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 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/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 |