Therapeutic Injections and Other Injectable Substances
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
Therapeutic injections and other injectable substances are covered, subject to scheduled copayments, when their use is indicated by standard medical practices. These injections are usually administered in the participating provider's office or professional outpatient facility. Refer to the Health Net Injectable Medications HCPCS/DOFR Crosswalk (PDF) table for therapeutic injectables information.
The following contraceptives are covered when determined to be medically necessary for the member and prescribed by a participating provider:
- Depo-Provera® Contraceptive Injections - One injection administered every three months to prevent pregnancy
- Depo-Sub Q Provera® 104 - One injection administered subcutaneously every three months to prevent pregnancy
- Lunelle™ Contraceptive Injections - One injection administered monthly to prevent pregnancy
Except for insulin, injectable medications defined as self-injectables continue to be processed as self-injectable medications when provided in an office setting.
Therapeutic and physician-administered injections are usually administered in the participating provider's office or professional outpatient facility. Refer to the Health Net Injectable Medications HCPCS/DOFR Crosswalk (PDF) table for therapeutic injectables information.
These injections may be covered by either Medi-Cal Rx under the pharmacy benefit or by Health Net. If submitted on a medical claim, the above crosswalk applies and financial responsibility for the claim is the plan’s risk. If the claim is submitted by a pharmacy, visit the Medi-Cal Rx website site and view the contract drug list to determine coverage.
The following contraceptives are covered when determined to be medically necessary for the member and prescribed by a participating provider:
- Depo-Provera® Contraceptive Injections - One injection administered every three months to prevent pregnancy
- Depo-Sub Q Provera® 104 - One injection administered subcutaneously every three months to prevent pregnancy
- Lunelle™ Contraceptive Injections - One injection administered monthly to prevent pregnancy