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Texas Insurance Code - INS § 1301.00553. Maximum Travel Time and Distance Standards by Preferred Provider Type
Current as of January 01, 2024 | Updated by Findlaw Staff
(a) In this section, “maximum distance” means the miles calculated to drive by automobile within a service area to a particular type of preferred provider.
(b) For purposes of this section, each county in this state is classified as a large metro, metro, micro, or rural county, or a county with extreme access considerations as determined by the federal Centers for Medicare and Medicaid Services by population and density thresholds as of March 1, 2023.
(c) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each large metro county are:
(1) for the following physicians, as designated by physician specialty:
|
|
Time |
Distance |
|
Allergy and Immunology |
30 |
15 |
|
Cardiology |
20 |
10 |
|
Cardiothoracic Surgery |
30 |
15 |
|
Dermatology |
20 |
10 |
|
Emergency Medicine |
20 |
10 |
|
Endocrinology |
30 |
15 |
|
Ear, Nose, and Throat/Otolaryngology |
30 |
15 |
|
Gastroenterology |
20 |
10 |
|
General Surgery |
20 |
10 |
|
Gynecology and Obstetrics |
10 |
5 |
|
Infectious Diseases |
30 |
15 |
|
Nephrology |
30 |
15 |
|
Neurology |
20 |
10 |
|
Neurosurgery |
30 |
15 |
|
Oncology: Medical, Surgical |
20 |
10 |
|
Oncology: Radiation |
30 |
15 |
|
Ophthalmology |
20 |
10 |
|
Orthopedic Surgery |
20 |
10 |
|
Physical Medicine and Rehabilitation |
30 |
15 |
|
Plastic Surgery |
30 |
15 |
|
Primary Care: Adults |
10 |
5 |
|
Primary Care: Pediatric |
10 |
5 |
|
Psychiatry |
20 |
10 |
|
Pulmonology |
20 |
10 |
|
Rheumatology |
30 |
15 |
|
Urology |
20 |
10 |
|
Vascular Surgery |
30 |
15 |
(2) for health care practitioners in the following disciplines:
|
|
Time |
Distance |
|
Chiropractic |
30 |
15 |
|
Occupational Therapy |
20 |
10 |
|
Physical Therapy |
20 |
10 |
|
Podiatry |
20 |
10 |
|
Speech Therapy |
20 |
10 |
(3) for the following types of institutional providers:
|
Time |
Distance |
|
|
Acute Inpatient Hospitals (Emergency Services Available 24/7) |
20 |
10 |
|
Cardiac Catheterization Services |
30 |
15 |
|
Cardiac Surgery Program |
30 |
15 |
|
Critical Care Services: Intensive Care Units |
20 |
10 |
|
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) |
20 |
10 |
|
Inpatient or Residential Behavioral Health Facility Services |
30 |
15 |
|
Mammography |
20 |
10 |
|
Outpatient Infusion/Chemotherapy |
20 |
10 |
|
Skilled Nursing Facilities |
20 |
10 |
|
Surgical Services (Outpatient or Ambulatory Surgical Center) |
20 |
10 |
(4) for the following settings:
|
|
Time |
Distance |
|
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) |
10 |
5 |
|
Urgent Care |
20 |
10 |
(d) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each metro county are:
(1) for the following physicians, as designated by physician specialty:
|
|
Time |
Distance |
|
Allergy and Immunology |
45 |
30 |
|
Cardiology |
30 |
20 |
|
Cardiothoracic Surgery |
60 |
40 |
|
Dermatology |
45 |
30 |
|
Emergency Medicine |
45 |
30 |
|
Endocrinology |
60 |
40 |
|
Ear, Nose, and Throat/Otolaryngology |
45 |
30 |
|
Gastroenterology |
45 |
30 |
|
General Surgery |
30 |
20 |
|
Gynecology and Obstetrics |
15 |
10 |
|
Infectious Diseases |
60 |
40 |
|
Nephrology |
45 |
30 |
|
Neurology |
45 |
30 |
|
Neurosurgery |
60 |
40 |
|
Oncology: Medical, Surgical |
45 |
30 |
|
Oncology: Radiation |
60 |
40 |
|
Ophthalmology |
30 |
20 |
|
Orthopedic Surgery |
30 |
20 |
|
Physical Medicine and Rehabilitation |
45 |
30 |
|
Plastic Surgery |
60 |
40 |
|
Primary Care: Adults |
15 |
10 |
|
Primary Care: Pediatric |
15 |
10 |
|
Psychiatry |
45 |
30 |
|
Pulmonology |
45 |
30 |
|
Rheumatology |
60 |
40 |
|
Urology |
45 |
30 |
|
Vascular Surgery |
60 |
40 |
(2) for health care practitioners in the following disciplines:
|
