 58 | 31 | 2/8/2021 |
| 95245 | Pharmacy | Not applicable | 76 | 40 | 2/8/2021 |
| 95246 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 128 | 86 | 2/8/2021 |
| 95246 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 95246 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95246 | Primary Care Provider | Pediatric | 45 | 38 | 2/8/2021 |
| 95246 | Pharmacy | Not applicable | 70 | 40 | 2/8/2021 |
| 95247 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 146 | 95 | 2/8/2021 |
| 95249 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 90 | 65 | 2/8/2021 |
| 95249 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95251 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 105 | 108 | 2/8/2021 |
| 95252 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 95252 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95255 | HIV/AIDS Specialists/Infectious Diseases | Adult | 88 | 65 | 2/8/2021 |
| 95255 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 100 | 75 | 2/8/2021 |
| 95255 | Primary Care Provider | Adult | 27 | 30 | 2/8/2021 |
| 95255 | Primary Care Provider | Pediatric | 27 | 30 | 2/8/2021 |
| 95255 | Pharmacy | Not applicable | 30 | 30 | 2/8/2021 |
| 95257 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 86 | 65 | 2/8/2021 |
| 95257 | Hospital | Not applicable | 24 | 25 | 2/8/2021 |
| 95257 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 95257 | Primary Care Provider | Pediatric | 15 | 15 | 2/8/2021 |
| 95257 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95912 | Hospital | Not applicable | 22 | 25 | 2/8/2021 |
| 95912 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95912 | Primary Care Provider | Pediatric | 13 | 15 | 2/8/2021 |
| 95912 | Pharmacy | Not applicable | 30 | 25 | 2/8/2021 |
| 95957 | Pharmacy | Not applicable | 17 | 16 | 2/8/2021 |
| 95970 | Hospital | Not applicable | 17 | 20 | 2/8/2021 |
| 95970 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 95970 | Primary Care Provider | Pediatric | 16 | 20 | 2/8/2021 |
| 95970 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95970 | Physical Medicine and Rehabilitation | Pediatric | 68 | 65 | 2/8/2021 |
| 95979 | Hematology | Adult | 69 | 65 | 2/8/2021 |
| 95979 | Hematology | Pediatric | 193 | 101 | 2/8/2021 |
| 95979 | Hospital | Not applicable | 35 | 30 | 2/8/2021 |
| 95979 | Neurology | Adult | 68 | 65 | 2/8/2021 |
| 95979 | Neurology | Pediatric | 68 | 65 | 2/8/2021 |
| 95979 | Oncology | Pediatric | 193 | 101 | 2/8/2021 |
| 95979 | Primary Care Provider | Adult | 45 | 40 | 2/8/2021 |
| 95979 | Primary Care Provider | Pediatric | 45 | 40 | 2/8/2021 |
| 95979 | Physical Medicine and Rehabilitation | Pediatric | 105 | 85 | 2/8/2021 |
| 95979 | Psychiatry | Adult | 74 | 68 | 2/8/2021 |
| 95979 | Pulmonology | Adult | 169 | 93 | 2/8/2021 |
| 95979 | Pulmonology | Pediatric | 171 | 95 | 2/8/2021 |
| 95987 | Endocrinology | Pediatric | 79 | 75 | 2/8/2021 |
| 95987 | Hematology | Pediatric | 70 | 65 | 2/8/2021 |
| 95987 | Oncology | Adult | 70 | 65 | 2/8/2021 |
| 95987 | Oncology | Pediatric | 70 | 65 | 2/8/2021 |
| 95987 | Primary Care Provider | Adult | 18 | 20 | 2/8/2021 |
| 95987 | Primary Care Provider | Pediatric | 18 | 20 | 2/8/2021 |
| 95987 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95987 | Physical Medicine and Rehabilitation | Pediatric | 79 | 70 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95629 | Hospital | Not applicable | 17 | 20 | 2/8/2021 |
| 95629 | Pharmacy | Not applicable | 12 | 12 | 2/8/2021 |
| 95633 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 55 | 50 | 2/8/2021 |
| 95633 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95634 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 56 | 55 | 2/8/2021 |
| 95634 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 95634 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95634 | Primary Care Provider | Pediatric | 13 | 15 | 2/8/2021 |
| 95634 | Pharmacy | Not applicable | 78 | 53 | 2/8/2021 |
| 95636 | Hospital | Not applicable | 24 | 25 | 2/8/2021 |
| 95636 | Primary Care Provider | Adult | 21 | 20 | 2/8/2021 |
| 95664 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95664 | Primary Care Provider | Pediatric | 13 | 15 | 2/8/2021 |
| 95667 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 66 | 50 | 2/8/2021 |
| 95682 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 95684 | Hospital | Not applicable | 24 | 25 | 2/8/2021 |
| 95720 | HIV/AIDS Specialists/Infectious Diseases | Adult | 90 | 65 | 2/8/2021 |
| 95720 | Hospital | Not applicable | 29 | 30 | 2/8/2021 |
| 95720 | Primary Care Provider | Adult | 27 | 25 | 2/8/2021 |
| 95726 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 95735 | HIV/AIDS Specialists/Infectious Diseases | Adult | 95 | 65 | 2/8/2021 |
| 95735 | Primary Care Provider | Adult | 16 | 15 | 2/8/2021 |
| 95735 | Psychiatry | Pediatric | 63 | 58 | 2/8/2021 |
| 96150 | Psychiatry | Adult | 74 | 68 | 2/8/2021 |
| 96150 | Psychiatry | Pediatric | 74 | 68 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95920 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 95920 | Primary Care Provider | Adult | 19 | 20 | 2/8/2021 |
| 95920 | Primary Care Provider | Pediatric | 19 | 20 | 2/8/2021 |
| 95920 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95939 | Endocrinology | Pediatric | 157 | 98 | 2/8/2021 |
| 95939 | Hospital | Not applicable | 35 | 35 | 2/8/2021 |
