Time and Distance to Care

Time and Distance to Care from Member's Residence
Provider Type	Time and Distance to Care from member's residence
Primary Care (Adult and Pediatric)	10 miles and 30 minutes
Specialty Care and Mental Health (non-Psychiatry) Outpatient Service (Adult and Pediatric)	Los Angeles and Sacramento counties: 15 miles and 30 minutes San Joaquin & Stanislaus counties: 30 miles and 60 minutes Amador and Tulare counties: 45 miles and 75 minutes Calaveras, Inyo, Mono and Tuolumne counties: 60 miles and 90 minutes
Hospitals	15 miles and 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 2024 Annual Network Certification
Alternate Access Standards Determination

Select a county below to see the 2024 Alternate Access travel time and distance standards

No Alternate Access requirement for Amador County.

Calaveras County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
95257	Dermatology	Pediatric	60	90	45	40	125	65	Approved
95255	Endocrinology	Pediatric	60	90	25	25	95	65	Approved
95246	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	85	60	120	75	Approved
95246	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	85	60	120	75	Approved
95255	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	75	55	125	80	Approved
95255	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	75	55	125	80	Approved
95257	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	85	60	130	80	Approved
95257	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	85	60	130	80	Approved
95223	Hospital	N/A	15	30	40	40	115	70	Approved
95228	Hospital	N/A	15	30	25	20	50	35	Approved
95230	Hospital	N/A	15	30	25	20	60	45	Approved
95236	Hospital	N/A	15	30	35	25	40	25	Approved
95246	Hospital	N/A	15	30	25	25	60	35	Approved
95247	Hospital	N/A	15	30	25	25	90	35	Approved
95255	Hospital	N/A	15	30	20	20	60	40	Approved
95257	Hospital	N/A	15	30	25	25	65	40	Approved
95257	Nephrology	Adult	60	90	60	50	105	65	Approved
95257	Nephrology	Pediatric	60	90	60	50	105	65	Approved
95222	PCP	Adult	10	30	10	10	50	30	Approved
95222	PCP	Pediatric	10	30	10	10	50	30	Approved
95223	PCP	Adult	10	30	30	30	175	105	Approved
95223	PCP	Pediatric	10	30	30	30	175	105	Approved
95230	PCP	Adult	10	30	20	15	45	35	Approved
95230	PCP	Pediatric	10	30	20	15	45	35	Approved
95232	PCP	Adult	10	30	20	15	40	25	Approved
95232	PCP	Pediatric	10	30	20	15	40	25	Approved
95245	PCP	Adult	10	30	20	20	45	35	Approved
95245	PCP	Pediatric	10	30	20	20	45	35	Approved
95246	PCP	Adult	10	30	15	15	60	30	Approved
95246	PCP	Pediatric	10	30	15	15	60	30	Approved
95247	PCP	Adult	10	30	15	15	80	30	Approved
95247	PCP	Pediatric	10	30	15	15	80	30	Approved
95252	PCP	Adult	10	30	25	20	40	30	Approved
95252	PCP	Pediatric	10	30	25	20	40	30	Approved
95255	Pulmonology	Pediatric	60	90	40	35	110	65	Approved
95246	Dermatology	Adult	60	90	35	35	105	65	Approved
95255	Dermatology	Pediatric	60	90	45	40	160	90	Approved
95245	Hospital	N/A	15	30	25	25	45	25	Approved
95255	PCP	Pediatric	10	30	20	20	60	40	Approved
95257	PCP	Adult	10	30	20	20	65	40	Approved
95257	PCP	Pediatric	10	30	20	20	75	40	Approved

Inyo County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
93545	General Surgery	Pediatric	60	90	75	70	250	250	Approved
92328	Hematology	Adult	60	90	90	85	170	160	Approved
92328	Cardiology/Interventional Cardiology	Adult	60	90	80	70	150	145	Approved
92328	Cardiology/Interventional Cardiology	Pediatric	60	90	125	115	210	200	Approved
93513	Cardiology/Interventional Cardiology	Adult	60	90	25	20	115	75	Approved
93513	Cardiology/Interventional Cardiology	Pediatric	60	90	25	20	115	75	Approved
93545	Cardiology/Interventional Cardiology	Pediatric	60	90	90	80	240	250	Approved
92328	Dermatology	Adult	60	90	90	85	170	160	Approved
92328	Dermatology	Pediatric	60	90	90	85	170	160	Approved
93513	Dermatology	Adult	60	90	25	20	115	75	Approved
93513	Dermatology	Pediatric	60	90	25	20	115	75	Approved
93545	Dermatology	Pediatric	60	90	75	70	240	260	Approved
92328	Endocrinology	Adult	60	90	120	110	230	215	Approved
92328	Endocrinology	Pediatric	60	90	120	110	230	215	Approved
93513	Endocrinology	Adult	60	90	25	20	115	75	Approved
93513	Endocrinology	Pediatric	60	90	25	20	115	75	Approved
93545	Endocrinology	Adult	60	90	75	70	245	245	Approved
92328	ENT/Otolaryngology	Adult	60	90	140	130	325	315	Approved
92328	ENT/Otolaryngology	Pediatric	60	90	155	140	325	315	Approved
93513	ENT/Otolaryngology	Adult	60	90	70	65	155	115	Approved
93513	ENT/Otolaryngology	Pediatric	60	90	70	65	155	115	Approved
93514	ENT/Otolaryngology	Adult	60	90	70	65	130	100	Approved
93514	ENT/Otolaryngology	Pediatric	60	90	70	65	130	100	Approved
93526	ENT/Otolaryngology	Adult	60	90	85	80	270	280	Approved
93526	ENT/Otolaryngology	Pediatric	60	90	85	80	260	240	Approved
93527	ENT/Otolaryngology	Adult	60	90	80	75	170	150	Approved
93527	ENT/Otolaryngology	Pediatric	60	90	95	80	170	150	Approved
93545	ENT/Otolaryngology	Pediatric	60	90	90	80	235	235	Approved
92328	Gastroenterology	Adult	60	90	90	85	170	160	Approved
92328	Gastroenterology	Pediatric	60	90	90	85	170	160	Approved
93513	Gastroenterology	Adult	60	90	25	20	115	75	Approved
93513	Gastroenterology	Pediatric	60	90	25	20	115	75	Approved
92328	General Surgery	Adult	60	90	90	85	170	160	Approved
92328	General Surgery	Pediatric	60	90	90	85	170	160	Approved
93513	General Surgery	Adult	60	90	25	20	115	75	Approved
93513	General Surgery	Pediatric	60	90	25	25	115	75	Approved
92328	Hematology	Pediatric	60	90	90	85	170	160	Approved
93513	Hematology	Adult	60	90	120	85	280	310	Approved
93513	Hematology	Pediatric	60	90	120	85	280	310	Approved
93514	Hematology	Adult	60	90	155	110	375	280	Approved
93514	Hematology	Pediatric	60	90	155	110	375	280	Approved
92328	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	125	115	210	200	Approved
92328	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	125	115	210	200	Approved
93513	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	25	20	110	75	Approved
93513	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	25	25	115	75	Approved
93527	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	105	75	105	75	Approved
93527	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	105	75	105	75	Approved
93545	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	75	70	245	245	Approved
93545	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	75	70	250	250	Approved
92328	Hospital	N/A	15	30	90	85	150	135	Approved
93526	Hospital	N/A	15	30	50	45	80	55	Approved
92328	Mental Health (non-psychiatry) Outpatient Services	Adult	60	90	120	110	170	180	Approved
92328	Mental Health (non-psychiatry) Outpatient Services	Pediatric	60	90	120	110	195	185	Approved
92328	Nephrology	Adult	60	90	120	110	240	220	Approved
92328	Nephrology	Pediatric	60	90	120	110	240	220	Approved
93513	Nephrology	Adult	60	90	25	25	110	75	Approved
93513	Nephrology	Pediatric	60	90	25	25	115	75	Approved
93545	Nephrology	Adult	60	90	70	65	265	260	Approved
93545	Nephrology	Pediatric	60	90	75	70	250	250	Approved
93513	Neurology	Adult	60	90	25	20	110	75	Approved
93513	Neurology	Pediatric	60	90	25	20	110	75	Approved
92328	OB/GYN	N/A	60	90	90	85	170	160	Approved
93513	OB/GYN	N/A	60	90	25	20	110	75	Approved
92328	Oncology	Adult	60	90	90	85	170	160	Approved
92328	Oncology	Pediatric	60	90	90	85	170	160	Approved
93513	Oncology	Adult	60	90	25	20	110	75	Approved
93513	Oncology	Pediatric	60	90	120	85	280	310	Approved
93514	Oncology	Pediatric	60	90	155	110	310	320	Approved
93545	Oncology	Adult	60	90	75	70	95	80	Approved
93545	Oncology	Pediatric	60	90	80	75	105	95	Approved
92328	Ophthalmology	Adult	60	90	125	115	190	190	Approved
92328	Ophthalmology	Pediatric	60	90	125	115	190	190	Approved
93527	Ophthalmology	Pediatric	60	90	80	75	170	150	Approved
92328	Orthopedic Surgery	Adult	60	90	80	70	150	140	Approved
92328	Orthopedic Surgery	Pediatric	60	90	80	70	150	140	Approved
93513	Orthopedic Surgery	Adult	60	90	25	20	110	70	Approved
93513	Orthopedic Surgery	Pediatric	60	90	25	20	110	75	Approved
92328	PCP	Adult	10	30	90	85	170	160	Approved
92328	PCP	Pediatric	10	30	90	85	170	160	Approved
93513	PCP	Adult	10	30	25	20	110	70	Approved
93513	PCP	Pediatric	10	30	25	20	110	70	Approved
93514	PCP	Adult	10	30	40	35	85	60	Approved
93514	PCP	Pediatric	10	30	40	35	85	60	Approved
93526	PCP	Adult	10	30	50	45	80	55	Approved
93526	PCP	Pediatric	10	30	50	45	80	55	Approved
93527	PCP	Adult	10	30	50	45	75	55	Approved
93527	PCP	Pediatric	10	30	50	45	75	55	Approved
93545	PCP	Adult	10	30	60	55	40	25	Approved
92328	Physical Medicine and Rehabilitation	Adult	60	90	125	115	195	190	Approved
92328	Physical Medicine and Rehabilitation	Pediatric	60	90	125	115	195	190	Approved
93513	Physical Medicine and Rehabilitation	Adult	60	90	120	85	280	310	Approved
93513	Physical Medicine and Rehabilitation	Pediatric	60	90	120	85	280	310	Approved
93514	Physical Medicine and Rehabilitation	Adult	60	90	160	110	310	245	Approved
93514	Physical Medicine and Rehabilitation	Pediatric	60	90	160	110	345	275	Approved
93526	Physical Medicine and Rehabilitation	Adult	60	90	115	85	300	310	Approved
93526	Physical Medicine and Rehabilitation	Pediatric	60	90	115	85	300	310	Approved
93545	Physical Medicine and Rehabilitation	Adult	60	90	90	75	200	175	Approved
93545	Physical Medicine and Rehabilitation	Pediatric	60	90	80	75	200	175	Approved
92328	Psychiatry	Adult	60	90	125	115	205	200	Approved
92328	Psychiatry	Pediatric	60	90	125	115	205	200	Approved
92328	Pulmonology	Adult	60	90	120	110	240	220	Approved
92328	Pulmonology	Pediatric	60	90	120	110	240	220	Approved
93513	Pulmonology	Adult	60	90	25	20	110	75	Approved
93513	Pulmonology	Pediatric	60	90	25	20	110	75	Approved
93545	Pulmonology	Adult	60	90	75	70	220	220	Approved
93545	Pulmonology	Pediatric	60	90	75	70	220	220	Approved
93545	Endocrinology	Pediatric	60	90	75	70	245	245	Approved
93545	ENT/Otolaryngology	Adult	60	90	80	75	235	235	Approved
93526	Hematology	Adult	60	90	115	80	275	270	Approved
93526	Hematology	Pediatric	60	90	115	80	115	115	Approved
92328	Neurology	Adult	60	90	117	110	230	215	Approved
92328	Neurology	Pediatric	60	90	117	110	230	210	Approved
93526	Oncology	Pediatric	60	90	115	85	115	115	Approved
93545	PCP	Pediatric	10	30	60	55	60	55	Approved
93527	Cardiology/Interventional Cardiology	Adult	60	90	45	45	165	105	Approved
93527	Cardiology/Interventional Cardiology	Pediatric	60	90	100	85	195	135	Approved
93527	Mental Health (non-psychiatry) Outpatient Services	Adult	60	90	70	65	150	155	Approved
93527	Mental Health (non-psychiatry) Outpatient Services	Pediatric	60	90	70	65	185	140	Approved
93545	Neurology	Pediatric	60	90	75	70	135	125	Approved
93527	Physical Medicine and Rehabilitation	Pediatric	60	90	80	70	265	270	Approved
93527	Psychiatry	Adult	60	90	100	80	130	120	Approved
93527	Psychiatry	Pediatric	60	90	100	80	130	120	Approved
93545	Hospital	N/A	15	30	75	70	40	25	Approved
93527	Physical Medicine and Rehabilitation	Adult	60	90	80	70	220	250	Approved