Time |
Distance |
|
|
Chiropractic |
45 |
30 |
|
Occupational Therapy |
45 |
30 |
|
Physical Therapy |
45 |
30 |
|
Podiatry |
45 |
30 |
|
Speech Therapy |
45 |
30 |
(3) for the following types of institutional providers:
|
|
Time |
Distance |
|
Acute Inpatient Hospitals (Emergency Services Available 24/7) |
45 |
30 |
|
Cardiac Catheterization Services |
60 |
40 |
|
Cardiac Surgery Program |
60 |
40 |
|
Critical Care Services: Intensive Care Units |
45 |
30 |
|
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) |
45 |
30 |
|
Inpatient or Residential Behavioral Health Facility Services |
70 |
45 |
|
Mammography |
45 |
30 |
|
Outpatient Infusion/Chemotherapy |
45 |
30 |
|
Skilled Nursing Facilities |
45 |
30 |
|
Surgical Services (Outpatient or Ambulatory Surgical Center) |
45 |
30 |
(4) for the following settings:
|
|
Time |
Distance |
|
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) |
15 |
10 |
|
Urgent Care |
45 |
30 |
(e) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each micro county are:
(1) for the following physicians, as designated by physician specialty:
|
|
Time |
Distance |
|
Allergy and Immunology |
80 |
60 |
|
Cardiology |
50 |
35 |
|
Cardiothoracic Surgery |
100 |
75 |
|
Dermatology |
60 |
45 |
|
Emergency Medicine |
80 |
60 |
|
Endocrinology |
100 |
75 |
|
Ear, Nose, and Throat/Otolaryngology |
80 |
60 |
|
Gastroenterology |
60 |
45 |
|
General Surgery |
50 |
35 |
|
Gynecology and Obstetrics |
30 |
20 |
|
Infectious Diseases |
100 |
75 |
|
Nephrology |
80 |
60 |
|
Neurology |
60 |
45 |
|
Neurosurgery |
100 |
75 |
|
Oncology: Medical, Surgical |
60 |
45 |
|
Oncology: Radiation |
100 |
75 |
|
Ophthalmology |
50 |
35 |
|
Orthopedic Surgery |
50 |
35 |
|
Physical Medicine and Rehabilitation |
80 |
60 |
|
Plastic Surgery |
100 |
75 |
|
Primary Care: Adults |
30 |
20 |
|
Primary Care: Pediatric |
30 |
20 |
|
Psychiatry |
60 |
45 |
|
Pulmonology |
60 |
45 |
|
Rheumatology |
100 |
75 |
|
Urology |
60 |
45 |
|
Vascular Surgery |
100 |
75 |
(2) for health care practitioners in the following disciplines:
|
|
Time |
Distance |
|
Chiropractic |
80 |
60 |
|
Occupational Therapy |
80 |
60 |
|
Physical Therapy |
80 |
60 |
|
Podiatry |
60 |
45 |
|
Speech Therapy |
80 |
60 |
(3) for the following types of institutional providers:
|
|
Time |
Distance |
|
Acute Inpatient Hospitals (Emergency Services Available 24/7) |
80 |
60 |
|
Cardiac Catheterization Services |
160 |
120 |
|
Cardiac Surgery Program |
160 |
120 |
|
Critical Care Services: Intensive Care Units |
160 |
120 |
|
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) |
80 |
60 |
|
Inpatient or Residential Behavioral Health Facility Services |
100 |
75 |
|
Mammography |
80 |
60 |
|
Outpatient Infusion/Chemotherapy |
80 |
60 |
|
Skilled Nursing Facilities |
80 |
60 |
|
Surgical Services (Outpatient or Ambulatory Surgical Center) |
80 |
60 |
(4) for the following settings:
|
|
Time |
Distance |
|
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) |
30 |
20 |
|
Urgent Care |
80 |
60 |
(f) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each rural county are:
(1) for the following physicians, as designated by physician specialty:
|
|
Time |
Distance |
|
Allergy and Immunology |
90 |
75 |
|
Cardiology |
75 |
60 |
|
Cardiothoracic Surgery |
110 |
90 |
|
Dermatology |
75 |
60 |
|
Emergency Medicine |
75 |
60 |
|
Endocrinology |
110 |
90 |
|
Ear, Nose, and Throat/Otolaryngology |
90 |
75 |
|
Gastroenterology |
75 |
60 |
|
General Surgery |
75 |
60 |
|
Gynecology and Obstetrics |
40 |
30 |
|
Infectious Diseases |
110 |
90 |
|
Nephrology |
90 |
75 |
|
Neurology |
75 |
60 |
|
Neurosurgery |
110 |
90 |
|
Oncology: Medical, Surgical |
75 |
60 |
|
Oncology: Radiation |
110 |
90 |
|
Ophthalmology |
75 |
60 |
|
Orthopedic Surgery |
75 |
60 |
|
Physical Medicine and Rehabilitation |
90 |
75 |
|
Plastic Surgery |