| 95939 | Primary Care Provider | Adult | 35 | 35 | 2/8/2021 |
| 95939 | Primary Care Provider | Pediatric | 35 | 35 | 2/8/2021 |
| 95939 | Physical Medicine and Rehabilitation | Pediatric | 103 | 58 | 2/8/2021 |
| 95939 | Pulmonology | Pediatric | 69 | 65 | 2/8/2021 |
| 95943 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 95943 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 95943 | Primary Care Provider | Pediatric | 15 | 15 | 2/8/2021 |
| 95943 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95963 | Hospital | Not applicable | 27 | 25 | 2/8/2021 |
| 95963 | Physical Medicine and Rehabilitation | Pediatric | 135 | 121 | 2/8/2021 |
| 95970 | Hospital | Not applicable | 17 | 20 | 2/8/2021 |
| 95970 | Pharmacy | Not applicable | 37 | 34 | 2/8/2021 |
| 95970 | Physical Medicine and Rehabilitation | Pediatric | 99 | 87 | 2/8/2021 |
| 95988 | Physical Medicine and Rehabilitation | Pediatric | 77 | 75 | 2/8/2021 |
| 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 | Pediatric | 155 | 170 | 2/8/2021 |
| 92227 | ENT/Otolaryngology | Pediatric | 115 | 110 | 2/8/2021 |
| 92227 | Primary Care Provider | Adult | 14 | 15 | 2/8/2021 |
| 92227 | Primary Care Provider | Pediatric | 14 | 15 | 2/8/2021 |
| 92227 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 92231 | Endocrinology | Pediatric | 140 | 110 | 2/8/2021 |
| 92231 | Hematology | Pediatric | 128 | 120 | 2/8/2021 |
| 92231 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 92233 | Endocrinology | Pediatric | 150 | 147 | 2/8/2021 |
| 92233 | ENT/Otolaryngology | Pediatric | 95 | 80 | 2/8/2021 |
| 92233 | Hematology | Pediatric | 155 | 145 | 2/8/2021 |
| 92233 | Hospital | Not applicable | 26 | 25 | 2/8/2021 |
| 92233 | Primary Care Provider | Adult | 23 | 25 | 2/8/2021 |
| 92233 | Primary Care Provider | Pediatric | 23 | 25 | 2/8/2021 |
| 92233 | Pharmacy | Not applicable | 30 | 25 | 2/8/2021 |
| 92243 | Endocrinology | Pediatric | 130 | 100 | 2/8/2021 |
| 92243 | ENT/Otolaryngology | Pediatric | 105 | 90 | 2/8/2021 |
| 92249 | Endocrinology | Pediatric | 140 | 110 | 2/8/2021 |
| 92250 | Endocrinology | Pediatric | 145 | 115 | 2/8/2021 |
| 92250 | Hematology | Pediatric | 145 | 140 | 2/8/2021 |
| 92250 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 92250 | Primary Care Provider | Pediatric | 18 | 20 | 2/8/2021 |
| 92250 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 92251 | Endocrinology | Pediatric | 130 | 100 | 2/8/2021 |
| 92251 | ENT/Otolaryngology | Pediatric | 105 | 85 | 2/8/2021 |
| 92251 | Hematology | Pediatric | 119 | 126 | 2/8/2021 |
| 92251 | Physical Medicine and Rehabilitation | Pediatric | 163 | 127 | 2/8/2021 |
| 92257 | Hematology | Pediatric | 176 | 166 | 2/8/2021 |
| 92257 | Hospital | Not applicable | 50 | 45 | 2/8/2021 |
| 92257 | Primary Care Provider | Adult | 19 | 20 | 2/8/2021 |
| 92257 | Primary Care Provider | Pediatric | 19 | 20 | 2/8/2021 |
| 92257 | Physical Medicine and Rehabilitation | Pediatric | 183 | 150 | 2/8/2021 |
| 92274 | Endocrinology | Adult | 130 | 109 | 2/8/2021 |
| 92274 | Endocrinology | Pediatric | 130 | 109 | 2/8/2021 |
| 92274 | Hematology | Pediatric | 148 | 123 | 2/8/2021 |
| 92274 | Hospital | Not applicable | 60 | 55 | 2/8/2021 |
| 92274 | Primary Care Provider | Adult | 20 | 20 | 2/8/2021 |
| 92274 | Primary Care Provider | Pediatric | 20 | 20 | 2/8/2021 |
| 92274 | Physical Medicine and Rehabilitation | Pediatric | 151 | 125 | 2/8/2021 |
| 92281 | Endocrinology | Pediatric | 125 | 100 | 2/8/2021 |
| 92281 | ENT/Otolaryngology | Pediatric | 88 | 75 | 2/8/2021 |
| 92281 | Hematology | Pediatric | 110 | 90 | 2/8/2021 |
| 92281 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 92281 | Primary Care Provider | Pediatric | 20 | 20 | 2/8/2021 |
| 92281 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 92281 | Physical Medicine and Rehabilitation | Pediatric | 110 | 95 | 2/8/2021 |
| 92283 | Dermatology | Adult | 72 | 70 | 2/8/2021 |
| 92283 | Dermatology | Pediatric | 72 | 70 | 2/8/2021 |
| 92283 | Endocrinology | Pediatric | 220 | 185 | 2/8/2021 |
| 92283 | ENT/Otolaryngology | Adult | 71 | 70 | 2/8/2021 |
| 92283 | ENT/Otolaryngology | Pediatric | 230 | 177 | 2/8/2021 |
| 92283 | Gastroenterology | Adult | 182 | 96 | 2/8/2021 |
| 92283 | Gastroenterology | Pediatric | 69 | 65 | 2/8/2021 |
| 92283 | General Surgery | Adult | 69 | 65 | 2/8/2021 |
| 92283 | General Surgery | Pediatric | 69 | 65 | 2/8/2021 |
| 92283 | Hematology | Adult | 72 | 70 | 2/8/2021 |
| 92283 | Hematology | Pediatric | 131 | 89 | 2/8/2021 |
| 92283 | HIV/AIDS Specialists/Infectious Diseases | Adult | 69 | 65 | 2/8/2021 |
| 92283 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 152 | 99 | 2/8/2021 |
| 92283 | Hospital | Not applicable | 70 | 65 | 2/8/2021 |
| 92283 | Nephrology | Adult | 69 | 65 | 2/8/2021 |
| 92283 | Nephrology | Pediatric | 69 | 65 | 2/8/2021 |
| 92283 | Neurology | Adult | 70 | 65 | 2/8/2021 |
| 92283 | Neurology | Pediatric | 71 | 65 | 2/8/2021 |
| 92283 | OB/GYN | Not applicable | 131 | 88 | 2/8/2021 |
| 92283 | Oncology | Pediatric | 132 | 89 | 2/8/2021 |
| 92283 | Ophthalmology | Adult | 134 | 84 | 2/8/2021 |
| 92283 | Ophthalmology | Pediatric | 134 | 84 | 2/8/2021 |
| 92283 | Orthopedic Surgery | Adult | 69 | 65 | 2/8/2021 |
| 92283 | Orthopedic Surgery | Pediatric | 69 | 65 | 2/8/2021 |
| 92283 | Primary Care Provider | Pediatric | 21 | 20 | 2/8/2021 |