Los Angeles County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
93536	Pulmonology	Adult	15	30	40	35	45	40	Approved
93536	Pulmonology	Pediatric	15	30	40	35	45	40	Approved
93543	Pulmonology	Adult	15	30	30	25	40	35	Approved
93543	Pulmonology	Pediatric	15	30	30	25	40	35	Approved
93544	Pulmonology	Adult	15	30	35	25	70	50	Approved
93544	Pulmonology	Pediatric	15	30	35	25	70	50	Approved
93553	Pulmonology	Adult	15	30	30	25	45	35	Approved
93553	Pulmonology	Pediatric	15	30	30	25	45	35	Approved
93560	Pulmonology	Adult	15	30	40	35	55	40	Approved
93560	Pulmonology	Pediatric	15	30	40	35	55	40	Approved
90265	Cardiology/Interventional Cardiology	Adult	15	30	30	25	50	45	Approved
90265	Cardiology/Interventional Cardiology	Pediatric	15	30	25	20	50	45	Approved
93243	Cardiology/Interventional Cardiology	Adult	15	30	60	40	40	40	Approved
93243	Cardiology/Interventional Cardiology	Pediatric	15	30	40	40	40	40	Approved
93532	Cardiology/Interventional Cardiology	Adult	15	30	40	35	45	40	Approved
93532	Cardiology/Interventional Cardiology	Pediatric	15	30	40	35	45	40	Approved
93535	Cardiology/Interventional Cardiology	Adult	15	30	35	30	50	35	Approved
93535	Cardiology/Interventional Cardiology	Pediatric	15	30	40	35	50	35	Approved
93543	Cardiology/Interventional Cardiology	Pediatric	15	30	35	25	35	25	Approved
93544	Cardiology/Interventional Cardiology	Adult	15	30	40	30	65	40	Approved
93544	Cardiology/Interventional Cardiology	Pediatric	15	30	35	30	65	40	Approved
93553	Cardiology/Interventional Cardiology	Adult	15	30	30	25	115	50	Approved
93553	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	115	50	Approved
93560	Cardiology/Interventional Cardiology	Adult	15	30	30	30	55	40	Approved
93560	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	55	40	Approved
93563	Cardiology/Interventional Cardiology	Adult	15	30	35	25	55	40	Approved
93563	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	55	40	Approved
93591	Cardiology/Interventional Cardiology	Pediatric	15	30	35	30	40	35	Approved
90265	Dermatology	Adult	15	30	30	20	65	45	Approved
90265	Dermatology	Pediatric	15	30	30	20	65	45	Approved
93243	Dermatology	Adult	15	30	50	40	40	40	Approved
93243	Dermatology	Pediatric	15	30	50	40	40	40	Approved
93532	Dermatology	Adult	15	30	35	30	45	40	Approved
93532	Dermatology	Pediatric	15	30	35	30	45	40	Approved
93535	Dermatology	Adult	15	30	40	30	75	50	Approved
93535	Dermatology	Pediatric	15	30	40	30	75	50	Approved
93544	Dermatology	Adult	15	30	40	30	65	40	Approved
93544	Dermatology	Pediatric	15	30	40	30	65	40	Approved
93553	Dermatology	Adult	15	30	30	25	110	50	Approved
93553	Dermatology	Pediatric	15	30	30	25	110	50	Approved
93560	Dermatology	Adult	15	30	35	30	55	40	Approved
93560	Dermatology	Pediatric	15	30	35	30	55	40	Approved
93563	Dermatology	Adult	15	30	30	25	50	40	Approved
93563	Dermatology	Pediatric	15	30	30	25	50	40	Approved
90265	Endocrinology	Adult	15	30	35	30	50	35	Approved
90265	Endocrinology	Pediatric	15	30	35	30	65	50	Approved
93243	Endocrinology	Adult	15	30	60	40	40	40	Approved
93243	Endocrinology	Pediatric	15	30	60	40	40	40	Approved
93532	Endocrinology	Adult	15	30	40	35	45	40	Approved
93532	Endocrinology	Pediatric	15	30	40	35	45	40	Approved
93535	Endocrinology	Adult	15	30	35	30	70	55	Approved
93535	Endocrinology	Pediatric	15	30	35	30	50	40	Approved
93536	Endocrinology	Adult	15	30	40	35	45	40	Approved
93543	Endocrinology	Adult	15	30	35	25	45	30	Approved
93543	Endocrinology	Pediatric	15	30	10	10	45	30	Approved
93544	Endocrinology	Adult	15	30	40	30	70	50	Approved
93544	Endocrinology	Pediatric	15	30	40	30	70	50	Approved
93553	Endocrinology	Adult	15	30	35	30	85	65	Approved
93553	Endocrinology	Pediatric	15	30	35	30	50	35	Approved
93560	Endocrinology	Adult	15	30	40	35	55	40	Approved
93560	Endocrinology	Pediatric	15	30	40	35	55	40	Approved
93563	Endocrinology	Adult	15	30	30	25	60	45	Approved
93563	Endocrinology	Pediatric	15	30	30	25	60	45	Approved
93591	Endocrinology	Adult	15	30	35	30	50	35	Approved
93591	Endocrinology	Pediatric	15	30	35	30	50	35	Approved
90265	ENT/Otolaryngology	Adult	15	30	35	25	50	35	Approved
90265	ENT/Otolaryngology	Pediatric	15	30	55	40	105	55	Approved
93243	ENT/Otolaryngology	Adult	15	30	50	40	40	40	Approved
93243	ENT/Otolaryngology	Pediatric	15	30	55	45	70	60	Approved
93532	ENT/Otolaryngology	Adult	15	30	35	30	45	40	Approved
93532	ENT/Otolaryngology	Pediatric	15	30	45	40	45	40	Approved
93535	ENT/Otolaryngology	Adult	15	30	35	30	70	55	Approved
93535	ENT/Otolaryngology	Pediatric	15	30	40	35	50	35	Approved
93536	ENT/Otolaryngology	Adult	15	30	35	30	45	40	Approved
93536	ENT/Otolaryngology	Pediatric	15	30	40	40	45	40	Approved
93543	ENT/Otolaryngology	Adult	15	30	35	25	35	25	Approved
93543	ENT/Otolaryngology	Pediatric	15	30	40	30	40	25	Approved
93544	ENT/Otolaryngology	Adult	15	30	40	30	65	40	Approved
93544	ENT/Otolaryngology	Pediatric	15	30	55	40	65	40	Approved
93553	ENT/Otolaryngology	Adult	15	30	35	25	40	30	Approved
93553	ENT/Otolaryngology	Pediatric	15	30	45	30	50	55	Approved
93560	ENT/Otolaryngology	Adult	15	30	35	30	55	40	Approved
93560	ENT/Otolaryngology	Pediatric	15	30	40	40	55	40	Approved
93563	ENT/Otolaryngology	Adult	15	30	35	25	50	40	Approved
93563	ENT/Otolaryngology	Pediatric	15	30	50	35	50	40	Approved
93591	ENT/Otolaryngology	Pediatric	15	30	35	30	45	30	Approved
90265	Gastroenterology	Adult	15	30	25	20	45	35	Approved
90265	Gastroenterology	Pediatric	15	30	30	25	45	35	Approved
93243	Gastroenterology	Adult	15	30	50	40	40	40	Approved
93243	Gastroenterology	Pediatric	15	30	50	40	40	40	Approved
93532	Gastroenterology	Adult	15	30	40	35	50	40	Approved
93532	Gastroenterology	Pediatric	15	30	40	35	50	40	Approved
93543	Gastroenterology	Adult	15	30	40	30	45	30	Approved
93543	Gastroenterology	Pediatric	15	30	40	30	40	35	Approved
93544	Gastroenterology	Adult	15	30	40	30	70	50	Approved
93544	Gastroenterology	Pediatric	15	30	40	30	70	50	Approved
93553	Gastroenterology	Adult	15	30	40	30	130	55	Approved
93553	Gastroenterology	Pediatric	15	30	40	30	45	35	Approved
93560	Gastroenterology	Adult	15	30	30	30	55	40	Approved
93560	Gastroenterology	Pediatric	15	30	30	30	55	40	Approved
93563	Gastroenterology	Adult	15	30	35	25	60	45	Approved
93563	Gastroenterology	Pediatric	15	30	35	25	60	45	Approved
93591	Gastroenterology	Adult	15	30	35	30	50	35	Approved
90265	General Surgery	Adult	15	30	25	20	50	35	Approved
90265	General Surgery	Pediatric	15	30	20	15	50	35	Approved
93243	General Surgery	Adult	15	30	50	40	40	40	Approved
93243	General Surgery	Pediatric	15	30	50	40	40	40	Approved
93532	General Surgery	Adult	15	30	35	30	45	40	Approved
93532	General Surgery	Pediatric	15	30	35	30	45	40	Approved
