Time and Distance to Care
| Provider Type | Time and Distance to Care from member's residence |
|---|---|
| Primary Care (Adult and Pediatric) | 10 miles or 30 minutes |
| Specialty Care and Mental Health (non-psychiatry) Outpatient Service (Adult and Pediatric) | Los Angeles and Sacramento Counties: 15 miles or 30 minutes San Joaquin & Stanislaus Counties: 30 miles or 60 minutes Tulare County: 45 miles or 75 minutes |
| Hospitals | 15 miles or 30 minutes |
DHCS Adult and Pediatric Core Specialists
- Cardiology/Interventional Cardiology
- Dermatology
- Endocrinology
- ENT/Otolaryngology
- Gastroenterology
- General Surgery
- Hematology
- HIV/AIDS Specialists/Infectious Diseases
- Mental Health (non-Psychiatry) Outpatient Services
- Nephrology
- Neurology
- Obstetrics/Gynecology (OB/GYN) - Adult
- Oncology
- Ophthalmology
- Orthopedic Surgery
- Physical Medicine and Rehabilitation
- Psychiatry
- Pulmonology
If neither your Participating Physician Group (PPG) nor Health Net Community Solutions (HNCS) can provide services within the travel standards indicated, an alternate access standard may be in place for that zip code. If your zip code and provider type are listed, HNCS must help you find an appointment. HNCS Members can call toll free 1-800-675-6110 (TTY: 711), 24 hours a day, 7 days a week to get help with finding an appointment to a closer specialist. If HNCS cannot find you an appointment with a closer specialist, HNCS will arrange transportation to see the specialist. Find Alternate Access standards for where you live below.
Health Net Community Solutions –
DHCS 2023 Annual Network Certification
Alternate Access Standards Determination
Select a county below to see the 2023 alternate access travel time and distance standards
| Zip Code | Provider Type | Pediatric, Adult or N/A | County Size Standards Minutes | County Size Standards Miles | DHCS Determination Minutes | DHCS Determination Miles | DHCS Rationale |
|---|---|---|---|---|---|---|---|
| 90265 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 50 | 30 | Approved |
| 90272 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 50 | 35 | Approved |
| 91390 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 40 | 25 | Approved |
| 93560 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93591 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 45 | 30 | Approved |
| 90265 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 50 | 30 | Approved |
| 90272 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91384 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91390 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 93560 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93591 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 90265 | Dermatology | Adult | 15 | 30 | 50 | 30 | Approved |
| 90272 | Dermatology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Dermatology | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Dermatology | Adult | 15 | 30 | 40 | 25 | Approved |
| 91390 | Dermatology | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Dermatology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Dermatology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Dermatology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Dermatology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Dermatology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Dermatology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | Dermatology | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | Dermatology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93560 | Dermatology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Dermatology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93591 | Dermatology | Adult | 15 | 30 | 40 | 35 | Approved |
| 90265 | Dermatology | Pediatric | 15 | 30 | 50 | 30 | Approved |
| 90272 | Dermatology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Dermatology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Dermatology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 91390 | Dermatology | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Dermatology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Dermatology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Dermatology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Dermatology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Dermatology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Dermatology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | Dermatology | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | Dermatology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93560 | Dermatology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Dermatology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93591 | Dermatology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 90265 | Endocrinology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90272 | Endocrinology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Endocrinology | Adult | 15 | 30 | 55 | 40 | Approved |
| 91042 | Endocrinology | Adult | 15 | 30 | 35 | 20 | Approved |
| 91390 | Endocrinology | Adult | 15 | 30 | 70 | 30 | Approved |
| 91702 | Endocrinology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Endocrinology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Endocrinology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93532 | Endocrinology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Endocrinology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93536 | Endocrinology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Endocrinology | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | Endocrinology | Adult | 15 | 30 | 70 | 50 | Approved |
| 93553 | Endocrinology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93560 | Endocrinology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Endocrinology | Adult | 15 | 30 | 60 | 45 | Approved |
| 93591 | Endocrinology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90265 | Endocrinology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90272 | Endocrinology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Endocrinology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Endocrinology | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91390 | Endocrinology | Pediatric | 15 | 30 | 70 | 30 | Approved |
| 91702 | Endocrinology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Endocrinology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Endocrinology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93532 | Endocrinology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Endocrinology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93536 | Endocrinology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Endocrinology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 93544 | Endocrinology | Pediatric | 15 | 30 | 70 | 50 | Approved |
| 93553 | Endocrinology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93560 | Endocrinology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Endocrinology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 93591 | Endocrinology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90265 | ENT/Otolaryngology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90272 | ENT/Otolaryngology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | ENT/Otolaryngology | Adult | 15 | 30 | 40 | 30 | Approved |
| 91042 | ENT/Otolaryngology | Adult | 15 | 30 | 45 | 20 | Approved |
| 91390 | ENT/Otolaryngology | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | ENT/Otolaryngology | Adult | 15 | 30 | 50 | 25 | Approved |
| 93243 | ENT/Otolaryngology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | ENT/Otolaryngology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | ENT/Otolaryngology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | ENT/Otolaryngology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | ENT/Otolaryngology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | ENT/Otolaryngology | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | ENT/Otolaryngology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93560 | ENT/Otolaryngology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | ENT/Otolaryngology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93591 | ENT/Otolaryngology | Adult | 15 | 30 | 45 | 30 | Approved |