| 92283 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 92283 | Physical Medicine and Rehabilitation | Pediatric | 229 | 199 | 2/8/2021 |
| 92283 | Psychiatry | Pediatric | 72 | 66 | 2/8/2021 |
| 92283 | Pulmonology | Pediatric | 134 | 89 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 92328 | Dermatology | Adult | 280 | 199 | 2/8/2021 |
| 92328 | Dermatology | Pediatric | 280 | 199 | 2/8/2021 |
| 92328 | Endocrinology | Pediatric | 280 | 204 | 2/8/2021 |
| 92328 | Hematology | Pediatric | 250 | 247 | 2/8/2021 |
| 92328 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 149 | 141 | 2/8/2021 |
| 92328 | Ophthalmology | Pediatric | 197 | 172 | 2/8/2021 |
| 92328 | Orthopedic Surgery | Pediatric | 181 | 164 | 2/8/2021 |
| 92328 | Primary Care Provider | Pediatric | 186 | 153 | 2/8/2021 |
| 92328 | Psychiatry | Adult | 232 | 213 | 2/8/2021 |
| 93513 | Hospital | Not applicable | 50 | 50 | 2/8/2021 |
| 93513 | Neurology | Pediatric | 321 | 227 | 2/8/2021 |
| 93513 | Primary Care Provider | Adult | 50 | 50 | 2/8/2021 |
| 93513 | Primary Care Provider | Pediatric | 176 | 78 | 2/8/2021 |
| 93514 | Hospital | Not applicable | 35 | 35 | 2/8/2021 |
| 93514 | Nephrology | Adult | 344 | 268 | 2/8/2021 |
| 93514 | Nephrology | Pediatric | 328 | 265 | 2/8/2021 |
| 93514 | Neurology | Pediatric | 344 | 256 | 2/8/2021 |
| 93514 | Oncology | Pediatric | 299 | 254 | 2/8/2021 |
| 93514 | Primary Care Provider | Pediatric | 73 | 59 | 2/8/2021 |
| 93514 | Pharmacy | Not applicable | 84 | 61 | 2/8/2021 |
| 93514 | Physical Medicine and Rehabilitation | Pediatric | 328 | 265 | 2/8/2021 |
| 93514 | Pulmonology | Pediatric | 255 | 213 | 2/8/2021 |
| 93526 | Dermatology | Pediatric | 84 | 80 | 2/8/2021 |
| 93526 | Endocrinology | Pediatric | 84 | 80 | 2/8/2021 |
| 93526 | Gastroenterology | Adult | 84 | 80 | 2/8/2021 |
| 93526 | Gastroenterology | Pediatric | 84 | 80 | 2/8/2021 |
| 93526 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 236 | 171 | 2/8/2021 |
| 93526 | Nephrology | Pediatric | 299 | 263 | 2/8/2021 |
| 93526 | Ophthalmology | Adult | 222 | 84 | 2/8/2021 |
| 93526 | Ophthalmology | Pediatric | 222 | 84 | 2/8/2021 |
| 93526 | Orthopedic Surgery | Pediatric | 84 | 80 | 2/8/2021 |
| 93526 | Primary Care Provider | Adult | 65 | 60 | 2/8/2021 |
| 93526 | Primary Care Provider | Pediatric | 75 | 70 | 2/8/2021 |
| 93526 | Psychiatry | Adult | 159 | 146 | 2/8/2021 |
| 93527 | Dermatology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Dermatology | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | Endocrinology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Endocrinology | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | Gastroenterology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Gastroenterology | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | General Surgery | Adult | 89 | 80 | 2/8/2021 |
| 93527 | General Surgery | Pediatric | 89 | 85 | 2/8/2021 |
| 93527 | Nephrology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Nephrology | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | Neurology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Neurology | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | OB/GYN | Not applicable | 95 | 85 | 2/8/2021 |
| 93527 | Ophthalmology | Adult | 130 | 113 | 2/8/2021 |
| 93527 | Ophthalmology | Pediatric | 130 | 113 | 2/8/2021 |
| 93527 | Orthopedic Surgery | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Orthopedic Surgery | Pediatric | 95 | 80 | 2/8/2021 |
| 93527 | Pharmacy | Not applicable | 24 | 26 | 2/8/2021 |
| 93527 | Pulmonology | Adult | 95 | 80 | 2/8/2021 |
| 93527 | Pulmonology | Pediatric | 123 | 117 | 2/8/2021 |
| 93545 | Dermatology | Adult | 95 | 85 | 2/8/2021 |
| 93545 | Dermatology | Pediatric | 95 | 85 | 2/8/2021 |
| 93545 | Endocrinology | Pediatric | 95 | 85 | 2/8/2021 |
| 93545 | Gastroenterology | Adult | 95 | 85 | 2/8/2021 |
| 93545 | Gastroenterology | Pediatric | 95 | 85 | 2/8/2021 |
| 93545 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 69 | 65 | 2/8/2021 |
| 93545 | Nephrology | Pediatric | 175 | 171 | 2/8/2021 |
| 93545 | Oncology | Pediatric | 254 | 210 | 2/8/2021 |
| 93545 | Ophthalmology | Adult | 90 | 75 | 2/8/2021 |
| 93545 | Ophthalmology | Pediatric | 90 | 75 | 2/8/2021 |
| 93545 | Orthopedic Surgery | Adult | 95 | 85 | 2/8/2021 |
| 93545 | Orthopedic Surgery | Pediatric | 95 | 85 | 2/8/2021 |
| 93545 | Primary Care Provider | Adult | 28 | 30 | 2/8/2021 |
| 93545 | Primary Care Provider | Pediatric | 70 | 65 | 2/8/2021 |
| 93545 | Psychiatry | Adult | 157 | 144 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 93601 | Hospital | Not applicable | 20 | 20 | 2/8/2021 |
| 93601 | Oncology | Adult | 95 | 90 | 2/8/2021 |
| 93601 | Oncology | Pediatric | 95 | 90 | 2/8/2021 |
| 93601 | Ophthalmology | Adult | 62 | 47 | 2/8/2021 |
| 93601 | Ophthalmology | Pediatric | 62 | 47 | 2/8/2021 |
| 93601 | Primary Care Provider | Adult | 20 | 20 | 2/8/2021 |
| 93601 | Primary Care Provider | Pediatric | 20 | 20 | 2/8/2021 |
| 93601 | Pharmacy | Not applicable | 11 | 12 | 2/8/2021 |
| 93623 | Hospital | Not applicable | 23 | 25 | 2/8/2021 |
| 93623 | Oncology | Adult | 94 | 56 | 2/8/2021 |
| 93623 | Oncology | Pediatric | 94 | 57 | 2/8/2021 |
| 93623 | Ophthalmology | Adult | 96 | 60 | 2/8/2021 |
| 93623 | Ophthalmology | Pediatric | 96 | 61 | 2/8/2021 |