93543	General Surgery	Adult	15	30	30	25	35	25	Approved
93543	General Surgery	Pediatric	15	30	30	25	35	25	Approved
93544	General Surgery	Adult	15	30	40	30	65	40	Approved
93544	General Surgery	Pediatric	15	30	40	30	65	40	Approved
93553	General Surgery	Adult	15	30	30	25	115	50	Approved
93553	General Surgery	Pediatric	15	30	30	25	115	50	Approved
93560	General Surgery	Adult	15	30	30	30	55	40	Approved
93560	General Surgery	Pediatric	15	30	35	30	55	40	Approved
93563	General Surgery	Adult	15	30	35	25	55	35	Approved
93563	General Surgery	Pediatric	15	30	35	25	55	35	Approved
90265	Hematology	Adult	15	30	20	20	45	35	Approved
90265	Hematology	Pediatric	15	30	20	20	45	35	Approved
93243	Hematology	Adult	15	30	50	40	40	40	Approved
93243	Hematology	Pediatric	15	30	50	40	40	40	Approved
93532	Hematology	Adult	15	30	35	30	50	40	Approved
93532	Hematology	Pediatric	15	30	35	30	50	40	Approved
93535	Hematology	Adult	15	30	40	35	55	35	Approved
93535	Hematology	Pediatric	15	30	40	35	55	40	Approved
93536	Hematology	Adult	15	30	35	30	45	40	Approved
93536	Hematology	Pediatric	15	30	35	30	45	40	Approved
93543	Hematology	Pediatric	15	30	35	25	40	35	Approved
93544	Hematology	Adult	15	30	40	30	70	50	Approved
93544	Hematology	Pediatric	15	30	40	30	70	50	Approved
93553	Hematology	Adult	15	30	35	30	125	55	Approved
93553	Hematology	Pediatric	15	30	35	30	45	35	Approved
93560	Hematology	Adult	15	30	30	30	55	40	Approved
93560	Hematology	Pediatric	15	30	35	30	55	40	Approved
93563	Hematology	Adult	15	30	35	25	60	45	Approved
93591	Hematology	Adult	15	30	35	30	50	35	Approved
93591	Hematology	Pediatric	15	30	35	30	50	35	Approved
90265	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	35	30	45	35	Approved
90265	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	45	35	Approved
93243	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	50	40	40	40	Approved
93243	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	50	40	40	40	Approved
93532	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	35	30	50	40	Approved
93532	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	35	30	50	40	Approved
93536	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	35	30	45	40	Approved
93536	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	35	30	45	40	Approved
93544	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	70	45	Approved
93544	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	70	45	Approved
93560	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	35	30	55	40	Approved
93560	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	35	30	60	40	Approved
93591	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	30	30	45	35	Approved
93591	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	55	40	40	30	Approved
90265	Hospital	N/A	15	30	40	30	65	45	Approved
91384	Hospital	N/A	15	30	35	30	60	30	Approved
91390	Hospital	N/A	15	30	25	20	35	30	Approved
93243	Hospital	N/A	15	30	55	45	45	50	Approved
93536	Hospital	N/A	15	30	40	35	45	40	Approved
93544	Hospital	N/A	15	30	40	30	50	30	Approved
93560	Hospital	N/A	15	30	35	30	55	40	Approved
93591	Hospital	N/A	15	30	35	30	50	35	Approved
93544	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	25	25	55	35	Approved
93544	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	25	25	55	35	Approved
93563	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	30	25	45	30	Approved
93563	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	30	25	45	30	Approved
93591	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	30	25	35	30	Approved
93591	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	30	25	35	30	Approved
90265	Nephrology	Adult	15	30	25	20	45	35	Approved
90265	Nephrology	Pediatric	15	30	25	20	45	35	Approved
93243	Nephrology	Adult	15	30	50	40	40	40	Approved
93243	Nephrology	Pediatric	15	30	50	40	40	40	Approved
93532	Nephrology	Adult	15	30	40	35	50	40	Approved
93532	Nephrology	Pediatric	15	30	40	35	50	40	Approved
93535	Nephrology	Pediatric	15	30	35	30	80	55	Approved
93536	Nephrology	Pediatric	15	30	35	30	45	40	Approved
93543	Nephrology	Adult	15	30	30	25	40	30	Approved
93543	Nephrology	Pediatric	15	30	30	25	40	30	Approved
93544	Nephrology	Adult	15	30	35	30	65	45	Approved
93544	Nephrology	Pediatric	15	30	35	25	65	45	Approved
93553	Nephrology	Adult	15	30	30	25	125	55	Approved
93553	Nephrology	Pediatric	15	30	30	25	125	55	Approved
93560	Nephrology	Adult	15	30	30	30	55	40	Approved
93560	Nephrology	Pediatric	15	30	30	30	55	40	Approved
93563	Nephrology	Adult	15	30	35	25	55	40	Approved
93563	Nephrology	Pediatric	15	30	35	25	55	40	Approved
90265	Neurology	Pediatric	15	30	40	30	65	45	Approved
93243	Neurology	Adult	15	30	50	40	40	40	Approved
93243	Neurology	Pediatric	15	30	50	40	40	40	Approved
93532	Neurology	Adult	15	30	35	30	45	40	Approved
93532	Neurology	Pediatric	15	30	35	30	45	40	Approved
93536	Neurology	Adult	15	30	35	30	45	40	Approved
93536	Neurology	Pediatric	15	30	35	30	45	40	Approved
93544	Neurology	Adult	15	30	40	30	45	30	Approved
93544	Neurology	Pediatric	15	30	40	30	45	30	Approved
93560	Neurology	Adult	15	30	35	30	55	40	Approved
93560	Neurology	Pediatric	15	30	35	30	55	40	Approved
93563	Neurology	Adult	15	30	35	25	35	25	Approved
93563	Neurology	Pediatric	15	30	35	25	35	25	Approved
93591	Neurology	Adult	15	30	35	30	40	25	Approved
90265	OB/GYN	N/A	15	30	25	20	65	45	Approved
93243	OB/GYN	N/A	15	30	40	35	40	40	Approved
93532	OB/GYN	N/A	15	30	35	30	45	40	Approved
93536	OB/GYN	N/A	15	30	35	30	45	35	Approved
93544	OB/GYN	N/A	15	30	40	30	60	35	Approved
93560	OB/GYN	N/A	15	30	35	30	55	35	Approved
90265	Oncology	Adult	15	30	20	20	45	35	Approved
90265	Oncology	Pediatric	15	30	20	20	45	35	Approved
93243	Oncology	Adult	15	30	50	40	40	40	Approved
93243	Oncology	Pediatric	15	30	50	40	40	40	Approved
93532	Oncology	Adult	15	30	35	30	50	40	Approved
93532	Oncology	Pediatric	15	30	35	30	50	40	Approved
93535	Oncology	Adult	15	30	35	30	40	35	Approved
93535	Oncology	Pediatric	15	30	40	35	55	40	Approved
93536	Oncology	Adult	15	30	35	30	45	40	Approved
93536	Oncology	Pediatric	15	30	35	30	45	40	Approved
93543	Oncology	Adult	15	30	35	25	45	30	Approved
93543	Oncology	Pediatric	15	30	35	30	40	35	Approved
93544	Oncology	Adult	15	30	40	30	70	50	Approved
93544	Oncology	Pediatric	15	30	35	30	70	50	Approved
93553	Oncology	Adult	15	30	35	30	130	55	Approved
93553	Oncology	Pediatric	15	30	35	30	130	60	Approved
93560	Oncology	Adult	15	30	30	30	55	40	Approved
93563	Oncology	Pediatric	15	30	35	25	60	45	Approved
93591	Oncology	Pediatric	15	30	35	30	50	35	Approved
90265	Ophthalmology	Adult	15	30	20	15	45	30	Approved
90265	Ophthalmology	Pediatric	15	30	20	15	45	30	Approved