| 90265 | ENT/Otolaryngology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90272 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91042 | ENT/Otolaryngology | Pediatric | 15 | 30 | 45 | 20 | Approved |
| 91390 | ENT/Otolaryngology | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | ENT/Otolaryngology | Pediatric | 15 | 30 | 50 | 25 | Approved |
| 93243 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | ENT/Otolaryngology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | ENT/Otolaryngology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | ENT/Otolaryngology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | ENT/Otolaryngology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | ENT/Otolaryngology | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93551 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 93553 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93560 | ENT/Otolaryngology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | ENT/Otolaryngology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93591 | ENT/Otolaryngology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90265 | Gastroenterology | Adult | 15 | 30 | 45 | 35 | Approved |
| 90704 | Gastroenterology | Adult | 15 | 30 | 40 | 30 | Approved |
| 91384 | Gastroenterology | Adult | 15 | 30 | 35 | 25 | Approved |
| 91390 | Gastroenterology | Adult | 15 | 30 | 75 | 30 | Approved |
| 91702 | Gastroenterology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Gastroenterology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Gastroenterology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93532 | Gastroenterology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | Gastroenterology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93536 | Gastroenterology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Gastroenterology | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | Gastroenterology | Adult | 15 | 30 | 70 | 50 | Approved |
| 93553 | Gastroenterology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93560 | Gastroenterology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Gastroenterology | Adult | 15 | 30 | 60 | 45 | Approved |
| 93591 | Gastroenterology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90265 | Gastroenterology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90704 | Gastroenterology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91384 | Gastroenterology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 91390 | Gastroenterology | Pediatric | 15 | 30 | 75 | 30 | Approved |
| 91702 | Gastroenterology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Gastroenterology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Gastroenterology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93532 | Gastroenterology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | Gastroenterology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Gastroenterology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Gastroenterology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 93544 | Gastroenterology | Pediatric | 15 | 30 | 70 | 50 | Approved |
| 93553 | Gastroenterology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 93560 | Gastroenterology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Gastroenterology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 93591 | Gastroenterology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90265 | General Surgery | Adult | 15 | 30 | 50 | 35 | Approved |
| 90704 | General Surgery | Adult | 15 | 30 | 40 | 30 | Approved |
| 91390 | General Surgery | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | General Surgery | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | General Surgery | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | General Surgery | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | General Surgery | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | General Surgery | Adult | 15 | 30 | 45 | 40 | Approved |
| 93544 | General Surgery | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | General Surgery | Adult | 15 | 30 | 40 | 25 | Approved |
| 93560 | General Surgery | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | General Surgery | Adult | 15 | 30 | 55 | 35 | Approved |
| 93591 | General Surgery | Adult | 15 | 30 | 45 | 30 | Approved |
| 90265 | General Surgery | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90704 | General Surgery | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91390 | General Surgery | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | General Surgery | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | General Surgery | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | General Surgery | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | General Surgery | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | General Surgery | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93544 | General Surgery | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | General Surgery | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 93560 | General Surgery | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | General Surgery | Pediatric | 15 | 30 | 55 | 35 | Approved |
| 93591 | General Surgery | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90265 | Hematology | Adult | 15 | 30 | 45 | 35 | Approved |
| 90704 | Hematology | Adult | 15 | 30 | 40 | 30 | Approved |
| 91042 | Hematology | Adult | 15 | 30 | 45 | 20 | Approved |
| 91390 | Hematology | Adult | 15 | 30 | 75 | 30 | Approved |
| 91702 | Hematology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Hematology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Hematology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93532 | Hematology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | Hematology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93536 | Hematology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Hematology | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | Hematology | Adult | 15 | 30 | 70 | 50 | Approved |
| 93553 | Hematology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93560 | Hematology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Hematology | Adult | 15 | 30 | 60 | 45 | Approved |
| 93591 | Hematology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90265 | Hematology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90704 | Hematology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91042 | Hematology | Pediatric | 15 | 30 | 45 | 20 | Approved |
| 91390 | Hematology | Pediatric | 15 | 30 | 75 | 30 | Approved |
| 91702 | Hematology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Hematology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Hematology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93532 | Hematology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | Hematology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Hematology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Hematology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 93544 | Hematology | Pediatric | 15 | 30 | 70 | 50 | Approved |
| 93553 | Hematology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 93560 | Hematology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Hematology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 93591 | Hematology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90265 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 35 | Approved |
| 90272 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 25 | Approved |
| 91390 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 75 | 30 | Approved |
| 91702 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 50 | 25 | Approved |
| 93243 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 30 | Approved |
| 93532 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 35 | Approved |
| 93536 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 70 | 45 | Approved |
| 93551 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 25 | Approved |