| 93623 | Primary Care Provider | Pediatric | 22 | 25 | 2/8/2021 |
| 93623 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 93653 | Pharmacy | Not applicable | 18 | 20 | 2/8/2021 |
| 95306 | Hospital | Not applicable | 22 | 20 | 2/8/2021 |
| 95306 | Primary Care Provider | Adult | 21 | 20 | 2/8/2021 |
| 95306 | Primary Care Provider | Pediatric | 26 | 25 | 2/8/2021 |
| 95306 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95311 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 204 | 114 | 2/8/2021 |
| 95311 | Oncology | Adult | 67 | 65 | 2/8/2021 |
| 95311 | Oncology | Pediatric | 67 | 65 | 2/8/2021 |
| 95311 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95311 | Primary Care Provider | Pediatric | 13 | 15 | 2/8/2021 |
| 95311 | Pharmacy | Not applicable | 30 | 20 | 2/8/2021 |
| 95321 | Hospital | Not applicable | 113 | 56 | 2/8/2021 |
| 95325 | Primary Care Provider | Adult | 16 | 15 | 2/8/2021 |
| 95325 | Primary Care Provider | Pediatric | 16 | 15 | 2/8/2021 |
| 95325 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95329 | Hospital | Not applicable | 28 | 30 | 2/8/2021 |
| 95329 | Pharmacy | Not applicable | 27 | 24 | 2/8/2021 |
| 95338 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 95338 | Oncology | Adult | 95 | 85 | 2/8/2021 |
| 95338 | Oncology | Pediatric | 95 | 85 | 2/8/2021 |
| 95338 | Ophthalmology | Adult | 90 | 70 | 2/8/2021 |
| 95338 | Ophthalmology | Pediatric | 90 | 70 | 2/8/2021 |
| 95338 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95338 | Primary Care Provider | Pediatric | 18 | 20 | 2/8/2021 |
| 95345 | Oncology | Adult | 79 | 75 | 2/8/2021 |
| 95345 | Oncology | Pediatric | 79 | 75 | 2/8/2021 |
| 95345 | Primary Care Provider | Adult | 12 | 15 | 2/8/2021 |
| 95345 | Primary Care Provider | Pediatric | 12 | 15 | 2/8/2021 |
| 95345 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95369 | HIV/AIDS Specialists/Infectious Diseases | Adult | 67 | 65 | 2/8/2021 |
| 95369 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 69 | 65 | 2/8/2021 |
| 95369 | Pharmacy | Not applicable | 21 | 23 | 2/8/2021 |
| 95389 | Hematology | Pediatric | 83 | 80 | 2/8/2021 |
| 95389 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 78 | 75 | 2/8/2021 |
| 95389 | Nephrology | Pediatric | 72 | 70 | 2/8/2021 |
| 95389 | Oncology | Adult | 88 | 85 | 2/8/2021 |
| 95389 | Oncology | Pediatric | 88 | 85 | 2/8/2021 |
| 95389 | Primary Care Provider | Adult | 23 | 25 | 2/8/2021 |
| 95389 | Primary Care Provider | Pediatric | 23 | 25 | 2/8/2021 |
| 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 | Pediatric | 198 | 171 | 2/8/2021 |
| 93512 | Hematology | Pediatric | 198 | 171 | 2/8/2021 |
| 93512 | Hospital | Not applicable | 45 | 40 | 2/8/2021 |
| 93512 | Nephrology | Adult | 285 | 245 | 2/8/2021 |
| 93512 | Nephrology | Pediatric | 256 | 252 | 2/8/2021 |
| 93512 | Neurology | Pediatric | 198 | 171 | 2/8/2021 |
| 93512 | Oncology | Pediatric | 198 | 171 | 2/8/2021 |
| 93512 | Primary Care Provider | Adult | 45 | 40 | 2/8/2021 |
| 93512 | Primary Care Provider | Pediatric | 45 | 40 | 2/8/2021 |
| 93512 | Physical Medicine and Rehabilitation | Pediatric | 198 | 171 | 2/8/2021 |
| 93512 | Pulmonology | Pediatric | 198 | 172 | 2/8/2021 |
| 93514 | Hospital | Not applicable | 35 | 35 | 2/8/2021 |
| 93514 | Pharmacy | Not applicable | 79 | 56 | 2/8/2021 |
| 93517 | Endocrinology | Pediatric | 121 | 105 | 2/8/2021 |
| 93517 | ENT/Otolaryngology | Pediatric | 150 | 118 | 2/8/2021 |
| 93517 | Gastroenterology | Pediatric | 120 | 105 | 2/8/2021 |
| 93517 | Hematology | Pediatric | 183 | 140 | 2/8/2021 |
| 93517 | HIV/AIDS Specialists/Infectious Diseases | Adult | 95 | 90 | 2/8/2021 |
| 93517 | Hospital | Not applicable | 60 | 55 | 2/8/2021 |
| 93517 | Neurology | Adult | 84 | 80 | 2/8/2021 |
| 93517 | Neurology | Pediatric | 95 | 85 | 2/8/2021 |
| 93517 | Oncology | Adult | 95 | 85 | 2/8/2021 |
| 93517 | Ophthalmology | Adult | 100 | 100 | 2/8/2021 |
| 93517 | Ophthalmology | Pediatric | 100 | 100 | 2/8/2021 |
| 93517 | Primary Care Provider | Pediatric | 60 | 55 | 2/8/2021 |
| 93517 | Physical Medicine and Rehabilitation | Pediatric | 150 | 118 | 2/8/2021 |
| 93517 | Psychiatry | Pediatric | 132 | 121 | 2/8/2021 |
| 93517 | Pulmonology | Pediatric | 185 | 138 | 2/8/2021 |
| 93546 | ENT/Otolaryngology | Adult | 240 | 156 | 2/8/2021 |
| 93546 | Hematology | Pediatric | 295 | 248 | 2/8/2021 |
| 93546 | Hospital | Not applicable | 21 | 20 | 2/8/2021 |
| 93546 | Nephrology | Adult | 381 | 351 | 2/8/2021 |
| 93546 | Oncology | Pediatric | 135 | 125 | 2/8/2021 |
| 93546 | Primary Care Provider | Adult | 21 | 20 | 2/8/2021 |
| 93546 | Primary Care Provider | Pediatric | 21 | 20 | 2/8/2021 |
| 93546 | Physical Medicine and Rehabilitation | Pediatric | 381 | 351 | 2/8/2021 |
| 93546 | Psychiatry | Pediatric | 168 | 154 | 2/8/2021 |
| 93546 | Pulmonology | Pediatric | 381 | 312 | 2/8/2021 |
| 96107 | Cardiology/Interventional Cardiology | Pediatric | 81 | 75 | 2/8/2021 |
| 96107 | Endocrinology | Pediatric | 141 | 107 | 2/8/2021 |
| 96107 | Hematology | Pediatric | 133 | 101 | 2/8/2021 |
| 96107 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 150 | 135 | 2/8/2021 |
| 96107 | Oncology | Pediatric | 133 | 101 | 2/8/2021 |
| 96107 | Ophthalmology | Adult | 145 | 128 | 2/8/2021 |
| 96107 | Ophthalmology | Pediatric | 145 | 128 | 2/8/2021 |
| 96107 | Primary Care Provider | Pediatric | 111 | 91 | 2/8/2021 |