93243	Ophthalmology	Adult	15	30	50	40	40	40	Approved
93243	Ophthalmology	Pediatric	15	30	50	40	40	40	Approved
93532	Ophthalmology	Adult	15	30	35	30	45	40	Approved
93532	Ophthalmology	Pediatric	15	30	35	30	45	40	Approved
93543	Ophthalmology	Adult	15	30	35	25	35	25	Approved
93543	Ophthalmology	Pediatric	15	30	10	10	35	25	Approved
93544	Ophthalmology	Adult	15	30	30	30	65	40	Approved
93553	Ophthalmology	Adult	15	30	30	25	110	50	Approved
93553	Ophthalmology	Pediatric	15	30	30	25	110	50	Approved
93560	Ophthalmology	Adult	15	30	35	30	55	40	Approved
93560	Ophthalmology	Pediatric	15	30	35	30	55	40	Approved
93563	Ophthalmology	Adult	15	30	30	25	50	40	Approved
93563	Ophthalmology	Pediatric	15	30	30	25	50	40	Approved
93591	Ophthalmology	Adult	15	30	35	30	45	30	Approved
90265	Orthopedic Surgery	Adult	15	30	20	15	65	45	Approved
90265	Orthopedic Surgery	Pediatric	15	30	20	15	65	45	Approved
93243	Orthopedic Surgery	Adult	15	30	50	40	40	40	Approved
93243	Orthopedic Surgery	Pediatric	15	30	50	40	40	40	Approved
93532	Orthopedic Surgery	Adult	15	30	40	30	45	40	Approved
93532	Orthopedic Surgery	Pediatric	15	30	40	30	45	40	Approved
93536	Orthopedic Surgery	Adult	15	30	35	30	45	40	Approved
93536	Orthopedic Surgery	Pediatric	15	30	35	30	45	40	Approved
93544	Orthopedic Surgery	Adult	15	30	40	30	65	40	Approved
93553	Orthopedic Surgery	Adult	15	30	30	25	115	50	Approved
93553	Orthopedic Surgery	Pediatric	15	30	30	25	115	50	Approved
93563	Orthopedic Surgery	Adult	15	30	35	25	55	40	Approved
93591	Orthopedic Surgery	Adult	15	30	35	30	45	30	Approved
93591	Orthopedic Surgery	Pediatric	15	30	35	30	45	30	Approved
90265	PCP	Adult	10	30	15	15	40	25	Approved
90265	PCP	Pediatric	10	30	20	20	40	25	Approved
93243	PCP	Adult	10	30	35	30	40	40	Approved
93243	PCP	Pediatric	10	30	35	30	40	40	Approved
93532	PCP	Adult	10	30	30	25	45	40	Approved
93532	PCP	Pediatric	10	30	35	25	45	40	Approved
93544	PCP	Adult	10	30	15	15	45	25	Approved
93544	PCP	Pediatric	10	30	25	25	45	25	Approved
93563	PCP	Adult	10	30	15	15	35	25	Approved
93563	PCP	Pediatric	10	30	30	25	35	25	Approved
90265	Physical Medicine and Rehabilitation	Adult	15	30	40	30	50	35	Approved
90265	Physical Medicine and Rehabilitation	Pediatric	15	30	35	30	50	35	Approved
93243	Physical Medicine and Rehabilitation	Adult	15	30	50	40	40	40	Approved
93243	Physical Medicine and Rehabilitation	Pediatric	15	30	50	40	40	40	Approved
93532	Physical Medicine and Rehabilitation	Adult	15	30	40	35	45	40	Approved
93532	Physical Medicine and Rehabilitation	Pediatric	15	30	40	35	45	40	Approved
93535	Physical Medicine and Rehabilitation	Adult	15	30	40	35	55	40	Approved
93535	Physical Medicine and Rehabilitation	Pediatric	15	30	40	35	55	40	Approved
93536	Physical Medicine and Rehabilitation	Adult	15	30	40	30	45	40	Approved
93536	Physical Medicine and Rehabilitation	Pediatric	15	30	40	30	45	40	Approved
93543	Physical Medicine and Rehabilitation	Adult	15	30	35	25	35	25	Approved
93543	Physical Medicine and Rehabilitation	Pediatric	15	30	35	25	35	25	Approved
93544	Physical Medicine and Rehabilitation	Pediatric	15	30	40	30	40	30	Approved
93553	Physical Medicine and Rehabilitation	Adult	15	30	35	25	115	50	Approved
93553	Physical Medicine and Rehabilitation	Pediatric	15	30	35	25	115	50	Approved
93560	Physical Medicine and Rehabilitation	Adult	15	30	40	30	60	40	Approved
93560	Physical Medicine and Rehabilitation	Pediatric	15	30	40	30	60	40	Approved
93563	Physical Medicine and Rehabilitation	Adult	15	30	35	25	55	40	Approved
93563	Physical Medicine and Rehabilitation	Pediatric	15	30	35	25	55	40	Approved
93591	Physical Medicine and Rehabilitation	Pediatric	15	30	35	30	40	35	Approved
93243	Psychiatry	Adult	15	30	50	40	40	40	Approved
93243	Psychiatry	Pediatric	15	30	50	40	40	40	Approved
93532	Psychiatry	Adult	15	30	35	30	45	40	Approved
93532	Psychiatry	Pediatric	15	30	35	30	45	40	Approved
93544	Psychiatry	Adult	15	30	30	25	60	40	Approved
93544	Psychiatry	Pediatric	15	30	30	25	60	40	Approved
93560	Psychiatry	Adult	15	30	35	30	55	40	Approved
93560	Psychiatry	Pediatric	15	30	35	30	55	40	Approved
93563	Psychiatry	Adult	15	30	25	20	50	35	Approved
93563	Psychiatry	Pediatric	15	30	25	20	50	35	Approved
93591	Psychiatry	Adult	15	30	25	25	35	30	Approved
93591	Psychiatry	Pediatric	15	30	25	25	35	30	Approved
90265	Pulmonology	Adult	15	30	45	35	45	35	Approved
90265	Pulmonology	Pediatric	15	30	45	35	45	35	Approved
93243	Pulmonology	Adult	15	30	50	45	60	45	Approved
93243	Pulmonology	Pediatric	15	30	50	45	60	45	Approved
93532	Pulmonology	Adult	15	30	40	35	50	40	Approved
93532	Pulmonology	Pediatric	15	30	40	35	50	40	Approved
93535	Pulmonology	Adult	15	30	40	35	55	40	Approved
93535	Pulmonology	Pediatric	15	30	40	35	55	40	Approved
93563	Pulmonology	Pediatric	15	30	30	25	60	45	Approved
93591	Pulmonology	Adult	15	30	30	30	55	35	Approved
93591	Pulmonology	Pediatric	15	30	30	30	55	35	Approved
93591	Dermatology	Adult	15	30	30	30	50	35	Approved
93591	Dermatology	Pediatric	15	30	30	30	50	35	Approved
93536	Endocrinology	Pediatric	15	30	40	35	60	50	Approved
93591	ENT/Otolaryngology	Adult	15	30	30	30	65	50	Approved
93591	Gastroenterology	Pediatric	15	30	35	30	50	40	Approved
93591	General Surgery	Pediatric	15	30	35	30	50	35	Approved
93543	Hematology	Adult	15	30	35	25	35	25	Approved
93563	Hematology	Pediatric	15	30	35	25	70	65	Approved
93563	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	35	25	60	40	Approved
93563	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	35	25	85	75	Approved
93532	Hospital	N/A	15	30	50	45	50	40	Approved
93563	Hospital	N/A	15	30	35	25	65	45	Approved
93536	Nephrology	Adult	15	30	35	30	60	50	Approved
93591	Nephrology	Adult	15	30	30	25	55	35	Approved
93591	Nephrology	Pediatric	15	30	30	25	55	35	Approved
93591	Neurology	Pediatric	15	30	35	30	45	35	Approved
93563	OB/GYN	N/A	15	30	35	25	65	40	Approved
93591	OB/GYN	N/A	15	30	30	25	40	25	Approved
93560	Oncology	Pediatric	15	30	35	30	45	45	Approved
93563	Oncology	Adult	15	30	35	25	105	75	Approved
93591	Oncology	Adult	15	30	30	30	50	35	Approved
93544	Ophthalmology	Pediatric	15	30	30	30	80	65	Approved
93591	Ophthalmology	Pediatric	15	30	35	30	50	35	Approved
93544	Orthopedic Surgery	Pediatric	15	30	40	30	75	65	Approved
93560	Orthopedic Surgery	Adult	15	30	30	30	50	40	Approved
93563	Orthopedic Surgery	Pediatric	15	30	35	25	35	25	Approved
93560	PCP	Adult	10	30	30	30	45	40	Approved
93560	PCP	Pediatric	10	30	40	30	45	45	Approved
93544	Physical Medicine and Rehabilitation	Adult	15	30	40	30	40	30	Approved
93591	Physical Medicine and Rehabilitation	Adult	15	30	35	30	50	35	Approved
93563	Pulmonology	Adult	15	30	30	25	65	45	Approved