| 93553 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 30 | Approved |
| 93560 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 60 | 40 | Approved |
| 93591 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 35 | Approved |
| 90265 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90272 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 91390 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 75 | 30 | Approved |
| 91702 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 50 | 25 | Approved |
| 93243 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93532 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 93544 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 70 | 45 | Approved |
| 93551 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93553 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 93560 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 93563 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 93591 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90265 | Hospital | n/a | 15 | 30 | 50 | 30 | Approved |
| 91042 | Hospital | n/a | 15 | 30 | 35 | 20 | Approved |
| 91384 | Hospital | n/a | 15 | 30 | 60 | 30 | Approved |
| 91702 | Hospital | n/a | 15 | 30 | 45 | 25 | Approved |
| 93243 | Hospital | n/a | 15 | 30 | 45 | 50 | Approved |
| 93532 | Hospital | n/a | 15 | 30 | 55 | 45 | Approved |
| 93535 | Hospital | n/a | 15 | 30 | 55 | 35 | Approved |
| 93536 | Hospital | n/a | 15 | 30 | 45 | 40 | Approved |
| 93544 | Hospital | n/a | 15 | 30 | 50 | 30 | Approved |
| 93560 | Hospital | n/a | 15 | 30 | 55 | 40 | Approved |
| 93563 | Hospital | n/a | 15 | 30 | 45 | 35 | Approved |
| 93591 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 91390 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 60 | 25 | Approved |
| 91702 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 45 | 25 | Approved |
| 93532 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 40 | 20 | Approved |
| 93535 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 55 | 35 | Approved |
| 93563 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 45 | 30 | Approved |
| 91390 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 60 | 25 | Approved |
| 91702 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93532 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 93535 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 93544 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 55 | 35 | Approved |
| 93563 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90265 | Nephrology | Adult | 15 | 30 | 45 | 35 | Approved |
| 90272 | Nephrology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Nephrology | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Nephrology | Adult | 15 | 30 | 40 | 20 | Approved |
| 91390 | Nephrology | Adult | 15 | 30 | 65 | 30 | Approved |
| 91702 | Nephrology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Nephrology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Nephrology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93532 | Nephrology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | Nephrology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Nephrology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Nephrology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93544 | Nephrology | Adult | 15 | 30 | 65 | 45 | Approved |
| 93553 | Nephrology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93560 | Nephrology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Nephrology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93591 | Nephrology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90265 | Nephrology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90272 | Nephrology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Nephrology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Nephrology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 91390 | Nephrology | Pediatric | 15 | 30 | 65 | 30 | Approved |
| 91702 | Nephrology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Nephrology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Nephrology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93532 | Nephrology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | Nephrology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Nephrology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Nephrology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93544 | Nephrology | Pediatric | 15 | 30 | 65 | 45 | Approved |
| 93553 | Nephrology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93560 | Nephrology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Nephrology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93591 | Nephrology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90265 | Neurology | Adult | 15 | 30 | 40 | 25 | Approved |
| 90272 | Neurology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Neurology | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Neurology | Adult | 15 | 30 | 35 | 20 | Approved |
| 91390 | Neurology | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Neurology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Neurology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Neurology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Neurology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Neurology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93544 | Neurology | Adult | 15 | 30 | 45 | 30 | Approved |
| 93560 | Neurology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93591 | Neurology | Adult | 15 | 30 | 40 | 25 | Approved |
| 90265 | Neurology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 90272 | Neurology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Neurology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Neurology | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91390 | Neurology | Pediatric | 15 | 30 | 70 | 30 | Approved |
| 91702 | Neurology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Neurology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Neurology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Neurology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Neurology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93544 | Neurology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 93560 | Neurology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93591 | Neurology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 90265 | OB/GYN | n/a | 15 | 30 | 45 | 30 | Approved |
| 90704 | OB/GYN | n/a | 15 | 30 | 40 | 30 | Approved |
| 91390 | OB/GYN | n/a | 15 | 30 | 65 | 25 | Approved |
| 91702 | OB/GYN | n/a | 15 | 30 | 40 | 20 | Approved |
| 93243 | OB/GYN | n/a | 15 | 30 | 40 | 40 | Approved |
| 93532 | OB/GYN | n/a | 15 | 30 | 45 | 40 | Approved |
| 93535 | OB/GYN | n/a | 15 | 30 | 50 | 35 | Approved |
| 93536 | OB/GYN | n/a | 15 | 30 | 45 | 35 | Approved |
| 93544 | OB/GYN | n/a | 15 | 30 | 60 | 35 | Approved |
| 93553 | OB/GYN | n/a | 15 | 30 | 35 | 25 | Approved |
| 93560 | OB/GYN | n/a | 15 | 30 | 55 | 35 | Approved |
| 93563 | OB/GYN | n/a | 15 | 30 | 45 | 35 | Approved |
| 90265 | Oncology | Adult | 15 | 30 | 45 | 35 | Approved |
| 90272 | Oncology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Oncology | Adult | 15 | 30 | 40 | 30 | Approved |
| 91042 | Oncology | Adult | 15 | 30 | 45 | 20 | Approved |
| 91390 | Oncology | Adult | 15 | 30 | 75 | 30 | Approved |
| 91702 | Oncology | Adult | 15 | 30 | 50 | 25 | Approved |
| 93243 | Oncology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Oncology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93532 | Oncology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | Oncology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93536 | Oncology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Oncology | Adult | 15 | 30 | 45 | 30 | Approved |
| 93544 | Oncology | Adult | 15 | 30 | 70 | 50 | Approved |
| 93553 | Oncology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93560 | Oncology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Oncology | Adult | 15 | 30 | 60 | 45 | Approved |
| 93591 | Oncology | Adult | 15 | 30 | 50 | 35 | Approved |