| 96133 | Cardiology/Interventional Cardiology | Pediatric | 81 | 75 | 2/8/2021 |
| 96133 | Endocrinology | Pediatric | 145 | 130 | 2/8/2021 |
| 96133 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 172 | 146 | 2/8/2021 |
| 96133 | Hospital | Not applicable | 55 | 50 | 2/8/2021 |
| 96133 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 70 | 65 | 2/8/2021 |
| 96133 | Nephrology | Adult | 68 | 65 | 2/8/2021 |
| 96133 | Ophthalmology | Adult | 140 | 115 | 2/8/2021 |
| 96133 | Ophthalmology | Pediatric | 140 | 115 | 2/8/2021 |
| 96133 | Primary Care Provider | Pediatric | 35 | 35 | 2/8/2021 |
| 96133 | Pharmacy | Not applicable | 55 | 50 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95946 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95949 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 95959 | Endocrinology | Pediatric | 60 | 50 | 2/8/2021 |
| 95959 | Primary Care Provider | Adult | 13 | 15 | 2/8/2021 |
| 95959 | Primary Care Provider | Pediatric | 13 | 15 | 2/8/2021 |
| 95959 | Pharmacy | Not applicable | 77 | 43 | 2/8/2021 |
| 95960 | Endocrinology | Pediatric | 54 | 50 | 2/8/2021 |
| 95960 | Pharmacy | Not applicable | 30 | 15 | 2/8/2021 |
| 95977 | Hospital | Not applicable | 18 | 20 | 2/8/2021 |
| 95977 | Primary Care Provider | Adult | 15 | 15 | 2/8/2021 |
| 96161 | Endocrinology | Pediatric | 50 | 50 | 2/8/2021 |
| 96161 | HIV/AIDS Specialists/Infectious Diseases | Adult | 85 | 80 | 2/8/2021 |
| 96161 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 131 | 112 | 2/8/2021 |
| 96161 | Nephrology | Adult | 74 | 70 | 2/8/2021 |
| 96161 | Nephrology | Pediatric | 134 | 106 | 2/8/2021 |
| 96161 | Ophthalmology | Adult | 75 | 65 | 2/8/2021 |
| 96161 | Ophthalmology | Pediatric | 75 | 65 | 2/8/2021 |
| 96161 | Psychiatry | Adult | 93 | 83 | 2/8/2021 |
| 96161 | Psychiatry | Pediatric | 93 | 85 | 2/8/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95602 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 36 | 35 | 2/18/2021 |
| 95603 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 40 | 40 | 2/18/2021 |
| 95648 | Hospital | Not applicable | 22 | 20 | 2/18/2021 |
| 95648 | Primary Care Provider | Adult | 21 | 20 | 2/18/2021 |
| 95648 | Primary Care Provider | Pediatric | 79 | 37 | 2/18/2021 |
| 95650 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 42 | 35 | 2/18/2021 |
| 95668 | Hospital | Not applicable | 24 | 20 | 2/18/2021 |
| 95677 | Oncology | Pediatric | 45 | 40 | 2/18/2021 |
| 95678 | Oncology | Pediatric | 59 | 45 | 2/18/2021 |
| 95681 | Hospital | Not applicable | 20 | 20 | 2/18/2021 |
| 95681 | Oncology | Pediatric | 36 | 35 | 2/18/2021 |
| 95681 | Primary Care Provider | Adult | 18 | 20 | 2/18/2021 |
| 95681 | Primary Care Provider | Pediatric | 18 | 20 | 2/18/2021 |
| 95703 | Dermatology | Pediatric | 38 | 35 | 2/18/2021 |
| 95703 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 37 | 35 | 2/18/2021 |
| 95703 | Nephrology | Pediatric | 37 | 35 | 2/18/2021 |
| 95713 | Endocrinology | Adult | 44 | 45 | 2/18/2021 |
| 95713 | HIV/AIDS Specialists/Infectious Diseases | Adult | 39 | 40 | 2/18/2021 |
| 95713 | Hospital | Not applicable | 18 | 20 | 2/18/2021 |
| 95713 | Primary Care Provider | Adult | 12 | 15 | 2/18/2021 |
| 95722 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 35 | 35 | 2/18/2021 |
| 95722 | Nephrology | Pediatric | 35 | 35 | 2/18/2021 |
| 95746 | Oncology | Pediatric | 43 | 40 | 2/18/2021 |
| 95747 | Oncology | Pediatric | 53 | 45 | 2/18/2021 |
| 95765 | Oncology | Pediatric | 45 | 40 | 2/18/2021 |
| 96140 | Ophthalmology | Pediatric | 90 | 75 | 2/18/2021 |
| 96141 | Ophthalmology | Pediatric | 110 | 90 | 2/18/2021 |
| 96143 | Ophthalmology | Pediatric | 80 | 75 | 2/18/2021 |
| 96146 | Ophthalmology | Pediatric | 80 | 75 | 2/18/2021 |
| 96146 | Primary Care Provider | Adult | 13 | 15 | 2/18/2021 |
| 96148 | Ophthalmology | Pediatric | 80 | 70 | 2/18/2021 |
| 96161 | Dermatology | Pediatric | 98 | 60 | 2/18/2021 |
| 96161 | Endocrinology | Pediatric | 51 | 50 | 2/18/2021 |
| 96161 | ENT/Otolaryngology | Pediatric | 35 | 35 | 2/18/2021 |
| 96161 | Gastroenterology | Pediatric | 35 | 35 | 2/18/2021 |
| 96161 | HIV/AIDS Specialists/Infectious Diseases | Adult | 85 | 80 | 2/18/2021 |
| 96161 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 127 | 104 | 2/18/2021 |
| 96161 | Nephrology | Adult | 70 | 65 | 2/18/2021 |
| 96161 | Nephrology | Pediatric | 85 | 80 | 2/18/2021 |
| 96161 | Neurology | Adult | 97 | 59 | 2/18/2021 |
| 96161 | Neurology | Pediatric | 99 | 60 | 2/18/2021 |
| 96161 | Ophthalmology | Adult | 65 | 65 | 2/18/2021 |
| 96161 | Ophthalmology | Pediatric | 65 | 65 | 2/18/2021 |
| 96161 | Orthopedic Surgery | Adult | 35 | 35 | 2/18/2021 |
| 96161 | Orthopedic Surgery | Pediatric | 98 | 60 | 2/18/2021 |
| 96161 | Pharmacy | Not applicable | 19 | 17 | 2/18/2021 |
| 96161 | Physical Medicine and Rehabilitation | Pediatric | 98 | 60 | 2/18/2021 |
| 96161 | Pulmonology | Pediatric | 98 | 60 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95923 | Hospital | Not applicable | 20 | 20 | 2/18/2021 |
| 95923 | Primary Care Provider | Adult | 20 | 20 | 2/18/2021 |
| 95923 | Primary Care Provider | Pediatric | 20 | 20 | 2/18/2021 |
| 95923 | Pharmacy | Not applicable | 65 | 36 | 2/18/2021 |
| 95934 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 68 | 65 | 2/18/2021 |
| 95934 | Nephrology | Pediatric | 71 | 65 | 2/18/2021 |
