Tiempo y distancia hasta el centro de atención
| Tipo de proveedor | Tiempo y distancia hasta el centro de atención desde la residencia del afiliado |
|---|---|
| Atención primaria (adultos y niños) | 10 millas o 30 minutos |
| Atención especializada y de salud mental (no psiquiátrica) Servicio para pacientes ambulatorios (adultos y niños) | Condados de Los Ángeles y Sacramento: 15 millas o 30 minutos Condados de San Joaquin y Stanislaus: 30 millas o 60 minutos Condado de Tulare: 45 millas o 75 minutos |
| Hospitales | 15 millas o 30 minutos |
Especialistas principales para adultos y niños del DHCS
- Cardiología/Cardiología intervencionista
- Dermatología
- Endocrinología
- ORL/Otorrinolaringología
- Gastroenterología
- Cirugía general
- Hematología
- Especialistas en VIH/SIDA/Enfermedades infecciosas
- Mental Health (non-Psychiatry) Outpatient Services
- Nefrología
- Neurología
- Obstetricia/Ginecología (OB/GYN), atención adulta
- Oncología
- Oftalmología
- Cirugía ortopédica
- Medicina física y rehabilitación
- Psiquiatría
- Neumología
Si ni su grupo médico participante (Participant Physician Group, PPG) ni Health Net Community Solutions (HNCS) pueden proporcionar servicios dentro de los estándares de viaje indicados, se puede establecer un estándar de acceso alternativo para ese código postal. Si su código postal y su tipo de proveedor aparecen en la lista, HNCS debe ayudarlo a programar una cita. Los afiliados de HNCS pueden llamar sin cargo al 1-800-675-6110 (TTY: 711), las 24 horas del día, los 7 días de la semana, para obtener ayuda para programar una cita con un especialista más cercano. Si HNCS no puede encontrarle una cita con un especialista más cercano, coordinará el transporte para que vea al especialista. Encuentre los estándares de acceso alternativo para su lugar de residencia a continuación.
Health Net Community Solutions –
DHCS 2023 Annual Network Certification
Alternate Access Standards Determination
Seleccione un condado a continuación para ver los estándares de tiempo y distancia de viaje de acceso alternativo de 2023
| 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 |