| 90265 | Oncology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90272 | Oncology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Oncology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91042 | Oncology | Pediatric | 15 | 30 | 45 | 20 | Approved |
| 91390 | Oncology | Pediatric | 15 | 30 | 75 | 30 | Approved |
| 91702 | Oncology | Pediatric | 15 | 30 | 50 | 25 | Approved |
| 93243 | Oncology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Oncology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93532 | Oncology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | Oncology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Oncology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Oncology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 93544 | Oncology | Pediatric | 15 | 30 | 70 | 50 | Approved |
| 93553 | Oncology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 93560 | Oncology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Oncology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 93591 | Oncology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90265 | Ophthalmology | Adult | 15 | 30 | 45 | 30 | Approved |
| 90704 | Ophthalmology | Adult | 15 | 30 | 40 | 30 | Approved |
| 91042 | Ophthalmology | Adult | 15 | 30 | 35 | 20 | Approved |
| 91390 | Ophthalmology | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Ophthalmology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Ophthalmology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Ophthalmology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Ophthalmology | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Ophthalmology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Ophthalmology | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | Ophthalmology | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | Ophthalmology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93560 | Ophthalmology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Ophthalmology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93591 | Ophthalmology | Adult | 15 | 30 | 45 | 30 | Approved |
| 90265 | Ophthalmology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90704 | Ophthalmology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 91042 | Ophthalmology | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91390 | Ophthalmology | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Ophthalmology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Ophthalmology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Ophthalmology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Ophthalmology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Ophthalmology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Ophthalmology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | Ophthalmology | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | Ophthalmology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93560 | Ophthalmology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Ophthalmology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93591 | Ophthalmology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90265 | Orthopedic Surgery | Adult | 15 | 30 | 50 | 30 | Approved |
| 90272 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Orthopedic Surgery | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Orthopedic Surgery | Adult | 15 | 30 | 35 | 20 | Approved |
| 91302 | Orthopedic Surgery | Adult | 15 | 30 | 35 | 20 | Approved |
| 91390 | Orthopedic Surgery | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Orthopedic Surgery | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Orthopedic Surgery | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Orthopedic Surgery | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Orthopedic Surgery | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Orthopedic Surgery | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | Orthopedic Surgery | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 30 | Approved |
| 93560 | Orthopedic Surgery | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Orthopedic Surgery | Adult | 15 | 30 | 55 | 40 | Approved |
| 93591 | Orthopedic Surgery | Adult | 15 | 30 | 45 | 30 | Approved |
| 90265 | Orthopedic Surgery | Pediatric | 15 | 30 | 50 | 30 | Approved |
| 90272 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Orthopedic Surgery | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Orthopedic Surgery | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91302 | Orthopedic Surgery | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91390 | Orthopedic Surgery | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Orthopedic Surgery | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Orthopedic Surgery | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Orthopedic Surgery | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Orthopedic Surgery | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Orthopedic Surgery | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | Orthopedic Surgery | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93560 | Orthopedic Surgery | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Orthopedic Surgery | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93591 | Orthopedic Surgery | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 90265 | PCP | Adult | 10 | 30 | 40 | 25 | Approved |
| 90704 | PCP | Adult | 10 | 30 | 40 | 30 | Approved |
| 91390 | PCP | Adult | 10 | 30 | 65 | 25 | Approved |
| 91702 | PCP | Adult | 10 | 30 | 40 | 20 | Approved |
| 93243 | PCP | Adult | 10 | 30 | 40 | 40 | Approved |
| 93532 | PCP | Adult | 10 | 30 | 45 | 40 | Approved |
| 93536 | PCP | Adult | 10 | 30 | 45 | 40 | Approved |
| 93544 | PCP | Adult | 10 | 30 | 45 | 25 | Approved |
| 93560 | PCP | Adult | 10 | 30 | 55 | 40 | Approved |
| 90265 | PCP | Pediatric | 10 | 30 | 40 | 25 | Approved |
| 90704 | PCP | Pediatric | 10 | 30 | 40 | 30 | Approved |
| 91390 | PCP | Pediatric | 10 | 30 | 65 | 25 | Approved |
| 91702 | PCP | Pediatric | 10 | 30 | 40 | 20 | Approved |
| 93243 | PCP | Pediatric | 10 | 30 | 40 | 40 | Approved |
| 93532 | PCP | Pediatric | 10 | 30 | 45 | 40 | Approved |
| 93536 | PCP | Pediatric | 10 | 30 | 45 | 40 | Approved |
| 93544 | PCP | Pediatric | 10 | 30 | 45 | 25 | Approved |
| 93560 | PCP | Pediatric | 10 | 30 | 55 | 40 | Approved |
| 90265 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 50 | 35 | Approved |
| 90272 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 40 | 25 | Approved |
| 91342 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 35 | 20 | Approved |
| 91390 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 55 | 40 | Approved |
| 93536 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 35 | 25 | Approved |
| 93544 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 65 | 40 | Approved |
| 93553 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 40 | 25 | Approved |
| 93560 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 60 | 40 | Approved |
| 93563 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 55 | 40 | Approved |
| 93591 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 40 | 35 | Approved |
| 90265 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 90272 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 91342 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 35 | 20 | Approved |
| 91390 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 93544 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 65 | 40 | Approved |
| 93553 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 93560 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 93563 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93591 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 91042 | Psychiatry | Adult | 15 | 30 | 40 | 20 | Approved |
| 91342 | Psychiatry | Adult | 15 | 30 | 40 | 20 | Approved |
| 91390 | Psychiatry | Adult | 15 | 30 | 65 | 25 | Approved |
| 91702 | Psychiatry | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Psychiatry | Adult | 15 | 30 | 40 | 40 | Approved |
| 93532 | Psychiatry | Adult | 15 | 30 | 45 | 40 | Approved |
| 93535 | Psychiatry | Adult | 15 | 30 | 50 | 35 | Approved |