| 95934 | Primary Care Provider | Adult | 16 | 15 | 2/18/2021 |
| 95934 | Primary Care Provider | Pediatric | 16 | 15 | 2/18/2021 |
| 95947 | Gastroenterology | Pediatric | 163 | 109 | 2/18/2021 |
| 95947 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 162 | 111 | 2/18/2021 |
| 95947 | Hospital | Not applicable | 26 | 25 | 2/18/2021 |
| 95947 | Nephrology | Pediatric | 162 | 111 | 2/18/2021 |
| 95947 | Primary Care Provider | Adult | 26 | 25 | 2/18/2021 |
| 95947 | Primary Care Provider | Pediatric | 91 | 54 | 2/18/2021 |
| 95947 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95947 | Pulmonology | Pediatric | 163 | 109 | 2/18/2021 |
| 95971 | Primary Care Provider | Pediatric | 14 | 15 | 2/18/2021 |
| 95971 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95983 | Gastroenterology | Adult | 72 | 70 | 2/18/2021 |
| 95983 | Gastroenterology | Pediatric | 197 | 116 | 2/18/2021 |
| 95983 | Hospital | Not applicable | 35 | 35 | 2/18/2021 |
| 95983 | Neurology | Adult | 214 | 110 | 2/18/2021 |
| 95983 | Neurology | Pediatric | 84 | 75 | 2/18/2021 |
| 95983 | Ophthalmology | Adult | 90 | 60 | 2/18/2021 |
| 95983 | Ophthalmology | Pediatric | 115 | 90 | 2/18/2021 |
| 95983 | Primary Care Provider | Adult | 151 | 59 | 2/18/2021 |
| 95983 | Primary Care Provider | Pediatric | 121 | 60 | 2/18/2021 |
| 95983 | Pharmacy | Not applicable | 137 | 48 | 2/18/2021 |
| 95983 | Pulmonology | Pediatric | 197 | 116 | 2/18/2021 |
| 96020 | Hematology | Pediatric | 73 | 65 | 2/18/2021 |
| 96020 | Hospital | Not applicable | 21 | 20 | 2/18/2021 |
| 96020 | Oncology | Pediatric | 72 | 65 | 2/18/2021 |
| 96020 | Primary Care Provider | Adult | 21 | 20 | 2/18/2021 |
| 96020 | Primary Care Provider | Pediatric | 21 | 20 | 2/18/2021 |
| 96020 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 96020 | Physical Medicine and Rehabilitation | Pediatric | 84 | 80 | 2/18/2021 |
| 96103 | Hospital | Not applicable | 19 | 20 | 2/18/2021 |
| 96103 | Nephrology | Pediatric | 186 | 140 | 2/18/2021 |
| 96103 | Neurology | Pediatric | 67 | 65 | 2/18/2021 |
| 96103 | Primary Care Provider | Adult | 18 | 20 | 2/18/2021 |
| 96103 | Primary Care Provider | Pediatric | 18 | 20 | 2/18/2021 |
| 96103 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 96105 | Gastroenterology | Pediatric | 170 | 114 | 2/18/2021 |
| 96105 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 168 | 142 | 2/18/2021 |
| 96105 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 96105 | Nephrology | Pediatric | 204 | 133 | 2/18/2021 |
| 96105 | Ophthalmology | Adult | 115 | 120 | 2/18/2021 |
| 96105 | Ophthalmology | Pediatric | 115 | 120 | 2/18/2021 |
| 96105 | Primary Care Provider | Adult | 23 | 25 | 2/18/2021 |
| 96105 | Primary Care Provider | Pediatric | 23 | 25 | 2/18/2021 |
| 96105 | Pharmacy | Not applicable | 30 | 25 | 2/18/2021 |
| 96105 | Pulmonology | Pediatric | 170 | 114 | 2/18/2021 |
| 96122 | Gastroenterology | Pediatric | 140 | 103 | 2/18/2021 |
| 96122 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 150 | 100 | 2/18/2021 |
| 96122 | Nephrology | Pediatric | 150 | 100 | 2/18/2021 |
| 96122 | Neurology | Pediatric | 147 | 116 | 2/18/2021 |
| 96122 | Ophthalmology | Adult | 130 | 115 | 2/18/2021 |
| 96122 | Ophthalmology | Pediatric | 130 | 115 | 2/18/2021 |
| 96122 | Pulmonology | Pediatric | 144 | 96 | 2/18/2021 |
| 96129 | Gastroenterology | Pediatric | 140 | 100 | 2/18/2021 |
| 96129 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 149 | 109 | 2/18/2021 |
| 96129 | Nephrology | Pediatric | 144 | 115 | 2/18/2021 |
| 96129 | Neurology | Adult | 73 | 70 | 2/18/2021 |
| 96129 | Neurology | Pediatric | 76 | 75 | 2/18/2021 |
| 96129 | Ophthalmology | Adult | 115 | 105 | 2/18/2021 |
| 96129 | Ophthalmology | Pediatric | 115 | 105 | 2/18/2021 |
| 96129 | Psychiatry | Adult | 89 | 82 | 2/18/2021 |
| 96129 | Psychiatry | Pediatric | 89 | 82 | 2/18/2021 |
| 96129 | Pulmonology | Pediatric | 150 | 102 | 2/18/2021 |
| 96137 | Pharmacy | Not applicable | 76 | 57 | 2/18/2021 |
| 96137 | Psychiatry | Adult | 69 | 64 | 2/18/2021 |
| 96137 | Psychiatry | Pediatric | 69 | 64 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95910 | Pharmacy | Not applicable | 35 | 30 | 2/18/2021 |
| 95922 | Primary Care Provider | Adult | 13 | 15 | 2/18/2021 |
| 95922 | Primary Care Provider | Pediatric | 66 | 38 | 2/18/2021 |
| 95922 | Pharmacy | Not applicable | 53 | 49 | 2/18/2021 |
| 95960 | Hospital | Not applicable | 21 | 20 | 2/18/2021 |
| 95960 | Pharmacy | Not applicable | 42 | 38 | 2/18/2021 |
| 96118 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 153 | 140 | 2/18/2021 |
| 96118 | Hospital | Not applicable | 35 | 30 | 2/18/2021 |
| 96118 | Nephrology | Pediatric | 155 | 141 | 2/18/2021 |
| 96118 | Ophthalmology | Adult | 115 | 100 | 2/18/2021 |
| 96118 | Ophthalmology | Pediatric | 115 | 100 | 2/18/2021 |
| 96118 | Primary Care Provider | Adult | 35 | 35 | 2/18/2021 |
| 96118 | Primary Care Provider | Pediatric | 35 | 35 | 2/18/2021 |
| 96124 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 160 | 100 | 2/18/2021 |
| 96124 | Hospital | Not applicable | 27 | 25 | 2/18/2021 |
| 96124 | Nephrology | Pediatric | 156 | 100 | 2/18/2021 |
| 96124 | Neurology | Adult | 68 | 65 | 2/18/2021 |
| 96124 | Neurology | Pediatric | 68 | 65 | 2/18/2021 |
| 96124 | Primary Care Provider | Adult | 25 | 25 | 2/18/2021 |