110 |
90 |
|
Primary Care: Adults |
40 |
30 |
|
Primary Care: Pediatric |
40 |
30 |
|
Psychiatry |
75 |
60 |
|
Pulmonology |
75 |
60 |
|
Rheumatology |
110 |
90 |
|
Urology |
75 |
60 |
|
Vascular Surgery |
110 |
90 |
(2) for health care practitioners in the following disciplines:
|
|
Time |
Distance |
|
Chiropractic |
90 |
75 |
|
Occupational Therapy |
75 |
60 |
|
Physical Therapy |
75 |
60 |
|
Podiatry |
75 |
60 |
|
Speech Therapy |
75 |
60 |
(3) for the following types of institutional providers:
|
|
Time |
Distance |
|
Acute Inpatient Hospitals (Emergency Services Available 24/7) |
75 |
60 |
|
Cardiac Catheterization Services |
145 |
120 |
|
Cardiac Surgery Program |
145 |
120 |
|
Critical Care Services: Intensive Care Units |
145 |
120 |
|
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) |
75 |
60 |
|
Inpatient or Residential Behavioral Health Facility Services |
90 |
75 |
|
Mammography |
75 |
60 |
|
Outpatient Infusion/Chemotherapy |
75 |
60 |
|
Skilled Nursing Facilities |
75 |
60 |
|
Surgical Services (Outpatient or Ambulatory Surgical Center) |
75 |
60 |
(4) for the following settings:
|
|
Time |
Distance |
|
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) |
40 |
30 |
|
Urgent Care |
75 |
60 |
(g) Maximum travel time in minutes and maximum distance in miles for preferred provider benefit plans by preferred provider type for each county with extreme access considerations are:
(1) for the following physicians, as designated by physician specialty:
|
|
Time |
Distance |
|
Allergy and Immunology |
125 |
110 |
|
Cardiology |
95 |
85 |
|
Cardiothoracic Surgery |
145 |
130 |
|
Dermatology |
110 |
100 |
|
Emergency Medicine |
110 |
100 |
|
Endocrinology |
145 |
130 |
|
Ear, Nose, and Throat/Otolaryngology |
125 |
110 |
|
Gastroenterology |
110 |
100 |
|
General Surgery |
95 |
85 |
|
Gynecology and Obstetrics |
70 |
60 |
|
Infectious Diseases |
145 |
130 |
|
Nephrology |
125 |
110 |
|
Neurology |
110 |
100 |
|
Neurosurgery |
145 |
130 |
|
Oncology: Medical, Surgical |
110 |
100 |
|
Oncology: Radiation |
145 |
130 |
|
Ophthalmology |
95 |
85 |
|
Orthopedic Surgery |
95 |
85 |
|
Physical Medicine and Rehabilitation |
125 |
110 |
|
Plastic Surgery |
145 |
130 |
|
Primary Care: Adults |
70 |
60 |
|
Primary Care: Pediatric |
70 |
60 |
|
Psychiatry |
110 |
100 |
|
Pulmonology |
110 |
100 |
|
Rheumatology |
145 |
130 |
|
Urology |
110 |
100 |
|
Vascular Surgery |
145 |
130 |
(2) for health care practitioners in the following disciplines:
|
|
Time |
Distance |
|
Chiropractic |
125 |
110 |
|
Occupational Therapy |
110 |
100 |
|
Physical Therapy |
110 |
100 |
|
Podiatry |
110 |
100 |
|
Speech Therapy |
110 |
100 |
(3) for the following institutional providers:
|
|
Time |
Distance |
|
Acute Inpatient Hospitals (Emergency Services Available 24/7) |
110 |
100 |
|
Cardiac Catheterization Services |
155 |
140 |
|
Cardiac Surgery Program |
155 |
140 |
|
Critical Care Services: Intensive Care Units |
155 |
140 |
|
Diagnostic Radiology (Freestanding; Hospital Outpatient; Ambulatory Health Facilities with Diagnostic Radiology) |
110 |
100 |
|
Inpatient or Residential Behavioral Health Facility Services |
155 |
140 |
|
Mammography |
110 |
100 |
|
Outpatient Infusion/Chemotherapy |
110 |
100 |
|
Skilled Nursing Facilities |
95 |
85 |
|
Surgical Services (Outpatient or Ambulatory Surgical Center) |
110 |
100 |
(4) for the following settings:
|
Time |
Distance |
|
|
Outpatient Clinical Behavioral Health (Licensed, Accredited, or Certified) |
70 |
60 |
|
Urgent Care |
110 |
100 |
Cite this article: FindLaw.com - Texas Insurance Code - INS § 1301.00553. Maximum Travel Time and Distance Standards by Preferred Provider Type - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1301-00553/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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