Mono County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
93517	Cardiology/Interventional Cardiology	Adult	60	90	65	60	135	95	Approved
93517	Cardiology/Interventional Cardiology	Pediatric	60	90	100	95	170	130	Approved
96107	Cardiology/Interventional Cardiology	Adult	60	90	85	75	128	95	Approved
96107	Cardiology/Interventional Cardiology	Pediatric	60	90	100	90	120	90	Approved
96133	Cardiology/Interventional Cardiology	Adult	60	90	80	75	100	75	Approved
96133	Cardiology/Interventional Cardiology	Pediatric	60	90	85	80	100	80	Approved
93517	Dermatology	Adult	60	90	65	60	135	95	Approved
93517	Dermatology	Pediatric	60	90	65	60	135	95	Approved
96107	Dermatology	Adult	60	90	85	75	100	100	Approved
96107	Dermatology	Pediatric	60	90	85	75	100	100	Approved
96133	Dermatology	Adult	60	90	80	75	95	75	Approved
96133	Dermatology	Pediatric	60	90	80	75	95	75	Approved
93517	Endocrinology	Adult	60	90	75	70	200	125	Approved
93517	Endocrinology	Pediatric	60	90	75	70	200	125	Approved
96107	Endocrinology	Adult	60	90	85	80	185	146	Approved
96107	Endocrinology	Pediatric	60	90	85	80	205	150	Approved
96133	Endocrinology	Adult	60	90	85	80	95	80	Approved
96133	Endocrinology	Pediatric	60	90	85	80	95	80	Approved
93514	ENT/Otolaryngology	Adult	60	90	70	65	120	100	Approved
93514	ENT/Otolaryngology	Pediatric	60	90	70	65	120	100	Approved
93517	ENT/Otolaryngology	Adult	60	90	65	60	135	95	Approved
93517	ENT/Otolaryngology	Pediatric	60	90	65	60	135	95	Approved
96107	ENT/Otolaryngology	Pediatric	60	90	85	80	125	100	Approved
96133	ENT/Otolaryngology	Adult	60	90	85	75	95	75	Approved
96133	ENT/Otolaryngology	Pediatric	60	90	85	75	95	75	Approved
93517	Gastroenterology	Adult	60	90	75	70	200	125	Approved
93517	Gastroenterology	Pediatric	60	90	75	70	200	125	Approved
96107	Gastroenterology	Pediatric	60	90	85	80	180	130	Approved
96133	Gastroenterology	Adult	60	90	80	75	95	75	Approved
96133	Gastroenterology	Pediatric	60	90	80	75	95	75	Approved
93517	General Surgery	Adult	60	90	65	60	135	95	Approved
93517	General Surgery	Pediatric	60	90	65	60	135	95	Approved
96107	General Surgery	Pediatric	60	90	85	80	125	100	Approved
96133	General Surgery	Adult	60	90	80	75	95	75	Approved
96133	General Surgery	Pediatric	60	90	80	75	95	75	Approved
93512	Hematology	Adult	60	90	150	105	325	220	Approved
93512	Hematology	Pediatric	60	90	150	105	325	220	Approved
93514	Hematology	Adult	60	90	155	110	370	275	Approved
93514	Hematology	Pediatric	60	90	155	110	375	275	Approved
93517	Hematology	Adult	60	90	75	70	200	125	Approved
93517	Hematology	Pediatric	60	90	75	70	200	125	Approved
96107	Hematology	Adult	60	90	85	80	190	110	Approved
96107	Hematology	Pediatric	60	90	85	80	190	110	Approved
96133	Hematology	Adult	60	90	85	80	95	80	Approved
96133	Hematology	Pediatric	60	90	85	80	95	80	Approved
93517	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	100	95	170	130	Approved
93517	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	100	95	170	130	Approved
96107	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	145	105	220	200	Approved
96107	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	145	105	220	200	Approved
96133	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	140	100	140	100	Approved
96133	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	140	100	140	100	Approved
93512	Hospital	N/A	15	30	40	40	75	60	Approved
93517	Hospital	N/A	15	30	65	60	135	95	Approved
96107	Hospital	N/A	15	30	65	60	110	95	Approved
96133	Hospital	N/A	15	30	50	50	75	55	Approved
93517	Nephrology	Adult	60	90	65	60	135	95	Approved
93517	Nephrology	Pediatric	60	90	65	60	135	95	Approved
96107	Nephrology	Adult	60	90	85	80	125	100	Approved
96107	Nephrology	Pediatric	60	90	85	80	125	100	Approved
96133	Nephrology	Adult	60	90	90	85	95	85	Approved
96133	Nephrology	Pediatric	60	90	90	85	95	85	Approved
96133	Neurology	Adult	60	90	80	75	95	75	Approved
96133	Neurology	Pediatric	60	90	80	75	95	75	Approved
96133	OB/GYN	N/A	60	90	80	75	95	75	Approved
93512	Oncology	Pediatric	60	90	150	105	325	220	Approved
93514	Oncology	Pediatric	60	90	155	110	370	275	Approved
93517	Oncology	Adult	60	90	75	70	195	125	Approved
93517	Oncology	Pediatric	60	90	75	70	195	125	Approved
96107	Oncology	Adult	60	90	85	80	170	110	Approved
96107	Oncology	Pediatric	60	90	85	80	190	110	Approved
96133	Oncology	Adult	60	90	85	80	95	80	Approved
96133	Oncology	Pediatric	60	90	85	80	95	80	Approved
96107	Ophthalmology	Adult	60	90	115	100	190	110	Approved
96107	Ophthalmology	Pediatric	60	90	115	100	190	110	Approved
96133	Ophthalmology	Adult	60	90	110	95	110	95	Approved
96133	Ophthalmology	Pediatric	60	90	110	95	110	95	Approved
93517	Orthopedic Surgery	Adult	60	90	65	60	130	95	Approved
93517	Orthopedic Surgery	Pediatric	60	90	65	60	130	95	Approved
96107	Orthopedic Surgery	Adult	60	90	85	80	125	100	Approved
96107	Orthopedic Surgery	Pediatric	60	90	85	80	125	100	Approved
96133	Orthopedic Surgery	Adult	60	90	85	75	95	75	Approved
96133	Orthopedic Surgery	Pediatric	60	90	85	75	95	75	Approved
93512	PCP	Adult	10	30	40	35	75	60	Approved
93512	PCP	Pediatric	10	30	40	35	75	60	Approved
93514	PCP	Adult	10	30	40	35	80	60	Approved
93514	PCP	Pediatric	10	30	40	35	80	60	Approved
93546	PCP	Adult	10	30	25	20	35	30	Approved
93546	PCP	Pediatric	10	30	25	20	35	30	Approved
93517	Physical Medicine and Rehabilitation	Adult	60	90	75	70	200	135	Approved
93517	Physical Medicine and Rehabilitation	Pediatric	60	90	75	70	200	135	Approved
93546	Physical Medicine and Rehabilitation	Adult	60	90	125	90	300	210	Approved
93546	Physical Medicine and Rehabilitation	Pediatric	60	90	125	90	300	210	Approved
96107	Physical Medicine and Rehabilitation	Adult	60	90	70	60	160	150	Approved
96107	Physical Medicine and Rehabilitation	Pediatric	60	90	85	80	150	100	Approved
96133	Physical Medicine and Rehabilitation	Adult	60	90	50	45	95	65	Approved
96133	Physical Medicine and Rehabilitation	Pediatric	60	90	85	80	95	80	Approved
96107	Psychiatry	Adult	60	90	70	60	190	110	Approved
96107	Psychiatry	Pediatric	60	90	70	60	190	110	Approved
93517	Pulmonology	Adult	60	90	75	70	200	140	Approved
93517	Pulmonology	Pediatric	60	90	75	70	200	140	Approved
93546	Pulmonology	Pediatric	60	90	55	50	95	65	Approved
96107	Pulmonology	Adult	60	90	85	80	170	145	Approved
96107	Pulmonology	Pediatric	60	90	85	80	170	145	Approved
96133	Pulmonology	Adult	60	90	80	75	95	75	Approved
96107	ENT/Otolaryngology	Adult	60	90	85	80	105	100	Approved
93514	Hospital	N/A	15	30	40	35	65	55	Approved
96133	PCP	Adult	10	30	50	45	75	50	Approved
96133	PCP	Pediatric	10	30	50	45	75	50	Approved
93512	Physical Medicine and Rehabilitation	Adult	60	90	150	105	325	220	Approved
93512	Physical Medicine and Rehabilitation	Pediatric	60	90	150	105	150	105	Approved
93514	Physical Medicine and Rehabilitation	Adult	60	90	155	110	375	280	Approved
93514	Physical Medicine and Rehabilitation	Pediatric	60	90	155	110	365	275	Approved
96133	Pulmonology	Pediatric	60	90	80	75	120	105	Approved
96107	Gastroenterology	Adult	60	90	85	80	185	135	Approved
96107	General Surgery	Adult	60	90	85	80	125	100	Approved
93546	Hematology	Adult	60	90	120	85	180	180	Approved
93546	Hematology	Pediatric	60	90	120	85	180	180	Approved
96107	Mental Health (non-psychiatry) Outpatient Services	Adult	60	90	65	60	125	105	Approved
96107	Mental Health (non-psychiatry) Outpatient Services	Pediatric	60	90	65	60	125	105	Approved
93517	Neurology	Adult	60	90	65	60	135	95	Approved
93517	Neurology	Pediatric	60	90	65	60	135	95	Approved
96107	Neurology	Adult	60	90	85	80	105	100	Approved
96107	Neurology	Pediatric	60	90	85	80	125	105	Approved
93517	OB/GYN	N/A	60	90	65	60	100	70	Approved
96107	OB/GYN	N/A	60	90	85	80	125	105	Approved
93546	Oncology	Pediatric	60	90	120	85	180	180	Approved
93517	PCP	Adult	10	30	51	47	190	120	Approved
93517	PCP	Pediatric	10	30	51	47	185	120	Approved
96107	PCP	Adult	10	30	47	43	180	110	Approved
96107	PCP	Pediatric	10	30	47	43	180	110	Approved