| 96124 | Primary Care Provider | Pediatric | 25 | 25 | 2/18/2021 |
| 96124 | Pharmacy | Not applicable | 30 | 25 | 2/18/2021 |
| 96124 | Psychiatry | Adult | 85 | 78 | 2/18/2021 |
| 96124 | Psychiatry | Pediatric | 85 | 76 | 2/18/2021 |
| 96125 | Hospital | Not applicable | 35 | 35 | 2/18/2021 |
| 96125 | Primary Care Provider | Adult | 17 | 20 | 2/18/2021 |
| 96125 | Primary Care Provider | Pediatric | 17 | 20 | 2/18/2021 |
| 96125 | Pharmacy | Not applicable | 35 | 30 | 2/18/2021 |
| 96126 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 88 | 85 | 2/18/2021 |
| 96126 | Hospital | Not applicable | 35 | 30 | 2/18/2021 |
| 96126 | Nephrology | Adult | 142 | 132 | 2/18/2021 |
| 96126 | Nephrology | Pediatric | 142 | 132 | 2/18/2021 |
| 96126 | Ophthalmology | Adult | 135 | 95 | 2/18/2021 |
| 96126 | Ophthalmology | Pediatric | 135 | 95 | 2/18/2021 |
| 96126 | Primary Care Provider | Adult | 35 | 30 | 2/18/2021 |
| 96126 | Primary Care Provider | Pediatric | 35 | 30 | 2/18/2021 |
| 96126 | Pharmacy | Not applicable | 30 | 30 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95626 | Oncology | Pediatric | 54 | 50 | 2/18/2021 |
| 95645 | Hospital | Not applicable | 24 | 25 | 2/18/2021 |
| 95645 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95659 | Hospital | Not applicable | 25 | 25 | 2/18/2021 |
| 95659 | Oncology | Pediatric | 55 | 55 | 2/18/2021 |
| 95659 | Primary Care Provider | Adult | 20 | 20 | 2/18/2021 |
| 95659 | Primary Care Provider | Pediatric | 20 | 20 | 2/18/2021 |
| 95659 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95668 | Hospital | Not applicable | 25 | 25 | 2/18/2021 |
| 95668 | Oncology | Pediatric | 54 | 50 | 2/18/2021 |
| 95668 | Primary Care Provider | Adult | 20 | 20 | 2/18/2021 |
| 95668 | Primary Care Provider | Pediatric | 20 | 20 | 2/18/2021 |
| 95668 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95674 | Primary Care Provider | Adult | 19 | 20 | 2/18/2021 |
| 95674 | Primary Care Provider | Pediatric | 19 | 20 | 2/18/2021 |
| 95674 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95692 | Hospital | Not applicable | 17 | 20 | 2/18/2021 |
| 95692 | Pharmacy | Not applicable | 17 | 16 | 2/18/2021 |
| 95836 | Hospital | Not applicable | 19 | 20 | 2/18/2021 |
| 95837 | Hospital | Not applicable | 19 | 20 | 2/18/2021 |
| 95837 | Oncology | Pediatric | 58 | 55 | 2/18/2021 |
| 95837 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95953 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95957 | Endocrinology | Pediatric | 58 | 50 | 2/18/2021 |
| 95957 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 95957 | Primary Care Provider | Adult | 20 | 20 | 2/18/2021 |
| 95957 | Primary Care Provider | Pediatric | 20 | 20 | 2/18/2021 |
| 95957 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95957 | Physical Medicine and Rehabilitation | Pediatric | 54 | 50 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95942 | Hospital | Not applicable | 35 | 35 | 2/18/2021 |
| 95942 | Pharmacy | Not applicable | 65 | 55 | 2/18/2021 |
| 95963 | Hospital | Not applicable | 110 | 68 | 2/18/2021 |
| 95963 | Pharmacy | Not applicable | 70 | 64 | 2/18/2021 |
| 95973 | Pharmacy | Not applicable | 47 | 24 | 2/18/2021 |
| 96021 | Hospital | Not applicable | 24 | 25 | 2/18/2021 |
| 96021 | Primary Care Provider | Adult | 12 | 15 | 2/18/2021 |
| 96021 | Primary Care Provider | Pediatric | 112 | 61 | 2/18/2021 |
| 96021 | Pharmacy | Not applicable | 117 | 64 | 2/18/2021 |
| 96021 | Physical Medicine and Rehabilitation | Pediatric | 166 | 126 | 2/18/2021 |
| 96022 | Hospital | Not applicable | 54 | 46 | 2/18/2021 |
| 96022 | Pharmacy | Not applicable | 14 | 16 | 2/18/2021 |
| 96022 | Physical Medicine and Rehabilitation | Pediatric | 196 | 175 | 2/18/2021 |
| 96029 | Hospital | Not applicable | 28 | 30 | 2/18/2021 |
| 96029 | Primary Care Provider | Adult | 15 | 15 | 2/18/2021 |
| 96029 | Primary Care Provider | Pediatric | 15 | 15 | 2/18/2021 |
| 96029 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 96035 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 96035 | Physical Medicine and Rehabilitation | Pediatric | 172 | 145 | 2/18/2021 |
| 96055 | Hospital | Not applicable | 18 | 20 | 2/18/2021 |
| 96055 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 96055 | Physical Medicine and Rehabilitation | Pediatric | 162 | 134 | 2/18/2021 |
| 96059 | Hospital | Not applicable | 40 | 35 | 2/18/2021 |
| 96059 | Primary Care Provider | Adult | 35 | 30 | 2/18/2021 |
| 96059 | Primary Care Provider | Pediatric | 35 | 30 | 2/18/2021 |
| 96059 | Pharmacy | Not applicable | 30 | 25 | 2/18/2021 |
| 96059 | Physical Medicine and Rehabilitation | Pediatric | 173 | 142 | 2/18/2021 |
| 96061 | Hospital | Not applicable | 35 | 30 | 2/18/2021 |
| 96061 | Primary Care Provider | Adult | 35 | 30 | 2/18/2021 |
| 96061 | Primary Care Provider | Pediatric | 35 | 30 | 2/18/2021 |
| 96061 | Pharmacy | Not applicable | 30 | 30 | 2/18/2021 |
| 96061 | Physical Medicine and Rehabilitation | Pediatric | 152 | 111 | 2/18/2021 |
| 96075 | Hospital | Not applicable | 40 | 35 | 2/18/2021 |
| 96075 | Primary Care Provider | Adult | 35 | 30 | 2/18/2021 |
| 96075 | Primary Care Provider | Pediatric | 35 | 30 | 2/18/2021 |
| 96075 | Physical Medicine and Rehabilitation | Pediatric | 105 | 95 | 2/18/2021 |
| 96076 | Hematology | Pediatric | 169 | 110 | 2/18/2021 |