| 93536 | Psychiatry | Adult | 15 | 30 | 45 | 40 | Approved |
| 93544 | Psychiatry | Adult | 15 | 30 | 60 | 40 | Approved |
| 93553 | Psychiatry | Adult | 15 | 30 | 40 | 25 | Approved |
| 93560 | Psychiatry | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Psychiatry | Adult | 15 | 30 | 50 | 35 | Approved |
| 93591 | Psychiatry | Adult | 15 | 30 | 35 | 30 | Approved |
| 91042 | Psychiatry | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 91342 | Psychiatry | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 91390 | Psychiatry | Pediatric | 15 | 30 | 65 | 25 | Approved |
| 91702 | Psychiatry | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Psychiatry | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93532 | Psychiatry | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93535 | Psychiatry | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93536 | Psychiatry | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93544 | Psychiatry | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 93553 | Psychiatry | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 93560 | Psychiatry | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Psychiatry | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 93591 | Psychiatry | Pediatric | 15 | 30 | 35 | 30 | Approved |
| 90265 | Pulmonology | Adult | 15 | 30 | 45 | 35 | Approved |
| 90272 | Pulmonology | Adult | 15 | 30 | 40 | 20 | Approved |
| 90704 | Pulmonology | Adult | 15 | 30 | 50 | 35 | Approved |
| 91042 | Pulmonology | Adult | 15 | 30 | 40 | 20 | Approved |
| 91390 | Pulmonology | Adult | 15 | 30 | 75 | 30 | Approved |
| 91702 | Pulmonology | Adult | 15 | 30 | 45 | 25 | Approved |
| 93243 | Pulmonology | Adult | 15 | 30 | 40 | 40 | Approved |
| 93510 | Pulmonology | Adult | 15 | 30 | 40 | 30 | Approved |
| 93532 | Pulmonology | Adult | 15 | 30 | 50 | 40 | Approved |
| 93535 | Pulmonology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93536 | Pulmonology | Adult | 15 | 30 | 45 | 40 | Approved |
| 93543 | Pulmonology | Adult | 15 | 30 | 40 | 35 | Approved |
| 93544 | Pulmonology | Adult | 15 | 30 | 70 | 50 | Approved |
| 93553 | Pulmonology | Adult | 15 | 30 | 45 | 35 | Approved |
| 93560 | Pulmonology | Adult | 15 | 30 | 55 | 40 | Approved |
| 93563 | Pulmonology | Adult | 15 | 30 | 60 | 45 | Approved |
| 93591 | Pulmonology | Adult | 15 | 30 | 55 | 35 | Approved |
| 90265 | Pulmonology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 90272 | Pulmonology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 90704 | Pulmonology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 91042 | Pulmonology | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 91390 | Pulmonology | Pediatric | 15 | 30 | 75 | 30 | Approved |
| 91702 | Pulmonology | Pediatric | 15 | 30 | 45 | 25 | Approved |
| 93243 | Pulmonology | Pediatric | 15 | 30 | 40 | 40 | Approved |
| 93510 | Pulmonology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 93532 | Pulmonology | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 93535 | Pulmonology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93536 | Pulmonology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 93543 | Pulmonology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 93544 | Pulmonology | Pediatric | 15 | 30 | 70 | 50 | Approved |
| 93553 | Pulmonology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 93560 | Pulmonology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 93563 | Pulmonology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 93591 | Pulmonology | Pediatric | 15 | 30 | 55 | 35 | Approved |
| Zip Code | Provider Type | Pediatric, Adult or N/A | County Size Standards Minutes | County Size Standards Miles | DHCS Determination Minutes | DHCS Determination Miles | DHCS Rationale |
|---|---|---|---|---|---|---|---|
| 94571 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 65 | 55 | Approved |
| 95615 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 50 | 30 | Approved |
| 95641 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95690 | Cardiology/Interventional Cardiology | Adult | 15 | 30 | 45 | 35 | Approved |
| 94571 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 70 | 55 | Approved |
| 95615 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95690 | Cardiology/Interventional Cardiology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 94571 | Dermatology | Adult | 15 | 30 | 65 | 55 | Approved |
| 95638 | Dermatology | Adult | 15 | 30 | 45 | 30 | Approved |
| 95641 | Dermatology | Adult | 15 | 30 | 50 | 45 | Approved |
| 95690 | Dermatology | Adult | 15 | 30 | 40 | 35 | Approved |
| 94571 | Dermatology | Pediatric | 15 | 30 | 65 | 55 | Approved |
| 95638 | Dermatology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | Dermatology | Pediatric | 15 | 30 | 50 | 45 | Approved |
| 95690 | Dermatology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 94571 | Endocrinology | Adult | 15 | 30 | 60 | 45 | Approved |
| 95615 | Endocrinology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Endocrinology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95641 | Endocrinology | Adult | 15 | 30 | 45 | 40 | Approved |
| 95690 | Endocrinology | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | Endocrinology | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 95615 | Endocrinology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Endocrinology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95641 | Endocrinology | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 95690 | Endocrinology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | ENT/Otolaryngology | Adult | 15 | 30 | 75 | 65 | Approved |
| 95615 | ENT/Otolaryngology | Adult | 15 | 30 | 65 | 55 | Approved |
| 95632 | ENT/Otolaryngology | Adult | 15 | 30 | 35 | 35 | Approved |
| 95638 | ENT/Otolaryngology | Adult | 15 | 30 | 60 | 40 | Approved |
| 95641 | ENT/Otolaryngology | Adult | 15 | 30 | 60 | 60 | Approved |
| 95683 | ENT/Otolaryngology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | ENT/Otolaryngology | Adult | 15 | 30 | 55 | 45 | Approved |
| 95693 | ENT/Otolaryngology | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | ENT/Otolaryngology | Pediatric | 15 | 30 | 75 | 65 | Approved |
| 95615 | ENT/Otolaryngology | Pediatric | 15 | 30 | 65 | 55 | Approved |
| 95632 | ENT/Otolaryngology | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95638 | ENT/Otolaryngology | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 95641 | ENT/Otolaryngology | Pediatric | 15 | 30 | 60 | 60 | Approved |
| 95690 | ENT/Otolaryngology | Pediatric | 15 | 30 | 55 | 45 | Approved |
| 95693 | ENT/Otolaryngology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Gastroenterology | Adult | 15 | 30 | 65 | 55 | Approved |
| 95615 | Gastroenterology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Gastroenterology | Adult | 15 | 30 | 50 | 30 | Approved |
| 95641 | Gastroenterology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95683 | Gastroenterology | Adult | 15 | 30 | 35 | 30 | Approved |
| 95690 | Gastroenterology | Adult | 15 | 30 | 45 | 35 | Approved |
| 94571 | Gastroenterology | Pediatric | 15 | 30 | 65 | 55 | Approved |
| 95615 | Gastroenterology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Gastroenterology | Pediatric | 15 | 30 | 50 | 30 | Approved |
| 95641 | Gastroenterology | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95690 | Gastroenterology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 94571 | General Surgery | Adult | 15 | 30 | 70 | 55 | Approved |
| 95615 | General Surgery | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | General Surgery | Adult | 15 | 30 | 45 | 30 | Approved |
| 95641 | General Surgery | Adult | 15 | 30 | 55 | 50 | Approved |
| 95690 | General Surgery | Adult | 15 | 30 | 45 | 35 | Approved |
| 94571 | General Surgery | Pediatric | 15 | 30 | 70 | 55 | Approved |
| 95615 | General Surgery | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | General Surgery | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | General Surgery | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95690 | General Surgery | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 94571 | Hematology | Adult | 15 | 30 | 70 | 55 | Approved |