Sacramento County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
95641	Psychiatry	Pediatric	15	30	45	30	50	45	Approved
95690	Psychiatry	Adult	15	30	40	30	40	30	Approved
95690	Psychiatry	Pediatric	15	30	40	30	40	30	Approved
94571	Pulmonology	Adult	15	30	45	30	65	55	Approved
94571	Pulmonology	Pediatric	15	30	45	30	75	65	Approved
94571	Cardiology/Interventional Cardiology	Adult	15	30	45	30	65	55	Approved
94571	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	70	55	Approved
95638	Cardiology/Interventional Cardiology	Adult	15	30	35	25	50	30	Approved
95638	Cardiology/Interventional Cardiology	Pediatric	15	30	45	30	45	30	Approved
95641	Cardiology/Interventional Cardiology	Adult	15	30	30	25	55	50	Approved
95641	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	55	50	Approved
95690	Cardiology/Interventional Cardiology	Adult	15	30	35	25	45	35	Approved
95690	Cardiology/Interventional Cardiology	Pediatric	15	30	40	30	45	35	Approved
94571	Dermatology	Adult	15	30	40	30	65	55	Approved
94571	Dermatology	Pediatric	15	30	40	30	65	55	Approved
95638	Dermatology	Adult	15	30	40	30	45	30	Approved
95638	Dermatology	Pediatric	15	30	40	30	45	30	Approved
95641	Dermatology	Adult	15	30	40	30	50	45	Approved
95641	Dermatology	Pediatric	15	30	40	30	50	45	Approved
95690	Dermatology	Adult	15	30	40	30	40	35	Approved
95690	Dermatology	Pediatric	15	30	40	30	40	35	Approved
94571	Endocrinology	Adult	15	30	40	30	60	45	Approved
94571	Endocrinology	Pediatric	15	30	40	30	60	45	Approved
95615	Endocrinology	Adult	15	30	30	20	60	40	Approved
95638	Endocrinology	Pediatric	15	30	30	25	40	25	Approved
95641	Endocrinology	Adult	15	30	25	25	45	40	Approved
95641	Endocrinology	Pediatric	15	30	45	35	45	40	Approved
95690	Endocrinology	Adult	15	30	25	20	40	30	Approved
95690	Endocrinology	Pediatric	15	30	40	30	40	30	Approved
94571	ENT/Otolaryngology	Adult	15	30	25	25	75	65	Approved
94571	ENT/Otolaryngology	Pediatric	15	30	65	45	75	65	Approved
95615	ENT/Otolaryngology	Adult	15	30	35	25	55	40	Approved
95615	ENT/Otolaryngology	Pediatric	15	30	40	30	55	40	Approved
95632	ENT/Otolaryngology	Adult	15	30	30	20	35	35	Approved
95632	ENT/Otolaryngology	Pediatric	15	30	55	40	50	45	Approved
95638	ENT/Otolaryngology	Adult	15	30	30	30	60	40	Approved
95638	ENT/Otolaryngology	Pediatric	15	30	50	40	60	40	Approved
95641	ENT/Otolaryngology	Adult	15	30	25	25	60	60	Approved
95641	ENT/Otolaryngology	Pediatric	15	30	55	40	60	60	Approved
95690	ENT/Otolaryngology	Adult	15	30	35	25	55	45	Approved
95690	ENT/Otolaryngology	Pediatric	15	30	50	35	55	45	Approved
95693	ENT/Otolaryngology	Adult	15	30	30	20	40	30	Approved
95693	ENT/Otolaryngology	Pediatric	15	30	40	30	40	30	Approved
94571	Gastroenterology	Adult	15	30	40	30	65	55	Approved
94571	Gastroenterology	Pediatric	15	30	40	30	65	55	Approved
95638	Gastroenterology	Adult	15	30	35	25	50	30	Approved
95638	Gastroenterology	Pediatric	15	30	35	25	50	30	Approved
95641	Gastroenterology	Adult	15	30	30	25	55	50	Approved
95641	Gastroenterology	Pediatric	15	30	30	25	55	50	Approved
95690	Gastroenterology	Adult	15	30	35	25	45	35	Approved
95690	Gastroenterology	Pediatric	15	30	35	25	45	35	Approved
94571	General Surgery	Adult	15	30	30	30	70	55	Approved
94571	General Surgery	Pediatric	15	30	40	30	70	55	Approved
95638	General Surgery	Adult	15	30	30	25	45	30	Approved
95638	General Surgery	Pediatric	15	30	30	25	45	30	Approved
95641	General Surgery	Adult	15	30	30	20	55	50	Approved
95641	General Surgery	Pediatric	15	30	30	20	55	50	Approved
95690	General Surgery	Adult	15	30	35	25	45	35	Approved
95690	General Surgery	Pediatric	15	30	35	25	45	35	Approved
94571	Hematology	Adult	15	30	45	30	70	55	Approved
94571	Hematology	Pediatric	15	30	45	30	70	55	Approved
95638	Hematology	Adult	15	30	35	25	50	30	Approved
95638	Hematology	Pediatric	15	30	35	25	50	30	Approved
95641	Hematology	Adult	15	30	30	20	55	50	Approved
95641	Hematology	Pediatric	15	30	30	20	55	50	Approved
95690	Hematology	Adult	15	30	35	25	45	35	Approved
95690	Hematology	Pediatric	15	30	35	25	45	35	Approved
94571	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	75	65	Approved
94571	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	75	65	Approved
95615	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	40	30	Approved
95630	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	25	20	40	30	Approved
95630	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	25	20	40	30	Approved
95632	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	35	35	Approved
95632	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	35	35	Approved
95638	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	45	35	60	40	Approved
95638	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	45	35	60	40	Approved
95641	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	60	55	Approved
95641	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	60	55	Approved
95683	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	45	30	45	30	Approved
95683	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	45	30	45	30	Approved
95690	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	55	45	Approved
95690	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	45	30	55	45	Approved
95693	HIV/AIDS Specialists/Infectious Diseases	Adult	15	30	40	30	45	30	Approved
95693	HIV/AIDS Specialists/Infectious Diseases	Pediatric	15	30	40	30	40	30	Approved
94571	Hospital	N/A	15	30	40	30	75	50	Approved
95638	Hospital	N/A	15	30	30	20	50	30	Approved
95641	Hospital	N/A	15	30	30	25	35	30	Approved
95690	Hospital	N/A	15	30	35	25	45	30	Approved
94571	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	35	25	60	45	Approved
94571	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	35	25	60	45	Approved
95641	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	30	20	50	40	Approved
95641	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	30	20	50	40	Approved
95690	Mental Health (non-psychiatry) Outpatient Services	Adult	15	30	25	20	40	30	Approved
95690	Mental Health (non-psychiatry) Outpatient Services	Pediatric	15	30	25	20	40	30	Approved
94571	Nephrology	Adult	15	30	30	30	60	50	Approved
94571	Nephrology	Pediatric	15	30	30	30	60	50	Approved
95638	Nephrology	Adult	15	30	30	25	55	40	Approved
95638	Nephrology	Pediatric	15	30	30	25	55	40	Approved
95641	Nephrology	Adult	15	30	30	20	50	45	Approved
95641	Nephrology	Pediatric	15	30	30	20	50	45	Approved
95690	Nephrology	Adult	15	30	30	25	40	30	Approved
95690	Nephrology	Pediatric	15	30	30	25	40	30	Approved
94571	Neurology	Adult	15	30	30	25	70	55	Approved
94571	Neurology	Pediatric	15	30	30	25	70	55	Approved
95638	Neurology	Adult	15	30	30	25	45	30	Approved
95638	Neurology	Pediatric	15	30	30	25	45	30	Approved
95641	Neurology	Adult	15	30	30	20	55	50	Approved
95641	Neurology	Pediatric	15	30	30	20	55	50	Approved
95690	Neurology	Adult	15	30	35	25	45	35	Approved
95690	Neurology	Pediatric	15	30	35	25	45	35	Approved
94571	OB/GYN	N/A	15	30	25	20	70	55	Approved
95638	OB/GYN	N/A	15	30	30	25	45	30	Approved
95641	OB/GYN	N/A	15	30	30	25	55	50	Approved
95690	OB/GYN	N/A	15	30	35	25	45	35	Approved
94571	Oncology	Adult	15	30	40	30	70	55	Approved
94571	Oncology	Pediatric	15	30	45	30	75	65	Approved
95615	Oncology	Pediatric	15	30	35	25	40	35	Approved
95632	Oncology	Pediatric	15	30	30	20	35	35	Approved
95638	Oncology	Adult	15	30	25	25	50	35	Approved
95638	Oncology	Pediatric	15	30	30	30	60	40	Approved
95641	Oncology	Adult	15	30	25	25	60	50	Approved
95641	Oncology	Pediatric	15	30	25	25	60	60	Approved
95690	Oncology	Adult	15	30	25	25	50	35	Approved
95690	Oncology	Pediatric	15	30	35	25	55	45	Approved
95693	Oncology	Pediatric	15	30	30	25	40	30	Approved
94571	Ophthalmology	Adult	15	30	30	30	70	55	Approved
94571	Ophthalmology	Pediatric	15	30	30	30	70	55	Approved
95638	Ophthalmology	Adult	15	30	30	25	45	30	Approved
95638	Ophthalmology	Pediatric	15	30	30	25	45	30	Approved
95641	Ophthalmology	Adult	15	30	25	25	55	50	Approved
95641	Ophthalmology	Pediatric	15	30	25	25	55	50	Approved
95690	Ophthalmology	Adult	15	30	30	25	50	35	Approved
95690	Ophthalmology	Pediatric	15	30	30	25	50	35	Approved
94571	Orthopedic Surgery	Adult	15	30	35	30	60	45	Approved
94571	Orthopedic Surgery	Pediatric	15	30	35	30	60	45	Approved
95615	Orthopedic Surgery	Adult	15	30	30	20	40	25	Approved
95615	Orthopedic Surgery	Pediatric	15	30	30	20	40	25	Approved
95641	Orthopedic Surgery	Adult	15	30	25	25	45	40	Approved
95641	Orthopedic Surgery	Pediatric	15	30	25	25	45	40	Approved
95690	Orthopedic Surgery	Adult	15	30	25	20	40	30	Approved
95690	Orthopedic Surgery	Pediatric	15	30	25	20	40	30	Approved
94571	PCP	Adult	10	30	25	25	60	45	Approved
94571	PCP	Pediatric	10	30	25	25	60	45	Approved
95615	PCP	Adult	10	30	25	20	40	25	Approved
95615	PCP	Pediatric	10	30	25	20	40	25	Approved
95641	PCP	Adult	10	30	25	25	45	40	Approved
95641	PCP	Pediatric	10	30	25	25	45	40	Approved
95690	PCP	Adult	10	30	25	25	40	30	Approved
95690	PCP	Pediatric	10	30	25	20	40	30	Approved
94571	Physical Medicine and Rehabilitation	Adult	15	30	35	30	70	60	Approved
94571	Physical Medicine and Rehabilitation	Pediatric	15	30	35	30	70	50	Approved
95638	Physical Medicine and Rehabilitation	Adult	15	30	35	25	50	35	Approved
95638	Physical Medicine and Rehabilitation	Pediatric	15	30	35	25	60	40	Approved
95641	Physical Medicine and Rehabilitation	Adult	15	30	30	20	60	50	Approved
95641	Physical Medicine and Rehabilitation	Pediatric	15	30	30	20	65	60	Approved
95690	Physical Medicine and Rehabilitation	Adult	15	30	35	25	50	35	Approved
95690	Physical Medicine and Rehabilitation	Pediatric	15	30	35	25	55	45	Approved
94571	Psychiatry	Adult	15	30	40	30	60	55	Approved
94571	Psychiatry	Pediatric	15	30	40	30	60	55	Approved
95638	Psychiatry	Adult	15	30	30	25	45	30	Approved
95638	Psychiatry	Pediatric	15	30	30	25	45	30	Approved
95641	Psychiatry	Adult	15	30	45	30	50	45	Approved
95615	Pulmonology	Pediatric	15	30	40	30	35	35	Approved
95632	Pulmonology	Adult	15	30	25	20	40	35	Approved
95632	Pulmonology	Pediatric	15	30	35	25	35	35	Approved
95638	Pulmonology	Adult	15	30	30	30	60	40	Approved
95638	Pulmonology	Pediatric	15	30	40	30	60	40	Approved
95641	Pulmonology	Adult	15	30	30	20	55	50	Approved
95641	Pulmonology	Pediatric	15	30	45	30	60	55	Approved
95690	Pulmonology	Adult	15	30	30	25	45	35	Approved
95690	Pulmonology	Pediatric	15	30	45	30	50	45	Approved
95693	Pulmonology	Adult	15	30	30	20	35	30	Approved
95693	Pulmonology	Pediatric	15	30	35	25	35	30	Approved