| 96076 | Hospital | Not applicable | 45 | 45 | 2/18/2021 |
| 96076 | Physical Medicine and Rehabilitation | Pediatric | 244 | 187 | 2/18/2021 |
| 96080 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 96080 | Primary Care Provider | Adult | 20 | 20 | 2/18/2021 |
| 96080 | Primary Care Provider | Pediatric | 20 | 20 | 2/18/2021 |
| 96080 | Pharmacy | Not applicable | 112 | 84 | 2/18/2021 |
| 96080 | Physical Medicine and Rehabilitation | Pediatric | 185 | 145 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95310 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 100 | 80 | 2/18/2021 |
| 95311 | Hospital | Not applicable | 111 | 58 | 2/18/2021 |
| 95311 | Pharmacy | Not applicable | 19 | 18 | 2/18/2021 |
| 95321 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 209 | 140 | 2/18/2021 |
| 95321 | Primary Care Provider | Adult | 93 | 46 | 2/18/2021 |
| 95321 | Primary Care Provider | Pediatric | 93 | 46 | 2/18/2021 |
| 95321 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95327 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 95 | 85 | 2/18/2021 |
| 95327 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 95327 | Primary Care Provider | Adult | 13 | 15 | 2/18/2021 |
| 95327 | Primary Care Provider | Pediatric | 13 | 15 | 2/18/2021 |
| 95327 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95329 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 82 | 80 | 2/18/2021 |
| 95329 | Hospital | Not applicable | 28 | 30 | 2/18/2021 |
| 95329 | Pharmacy | Not applicable | 30 | 25 | 2/18/2021 |
| 95335 | Cardiology/Interventional Cardiology | Pediatric | 78 | 75 | 2/18/2021 |
| 95335 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 152 | 132 | 2/18/2021 |
| 95335 | Primary Care Provider | Pediatric | 40 | 35 | 2/18/2021 |
| 95335 | Pharmacy | Not applicable | 40 | 35 | 2/18/2021 |
| 95346 | Cardiology/Interventional Cardiology | Pediatric | 78 | 70 | 2/18/2021 |
| 95346 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 240 | 134 | 2/18/2021 |
| 95346 | Hospital | Not applicable | 30 | 30 | 2/18/2021 |
| 95346 | Primary Care Provider | Adult | 25 | 25 | 2/18/2021 |
| 95346 | Primary Care Provider | Pediatric | 25 | 25 | 2/18/2021 |
| 95346 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95364 | Cardiology/Interventional Cardiology | Pediatric | 75 | 70 | 2/18/2021 |
| 95364 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 234 | 165 | 2/18/2021 |
| 95364 | Primary Care Provider | Adult | 40 | 40 | 2/18/2021 |
| 95364 | Primary Care Provider | Pediatric | 40 | 35 | 2/18/2021 |
| 95364 | Pharmacy | Not applicable | 40 | 40 | 2/18/2021 |
| 95370 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 100 | 85 | 2/18/2021 |
| 95379 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 135 | 115 | 2/18/2021 |
| 95383 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 136 | 118 | 2/18/2021 |
| ZIP Code | Access Type | Category Type (Pediatric or Adults, Not Applicable) | Approved Alternative Access Standard (Minutes) |
Approved Alternative Access Standard (Miles) |
Approval Date |
|---|---|---|---|---|---|
| 95692 | Primary Care Provider | Adult | 16 | 15 | 2/18/2021 |
| 95692 | Primary Care Provider | Pediatric | 12 | 15 | 2/18/2021 |
| 95692 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95901 | Hospital | Not applicable | 20 | 20 | 2/18/2021 |
| 95901 | Primary Care Provider | Pediatric | 14 | 15 | 2/18/2021 |
| 95901 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95903 | Hospital | Not applicable | 18 | 20 | 2/18/2021 |
| 95903 | Primary Care Provider | Adult | 13 | 15 | 2/18/2021 |
| 95903 | Primary Care Provider | Pediatric | 13 | 15 | 2/18/2021 |
| 95903 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95914 | Hospital | Not applicable | 18 | 20 | 2/18/2021 |
| 95914 | Pharmacy | Not applicable | 32 | 29 | 2/18/2021 |
| 95918 | Hospital | Not applicable | 22 | 25 | 2/18/2021 |
| 95918 | Primary Care Provider | Adult | 15 | 15 | 2/18/2021 |
| 95918 | Primary Care Provider | Pediatric | 15 | 15 | 2/18/2021 |
| 95918 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95919 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 95919 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95922 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95925 | Hospital | Not applicable | 24 | 25 | 2/18/2021 |
| 95925 | Pharmacy | Not applicable | 30 | 25 | 2/18/2021 |
| 95935 | Endocrinology | Pediatric | 50 | 50 | 2/18/2021 |
| 95935 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 95935 | Pharmacy | Not applicable | 30 | 15 | 2/18/2021 |
| 95941 | Hospital | Not applicable | 17 | 20 | 2/18/2021 |
| 95941 | Pharmacy | Not applicable | 39 | 36 | 2/18/2021 |
| 95960 | Hospital | Not applicable | 17 | 20 | 2/18/2021 |
| 95960 | Pharmacy | Not applicable | 39 | 36 | 2/18/2021 |
| 95962 | Hospital | Not applicable | 23 | 25 | 2/18/2021 |
| 95962 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95966 | Pharmacy | Not applicable | 38 | 34 | 2/18/2021 |
| 95972 | Hospital | Not applicable | 21 | 20 | 2/18/2021 |
| 95972 | Pharmacy | Not applicable | 30 | 20 | 2/18/2021 |
| 95977 | Hospital | Not applicable | 18 | 20 | 2/18/2021 |
| 95977 | Pharmacy | Not applicable | 22 | 20 | 2/18/2021 |
| 95981 | Hospital | Not applicable | 28 | 30 | 2/18/2021 |
| 95981 | Primary Care Provider | Pediatric | 109 | 68 | 2/18/2021 |
| 95981 | Pharmacy | Not applicable | 30 | 30 | 2/18/2021 |