| 95615 | Hematology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Hematology | Adult | 15 | 30 | 50 | 30 | Approved |
| 95641 | Hematology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95683 | Hematology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | Hematology | Adult | 15 | 30 | 45 | 35 | Approved |
| 94571 | Hematology | Pediatric | 15 | 30 | 70 | 55 | Approved |
| 95615 | Hematology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Hematology | Pediatric | 15 | 30 | 50 | 30 | Approved |
| 95641 | Hematology | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95683 | Hematology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 95690 | Hematology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 94571 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 75 | 65 | Approved |
| 95615 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 30 | Approved |
| 95630 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 30 | Approved |
| 95632 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 35 | 35 | Approved |
| 95638 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 60 | 40 | Approved |
| 95641 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 60 | 55 | Approved |
| 95683 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 45 | 30 | Approved |
| 95690 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 55 | 45 | Approved |
| 95693 | HIV/AIDS Specialists/Infectious Diseases | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 75 | 65 | Approved |
| 95615 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 95630 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 95632 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95638 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 95641 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 60 | 55 | Approved |
| 95683 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95690 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 55 | 45 | Approved |
| 95693 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Hospital | n/a | 15 | 30 | 50 | 35 | Approved |
| 95638 | Hospital | n/a | 15 | 30 | 50 | 30 | Approved |
| 95641 | Hospital | n/a | 15 | 30 | 35 | 30 | Approved |
| 95683 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 95690 | Hospital | n/a | 15 | 30 | 45 | 30 | Approved |
| 94571 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 60 | 45 | Approved |
| 95641 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 50 | 40 | Approved |
| 95683 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 40 | 20 | Approved |
| 95690 | Mental Health (non-psychiatry) Outpatient Services | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 95641 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 50 | 40 | Approved |
| 95683 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 40 | 20 | Approved |
| 95690 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Nephrology | Adult | 15 | 30 | 60 | 50 | Approved |
| 95638 | Nephrology | Adult | 15 | 30 | 55 | 40 | Approved |
| 95641 | Nephrology | Adult | 15 | 30 | 50 | 45 | Approved |
| 95683 | Nephrology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | Nephrology | Adult | 15 | 30 | 40 | 30 | Approved |
| 95693 | Nephrology | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | Nephrology | Pediatric | 15 | 30 | 60 | 50 | Approved |
| 95638 | Nephrology | Pediatric | 15 | 30 | 55 | 40 | Approved |
| 95641 | Nephrology | Pediatric | 15 | 30 | 50 | 45 | Approved |
| 95683 | Nephrology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 95690 | Nephrology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 95693 | Nephrology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Neurology | Adult | 15 | 30 | 70 | 55 | Approved |
| 95615 | Neurology | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Neurology | Adult | 15 | 30 | 45 | 30 | Approved |
| 95641 | Neurology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95690 | Neurology | Adult | 15 | 30 | 45 | 35 | Approved |
| 94571 | Neurology | Pediatric | 15 | 30 | 70 | 55 | Approved |
| 95615 | Neurology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Neurology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | Neurology | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95690 | Neurology | Pediatric | 15 | 30 | 45 | 35 | Approved |
| 94571 | OB/GYN | n/a | 15 | 30 | 70 | 55 | Approved |
| 95615 | OB/GYN | n/a | 15 | 30 | 40 | 25 | Approved |
| 95638 | OB/GYN | n/a | 15 | 30 | 45 | 30 | Approved |
| 95641 | OB/GYN | n/a | 15 | 30 | 55 | 50 | Approved |
| 95683 | OB/GYN | n/a | 15 | 30 | 35 | 25 | Approved |
| 95690 | OB/GYN | n/a | 15 | 30 | 45 | 35 | Approved |
| 94571 | Oncology | Adult | 15 | 30 | 70 | 55 | Approved |
| 95638 | Oncology | Adult | 15 | 30 | 50 | 35 | Approved |
| 95641 | Oncology | Adult | 15 | 30 | 60 | 50 | Approved |
| 95683 | Oncology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | Oncology | Adult | 15 | 30 | 50 | 35 | Approved |
| 94571 | Oncology | Pediatric | 15 | 30 | 75 | 65 | Approved |
| 95615 | Oncology | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 95632 | Oncology | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95638 | Oncology | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 95641 | Oncology | Pediatric | 15 | 30 | 60 | 60 | Approved |
| 95683 | Oncology | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95690 | Oncology | Pediatric | 15 | 30 | 55 | 45 | Approved |
| 95693 | Oncology | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Ophthalmology | Adult | 15 | 30 | 70 | 55 | Approved |
| 95638 | Ophthalmology | Adult | 15 | 30 | 45 | 30 | Approved |
| 95641 | Ophthalmology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95683 | Ophthalmology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | Ophthalmology | Adult | 15 | 30 | 50 | 35 | Approved |
| 94571 | Ophthalmology | Pediatric | 15 | 30 | 70 | 55 | Approved |
| 95638 | Ophthalmology | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | Ophthalmology | Pediatric | 15 | 30 | 55 | 50 | Approved |
| 95683 | Ophthalmology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 95690 | Ophthalmology | Pediatric | 15 | 30 | 50 | 35 | Approved |
| 94571 | Orthopedic Surgery | Adult | 15 | 30 | 60 | 45 | Approved |
| 95615 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 25 | Approved |
| 95638 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 25 | Approved |
| 95641 | Orthopedic Surgery | Adult | 15 | 30 | 45 | 40 | Approved |
| 95690 | Orthopedic Surgery | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | Orthopedic Surgery | Pediatric | 15 | 30 | 60 | 45 | Approved |
| 95615 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95638 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 25 | Approved |
| 95641 | Orthopedic Surgery | Pediatric | 15 | 30 | 45 | 40 | Approved |
| 95690 | Orthopedic Surgery | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | PCP | Adult | 10 | 30 | 60 | 45 | Approved |
| 95615 | PCP | Adult | 10 | 30 | 40 | 25 | Approved |
| 95638 | PCP | Adult | 10 | 30 | 40 | 25 | Approved |
| 95641 | PCP | Adult | 10 | 30 | 45 | 40 | Approved |
| 95690 | PCP | Adult | 10 | 30 | 40 | 30 | Approved |
| 94571 | PCP | Pediatric | 10 | 30 | 60 | 45 | Approved |
| 95615 | PCP | Pediatric | 10 | 30 | 40 | 25 | Approved |
| 95638 | PCP | Pediatric | 10 | 30 | 40 | 25 | Approved |
| 95641 | PCP | Pediatric | 10 | 30 | 45 | 40 | Approved |
| 95690 | PCP | Pediatric | 10 | 30 | 40 | 30 | Approved |
| 94571 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 70 | 60 | Approved |
| 95638 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 50 | 35 | Approved |
| 95641 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 60 | 50 | Approved |
| 95690 | Physical Medicine and Rehabilitation | Adult | 15 | 30 | 50 | 35 | Approved |
| 94571 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 75 | 65 | Approved |
| 95615 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 40 | 35 | Approved |
| 95632 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95638 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 95641 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 65 | 60 | Approved |