San Joaquin County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
95236	Hospital	N/A	15	30	25	15	35	25	Approved

Stanislaus County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
95323	Hospital	n/a	15	30	30	20	35	25	Approved
95329	Hospital	n/a	15	30	40	30	40	35	Approved
95360	Hospital	n/a	15	30	40	30	120	60	Approved
95386	Hospital	n/a	15	30	35	25	35	30	Approved

Tulare County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
93265	Dermatology	Adult	45	75	40	40	175	60	Approved
93265	Dermatology	Pediatric	45	75	40	40	175	60	Approved
93603	Dermatology	Pediatric	45	75	35	35	100	50	Approved
93265	Endocrinology	Adult	45	75	40	40	185	65	Approved
93265	Endocrinology	Pediatric	45	75	40	40	185	65	Approved
93265	ENT/Otolaryngology	Adult	45	75	45	45	130	80	Approved
93265	ENT/Otolaryngology	Pediatric	45	75	65	55	165	95	Approved
93207	HIV/AIDS Specialists/Infectious Diseases	Pediatric	45	75	65	45	120	80	Approved
93265	HIV/AIDS Specialists/Infectious Diseases	Adult	45	75	55	40	185	65	Approved
93265	HIV/AIDS Specialists/Infectious Diseases	Pediatric	45	75	55	40	195	70	Approved
93603	HIV/AIDS Specialists/Infectious Diseases	Adult	45	75	35	30	105	50	Approved
93603	HIV/AIDS Specialists/Infectious Diseases	Pediatric	45	75	35	35	105	50	Approved
93207	Hospital	N/A	15	30	35	30	50	35	Approved
93212	Hospital	N/A	15	30	30	25	50	40	Approved
93221	Hospital	N/A	15	30	25	20	55	60	Approved
93256	Hospital	N/A	15	30	30	25	40	30	Approved
93260	Hospital	N/A	15	30	30	30	115	55	Approved
93265	Hospital	N/A	15	30	40	40	145	80	Approved
93271	Hospital	N/A	15	30	40	35	105	70	Approved
93286	Hospital	N/A	15	30	25	25	35	30	Approved
93603	Hospital	N/A	15	30	35	30	115	55	Approved
93641	Hospital	N/A	15	30	71	48	85	55	Approved
93647	Hospital	N/A	15	30	25	25	60	35	Approved
93265	Neurology	Adult	45	75	45	40	175	60	Approved
93265	Ophthalmology	Adult	45	75	40	40	175	60	Approved
93265	Ophthalmology	Pediatric	45	75	45	40	175	60	Approved
93603	Ophthalmology	Pediatric	45	75	40	40	115	55	Approved
93207	PCP	Adult	10	30	20	20	75	45	Approved
93207	PCP	Pediatric	10	30	20	20	75	45	Approved
93219	PCP	Adult	10	30	20	20	35	20	Approved
93221	PCP	Adult	10	30	15	15	45	35	Approved
93260	PCP	Adult	10	30	25	20	60	40	Approved
93260	PCP	Pediatric	10	30	25	20	60	40	Approved
93265	PCP	Adult	10	30	25	25	155	40	Approved
93265	PCP	Pediatric	10	30	25	25	155	40	Approved
93271	PCP	Adult	10	30	10	10	100	15	Approved
93271	PCP	Pediatric	10	30	10	10	100	15	Approved
93603	PCP	Adult	10	30	25	20	95	65	Approved
93603	PCP	Pediatric	10	30	25	20	95	65	Approved
93641	PCP	Adult	10	30	47	27	55	30	Approved
93641	PCP	Pediatric	10	30	47	27	55	30	Approved
93265	Physical Medicine and Rehabilitation	Pediatric	45	75	45	45	180	60	Approved
93603	Physical Medicine and Rehabilitation	Adult	45	75	45	40	125	85	Approved
93260	Psychiatry	Adult	45	75	45	40	115	60	Approved
93265	Psychiatry	Adult	45	75	50	45	195	70	Approved
93265	Psychiatry	Pediatric	45	75	50	45	195	70	Approved
93207	Physical Medicine and Rehabilitation	Pediatric	45	75	35	30	120	60	Approved