| 95690 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 55 | 45 | Approved |
| 95757 | Physical Medicine and Rehabilitation | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 94571 | Psychiatry | Adult | 15 | 30 | 60 | 55 | Approved |
| 95638 | Psychiatry | Adult | 15 | 30 | 45 | 30 | Approved |
| 95641 | Psychiatry | Adult | 15 | 30 | 50 | 45 | Approved |
| 95683 | Psychiatry | Adult | 15 | 30 | 40 | 30 | Approved |
| 95690 | Psychiatry | Adult | 15 | 30 | 40 | 30 | Approved |
| 94571 | Psychiatry | Pediatric | 15 | 30 | 60 | 55 | Approved |
| 95638 | Psychiatry | Pediatric | 15 | 30 | 45 | 30 | Approved |
| 95641 | Psychiatry | Pediatric | 15 | 30 | 50 | 45 | Approved |
| 95683 | Psychiatry | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 95690 | Psychiatry | Pediatric | 15 | 30 | 40 | 30 | Approved |
| 94571 | Pulmonology | Adult | 15 | 30 | 65 | 55 | Approved |
| 95615 | Pulmonology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95632 | Pulmonology | Adult | 15 | 30 | 40 | 35 | Approved |
| 95638 | Pulmonology | Adult | 15 | 30 | 60 | 40 | Approved |
| 95641 | Pulmonology | Adult | 15 | 30 | 55 | 50 | Approved |
| 95683 | Pulmonology | Adult | 15 | 30 | 35 | 25 | Approved |
| 95690 | Pulmonology | Adult | 15 | 30 | 45 | 35 | Approved |
| 95693 | Pulmonology | Adult | 15 | 30 | 35 | 30 | Approved |
| 94571 | Pulmonology | Pediatric | 15 | 30 | 75 | 65 | Approved |
| 95615 | Pulmonology | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95632 | Pulmonology | Pediatric | 15 | 30 | 35 | 35 | Approved |
| 95638 | Pulmonology | Pediatric | 15 | 30 | 60 | 40 | Approved |
| 95641 | Pulmonology | Pediatric | 15 | 30 | 60 | 55 | Approved |
| 95683 | Pulmonology | Pediatric | 15 | 30 | 35 | 25 | Approved |
| 95690 | Pulmonology | Pediatric | 15 | 30 | 50 | 45 | Approved |
| Zip Code | Provider Type | Pediatric, Adult or N/A | County Size Standards Minutes | County Size Standards Miles | DHCS Determination Minutes | DHCS Determination Miles | DHCS Rationale |
|---|---|---|---|---|---|---|---|
| 95219 | Hospital | n/a | 15 | 30 | 50 | 25 | Approved |
| 95236 | Hospital | n/a | 15 | 30 | 35 | 25 | Approved |
| 95219 | PCP | Adult | 10 | 30 | 50 | 25 | Approved |
| 95219 | PCP | Pediatric | 10 | 30 | 50 | 25 | Approved |
| Zip Code | Provider Type | Pediatric, Adult or N/A | County Size Standards Minutes | County Size Standards Miles | DHCS Determination Minutes | DHCS Determination Miles | DHCS Rationale |
|---|---|---|---|---|---|---|---|
| 95313 | Hospital | n/a | 15 | 30 | 35 | 25 | Approved |
| 95322 | Hospital | n/a | 15 | 30 | 45 | 30 | Approved |
| 95329 | Hospital | n/a | 15 | 30 | 40 | 35 | Approved |
| 95360 | Hospital | n/a | 15 | 30 | 45 | 30 | Approved |
| 95363 | Hospital | n/a | 15 | 30 | 55 | 35 | Approved |
| 95386 | Hospital | n/a | 15 | 30 | 35 | 30 | Approved |
| Zip Code | Provider Type | Pediatric, Adult or N/A | County Size Standards Minutes | County Size Standards Miles | DHCS Determination Minutes | DHCS Determination Miles | DHCS Rationale |
|---|---|---|---|---|---|---|---|
| 93238 | Cardiology/Interventional Cardiology | Adult | 45 | 75 | 125 | 105 | Approved |
| 93262 | Cardiology/Interventional Cardiology | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | Cardiology/Interventional Cardiology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Cardiology/Interventional Cardiology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Cardiology/Interventional Cardiology | Pediatric | 45 | 75 | 125 | 105 | Approved |
| 93262 | Cardiology/Interventional Cardiology | Pediatric | 45 | 75 | 100 | 55 | Approved |
| 93265 | Cardiology/Interventional Cardiology | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Cardiology/Interventional Cardiology | Pediatric | 45 | 75 | 250 | 210 | Approved |
| 93238 | Dermatology | Adult | 45 | 75 | 125 | 110 | Approved |
| 93257 | Dermatology | Adult | 45 | 75 | 135 | 50 | Approved |
| 93262 | Dermatology | Adult | 45 | 75 | 85 | 60 | Approved |
| 93265 | Dermatology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Dermatology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Dermatology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Dermatology | Pediatric | 45 | 75 | 90 | 65 | Approved |
| 93265 | Dermatology | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Dermatology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93238 | Endocrinology | Adult | 45 | 75 | 135 | 120 | Approved |
| 93260 | Endocrinology | Adult | 45 | 75 | 85 | 55 | Approved |
| 93262 | Endocrinology | Adult | 45 | 75 | 110 | 65 | Approved |
| 93265 | Endocrinology | Adult | 45 | 75 | 185 | 65 | Approved |
| 93527 | Endocrinology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Endocrinology | Pediatric | 45 | 75 | 135 | 120 | Approved |
| 93257 | Endocrinology | Pediatric | 45 | 75 | 85 | 60 | Approved |
| 93260 | Endocrinology | Pediatric | 45 | 75 | 85 | 55 | Approved |
| 93262 | Endocrinology | Pediatric | 45 | 75 | 100 | 65 | Approved |
| 93265 | Endocrinology | Pediatric | 45 | 75 | 185 | 65 | Approved |
| 93527 | Endocrinology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93603 | Endocrinology | Pediatric | 45 | 75 | 110 | 55 | Approved |
| 93238 | ENT/Otolaryngology | Adult | 45 | 75 | 125 | 120 | Approved |
| 93260 | ENT/Otolaryngology | Adult | 45 | 75 | 100 | 70 | Approved |
| 93262 | ENT/Otolaryngology | Adult | 45 | 75 | 105 | 75 | Approved |
| 93265 | ENT/Otolaryngology | Adult | 45 | 75 | 130 | 80 | Approved |
| 93527 | ENT/Otolaryngology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93603 | ENT/Otolaryngology | Adult | 45 | 75 | 115 | 60 | Approved |
| 93238 | ENT/Otolaryngology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | ENT/Otolaryngology | Pediatric | 45 | 75 | 105 | 75 | Approved |
| 93265 | ENT/Otolaryngology | Pediatric | 45 | 75 | 130 | 60 | Approved |
| 93527 | ENT/Otolaryngology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93603 | ENT/Otolaryngology | Pediatric | 45 | 75 | 85 | 55 | Approved |
| 93238 | Gastroenterology | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | Gastroenterology | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | Gastroenterology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Gastroenterology | Adult | 45 | 75 | 260 | 210 | Approved |
| 93238 | Gastroenterology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Gastroenterology | Pediatric | 45 | 75 | 105 | 60 | Approved |
| 93265 | Gastroenterology | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Gastroenterology | Pediatric | 45 | 75 | 260 | 210 | Approved |
| 93603 | Gastroenterology | Pediatric | 45 | 75 | 105 | 55 | Approved |
| 93238 | General Surgery | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | General Surgery | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | General Surgery | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | General Surgery | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | General Surgery | Pediatric | 45 | 75 | 125 | 105 | Approved |
| 93262 | General Surgery | Pediatric | 45 | 75 | 85 | 60 | Approved |
| 93265 | General Surgery | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | General Surgery | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93238 | Hematology | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | Hematology | Adult | 45 | 75 | 100 | 75 | Approved |
| 93265 | Hematology | Adult | 45 | 75 | 180 | 110 | Approved |
| 93527 | Hematology | Adult | 45 | 75 | 260 | 210 | Approved |
| 93603 | Hematology | Adult | 45 | 75 | 115 | 60 | Approved |
| 93238 | Hematology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Hematology | Pediatric | 45 | 75 | 100 | 75 | Approved |
| 93265 | Hematology | Pediatric | 45 | 75 | 180 | 110 | Approved |
| 93527 | Hematology | Pediatric | 45 | 75 | 260 | 210 | Approved |
| 93603 | Hematology | Pediatric | 45 | 75 | 115 | 60 | Approved |
| 93238 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 135 | 120 | Approved |
| 93257 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 85 | 60 | Approved |
| 93260 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 135 | 75 | Approved |
| 93262 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 85 | 60 | Approved |