Tuolumne County alternate access travel time and distance standards
Zip Code	Provider Type	Pediatric, Adult or N/A	County Size Standards Minutes	County Size Standards Miles	MCP Requested Minutes	MCP Requested Miles	DHCS Determination Minutes	DHCS Determination Miles	DHCS Rationale
95311	Dermatology	Adult	60	90	25	20	95	70	Approved
95311	Dermatology	Pediatric	60	90	25	25	100	70	Approved
95311	Endocrinology	Adult	60	90	30	30	100	70	Approved
95311	Endocrinology	Pediatric	60	90	30	30	100	70	Approved
95311	ENT/Otolaryngology	Adult	60	90	30	30	100	70	Approved
95311	ENT/Otolaryngology	Pediatric	60	90	30	30	100	70	Approved
95311	Hematology	Adult	60	90	30	30	100	70	Approved
95311	Hematology	Pediatric	60	90	30	30	100	70	Approved
95311	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	70	50	120	90	Approved
95311	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	70	50	120	90	Approved
95321	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	100	70	145	95	Approved
95321	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	100	70	145	95	Approved
95364	HIV/AIDS Specialists/Infectious Diseases	Adult	60	90	130	90	145	110	Approved
95364	HIV/AIDS Specialists/Infectious Diseases	Pediatric	60	90	130	90	145	110	Approved
95311	Hospital	N/A	15	30	30	30	55	40	Approved
95321	Hospital	N/A	15	30	40	35	105	60	Approved
95329	Hospital	N/A	15	30	40	30	60	35	Approved
95364	Hospital	N/A	15	30	55	50	90	65	Approved
95321	Neurology	Pediatric	60	90	45	40	120	70	Approved
95311	Oncology	Adult	60	90	30	30	100	70	Approved
95311	Oncology	Pediatric	60	90	30	30	100	70	Approved
95311	Orthopedic Surgery	Pediatric	60	90	30	30	100	70	Approved
95310	PCP	Adult	10	30	15	10	90	35	Approved
95311	PCP	Adult	10	30	20	15	75	50	Approved
95311	PCP	Pediatric	10	30	20	15	75	50	Approved
95321	PCP	Adult	10	30	30	30	65	35	Approved
95321	PCP	Pediatric	10	30	30	30	65	30	Approved
95327	PCP	Adult	10	30	20	20	35	30	Approved
95327	PCP	Pediatric	10	30	20	20	35	30	Approved
95329	PCP	Adult	10	30	25	25	45	35	Approved
95329	PCP	Pediatric	10	30	25	25	45	35	Approved
95364	PCP	Adult	10	30	40	40	130	95	Approved
95364	PCP	Pediatric	10	30	40	40	130	95	Approved
95370	PCP	Adult	10	30	15	15	165	115	Approved
95370	PCP	Pediatric	10	30	15	15	165	115	Approved
95372	PCP	Adult	10	30	5	5	210	145	Approved
95372	PCP	Pediatric	10	30	5	5	210	145	Approved
95379	PCP	Adult	10	30	5	5	95	65	Approved
95379	PCP	Pediatric	10	30	5	5	95	65	Approved
95383	PCP	Adult	10	30	15	15	90	60	Approved
95383	PCP	Pediatric	10	30	15	15	90	60	Approved
95311	Physical Medicine and Rehabilitation	Adult	60	90	30	30	100	70	Approved
95311	Physical Medicine and Rehabilitation	Pediatric	60	90	30	30	100	70	Approved
95364	Physical Medicine and Rehabilitation	Pediatric	60	90	55	50	95	65	Approved
95311	Pulmonology	Adult	60	90	30	30	100	70	Approved
95311	Pulmonology	Pediatric	60	90	30	30	100	70	Approved
95321	Neurology	Adult	60	90	45	40	145	70	Approved
95335	PCP	Adult	10	30	25	20	35	30	Approved
95335	PCP	Pediatric	10	30	25	20	35	30	Approved

Last Updated: 01/13/2026

Time and Distance to Care

DHCS Adult and Pediatric Core Specialists

Health Net Community Solutions –
DHCS 2024 Annual Network Certification
Alternate Access Standards Determination

Select a county below to see the 2024 Alternate Access travel time and distance standards

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AG SETTLEMENT / PROVIDER DIRECTORIES

Do Not Sell My Personal Information

Choosing Who Can See My Confidential Medical Information

Time and Distance to Care

DHCS Adult and Pediatric Core Specialists

Health Net Community Solutions – DHCS 2024 Annual Network Certification Alternate Access Standards Determination

Select a county below to see the 2024 Alternate Access travel time and distance standards

Amador County

Calaveras County

Inyo County

Los Angeles County

Mono County

Sacramento County

San Joaquin County

Stanislaus County

Tulare County

Tuolumne County

AG SETTLEMENT / PROVIDER DIRECTORIES

Do Not Sell My Personal Information

Choosing Who Can See My Confidential Medical Information

Health Net Community Solutions –
DHCS 2024 Annual Network Certification
Alternate Access Standards Determination