| 93265 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 185 | 65 | Approved |
| 93527 | HIV/AIDS Specialists/Infectious Diseases | Adult | 45 | 75 | 265 | 220 | Approved |
| 93238 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 135 | 135 | Approved |
| 93257 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 95 | 70 | Approved |
| 93260 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 95 | 65 | Approved |
| 93262 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 95 | 75 | Approved |
| 93265 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 195 | 70 | Approved |
| 93527 | HIV/AIDS Specialists/Infectious Diseases | Pediatric | 45 | 75 | 265 | 220 | Approved |
| 93207 | Hospital | n/a | 15 | 30 | 50 | 35 | Approved |
| 93212 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 93221 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 93256 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 93257 | Hospital | n/a | 15 | 30 | 135 | 50 | Approved |
| 93260 | Hospital | n/a | 15 | 30 | 70 | 45 | Approved |
| 93262 | Hospital | n/a | 15 | 30 | 90 | 65 | Approved |
| 93265 | Hospital | n/a | 15 | 30 | 175 | 60 | Approved |
| 93271 | Hospital | n/a | 15 | 30 | 135 | 45 | Approved |
| 93272 | Hospital | n/a | 15 | 30 | 45 | 30 | Approved |
| 93274 | Hospital | n/a | 15 | 30 | 40 | 30 | Approved |
| 93527 | Hospital | n/a | 15 | 30 | 110 | 55 | Approved |
| 93603 | Hospital | n/a | 15 | 30 | 115 | 55 | Approved |
| 93647 | Hospital | n/a | 15 | 30 | 60 | 35 | Approved |
| 93238 | Mental Health (non-psychiatry) Outpatient Services | Adult | 45 | 75 | 105 | 95 | Approved |
| 93262 | Mental Health (non-psychiatry) Outpatient Services | Adult | 45 | 75 | 90 | 65 | Approved |
| 93527 | Mental Health (non-psychiatry) Outpatient Services | Adult | 45 | 75 | 230 | 185 | Approved |
| 93238 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 45 | 75 | 105 | 95 | Approved |
| 93262 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 45 | 75 | 90 | 65 | Approved |
| 93527 | Mental Health (non-psychiatry) Outpatient Services | Pediatric | 45 | 75 | 230 | 185 | Approved |
| 93238 | Nephrology | Adult | 45 | 75 | 125 | 105 | Approved |
| 93262 | Nephrology | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | Nephrology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Nephrology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Nephrology | Pediatric | 45 | 75 | 125 | 105 | Approved |
| 93262 | Nephrology | Pediatric | 45 | 75 | 85 | 60 | Approved |
| 93265 | Nephrology | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Nephrology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93262 | Neurology | Adult | 45 | 75 | 90 | 65 | Approved |
| 93265 | Neurology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Neurology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Neurology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Neurology | Pediatric | 45 | 75 | 150 | 90 | Approved |
| 93265 | Neurology | Pediatric | 45 | 75 | 180 | 60 | Approved |
| 93527 | Neurology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93238 | OB/GYN | n/a | 45 | 75 | 105 | 95 | Approved |
| 93262 | OB/GYN | n/a | 45 | 75 | 100 | 55 | Approved |
| 93265 | OB/GYN | n/a | 45 | 75 | 175 | 55 | Approved |
| 93527 | OB/GYN | n/a | 45 | 75 | 230 | 185 | Approved |
| 93238 | Oncology | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | Oncology | Adult | 45 | 75 | 105 | 75 | Approved |
| 93265 | Oncology | Adult | 45 | 75 | 180 | 110 | Approved |
| 93527 | Oncology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93603 | Oncology | Adult | 45 | 75 | 115 | 60 | Approved |
| 93238 | Oncology | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Oncology | Pediatric | 45 | 75 | 105 | 75 | Approved |
| 93265 | Oncology | Pediatric | 45 | 75 | 180 | 110 | Approved |
| 93527 | Oncology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93603 | Oncology | Pediatric | 45 | 75 | 115 | 60 | Approved |
| 93238 | Ophthalmology | Adult | 45 | 75 | 100 | 90 | Approved |
| 93262 | Ophthalmology | Adult | 45 | 75 | 90 | 60 | Approved |
| 93265 | Ophthalmology | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Ophthalmology | Adult | 45 | 75 | 230 | 180 | Approved |
| 93238 | Ophthalmology | Pediatric | 45 | 75 | 100 | 90 | Approved |
| 93262 | Ophthalmology | Pediatric | 45 | 75 | 90 | 65 | Approved |
| 93265 | Ophthalmology | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Ophthalmology | Pediatric | 45 | 75 | 230 | 180 | Approved |
| 93603 | Ophthalmology | Pediatric | 45 | 75 | 115 | 55 | Approved |
| 93238 | Orthopedic Surgery | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | Orthopedic Surgery | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | Orthopedic Surgery | Adult | 45 | 75 | 175 | 60 | Approved |
| 93527 | Orthopedic Surgery | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Orthopedic Surgery | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Orthopedic Surgery | Pediatric | 45 | 75 | 105 | 60 | Approved |
| 93265 | Orthopedic Surgery | Pediatric | 45 | 75 | 175 | 60 | Approved |
| 93527 | Orthopedic Surgery | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93207 | PCP | Adult | 10 | 30 | 40 | 30 | Approved |
| 93257 | PCP | Adult | 10 | 30 | 65 | 45 | Approved |
| 93260 | PCP | Adult | 10 | 30 | 60 | 40 | Approved |
| 93262 | PCP | Adult | 10 | 30 | 70 | 45 | Approved |
| 93265 | PCP | Adult | 10 | 30 | 155 | 40 | Approved |
| 93271 | PCP | Adult | 10 | 30 | 100 | 15 | Approved |
| 93527 | PCP | Adult | 10 | 30 | 145 | 85 | Approved |
| 93603 | PCP | Adult | 10 | 30 | 95 | 65 | Approved |
| 93647 | PCP | Adult | 10 | 30 | 40 | 20 | Approved |
| 93207 | PCP | Pediatric | 10 | 30 | 40 | 30 | Approved |
| 93257 | PCP | Pediatric | 10 | 30 | 65 | 45 | Approved |
| 93260 | PCP | Pediatric | 10 | 30 | 60 | 40 | Approved |
| 93262 | PCP | Pediatric | 10 | 30 | 70 | 45 | Approved |
| 93265 | PCP | Pediatric | 10 | 30 | 155 | 40 | Approved |
| 93271 | PCP | Pediatric | 10 | 30 | 100 | 15 | Approved |
| 93527 | PCP | Pediatric | 10 | 30 | 145 | 85 | Approved |
| 93603 | PCP | Pediatric | 10 | 30 | 95 | 65 | Approved |
| 93647 | PCP | Pediatric | 10 | 30 | 40 | 20 | Approved |
| 93238 | Physical Medicine and Rehabilitation | Adult | 45 | 75 | 125 | 110 | Approved |
| 93262 | Physical Medicine and Rehabilitation | Adult | 45 | 75 | 100 | 75 | Approved |
| 93265 | Physical Medicine and Rehabilitation | Adult | 45 | 75 | 180 | 60 | Approved |
| 93527 | Physical Medicine and Rehabilitation | Adult | 45 | 75 | 265 | 210 | Approved |
| 93603 | Physical Medicine and Rehabilitation | Adult | 45 | 75 | 125 | 85 | Approved |
| 93238 | Physical Medicine and Rehabilitation | Pediatric | 45 | 75 | 125 | 110 | Approved |
| 93262 | Physical Medicine and Rehabilitation | Pediatric | 45 | 75 | 100 | 75 | Approved |
| 93265 | Physical Medicine and Rehabilitation | Pediatric | 45 | 75 | 180 | 60 | Approved |
| 93527 | Physical Medicine and Rehabilitation | Pediatric | 45 | 75 | 265 | 210 | Approved |
| 93603 | Physical Medicine and Rehabilitation | Pediatric | 45 | 75 | 125 | 85 | Approved |
| 93238 | Psychiatry | Adult | 45 | 75 | 105 | 95 | Approved |
| 93262 | Psychiatry | Adult | 45 | 75 | 95 | 65 | Approved |
| 93265 | Psychiatry | Adult | 45 | 75 | 195 | 70 | Approved |
| 93527 | Psychiatry | Adult | 45 | 75 | 230 | 185 | Approved |
| 93238 | Psychiatry | Pediatric | 45 | 75 | 105 | 95 | Approved |
| 93262 | Psychiatry | Pediatric | 45 | 75 | 95 | 65 | Approved |
| 93265 | Psychiatry | Pediatric | 45 | 75 | 195 | 70 | Approved |
| 93527 | Psychiatry | Pediatric | 45 | 75 | 230 | 185 | Approved |
| 93238 | Pulmonology | Adult | 45 | 75 | 125 | 105 | Approved |
| 93262 | Pulmonology | Adult | 45 | 75 | 100 | 55 | Approved |
| 93265 | Pulmonology | Adult | 45 | 75 | 175 | 105 | Approved |
| 93527 | Pulmonology | Adult | 45 | 75 | 255 | 210 | Approved |
| 93238 | Pulmonology | Pediatric | 45 | 75 | 125 | 105 | Approved |
| 93262 | Pulmonology | Pediatric | 45 | 75 | 100 | 75 | Approved |
| 93265 | Pulmonology | Pediatric | 45 | 75 | 175 | 105 | Approved |
| 93527 | Pulmonology | Pediatric | 45 | 75 | 255 | 210 | Approved |
| 93603 | Pulmonology | Pediatric | 45 | 75 | 85 | 55 | Approved |