21-357 Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 1st Quarter 2021
Date: 05/14/21
This information applies to Participating Physician Groups (PPGs).
Use the updates for dates of service on and after July 16, 2021
On April 13, 2021, the Health Net Pharmacy and Therapeutics (P&T) Committee approved updates to the Injectable Medication Healthcare Common Procedure Coding System (HCPCS)/Division of Financial Responsibility (DOFR) Crosswalk.
The approved updates, effective July 16, 2021, are listed below. Injectable medications are placed in DOFR categories that mirror the DOFR matrix categories in the Health Net Provider Participation Agreement (PPA).
The update includes:
- 16 new injectable medications and DOFR categories.
- 9 updates and changes to injectable medication procedure codes.
Additions to injectable medication HCPCS/DOFR crosswalk
The following medications have been approved by the Health Net P&T Committee as additions to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table. P&T Committee members include physicians and representatives from Health Net participating physician groups (PPGs).
New drugs
HCPCS | Drug name | Generic name | Primary category | Secondary category |
|---|---|---|---|---|
J3490 | Amondys 45™ | Casimersen injection, for intravenous use | Therapeutic injection |
|
J9999 | Breyanzi® | Lisocabtagene maraleucel suspension for intravenous infusion | Therapeutic injection | Chemotherapy* |
J2354 | Bynfezia™ | Octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg | Self-injection |
|
J3490 | Cabenuva™ | Cabotegravir suspension Extended Release cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension), co-packaged for | Therapeutic injection |
|
J9027 | Cloar® | Clofarabine, 1 mg Injection | Therapeutic injection | Chemotherapy* |
J3490 | Cosela™ | Trilaciclib for injection, for intravenous | Therapeutic injection | Chemotherapy Adjunctive* |
J9358 | Enhertu® | Fam-trastuzumab deruxtecan-nxki, for injection, for intravenous use | Therapeutic injection | Chemotherapy* |
J3590 | Enspryng™ | Satralizumab-mwge for subcutaneous use | Self-injection |
|
J3590 | Evkeeza™ | Evinacumab-dgnb injection, for intravenous | Therapeutic injection |
|
J3490 | Imcivree™ | Setmelanotide injection, for subcutaneous use | Self-injection |
|
J3490 | Nulibry™ | Fosdenopterin, for injection, for intravenous use | Therapeutic injection |
|
J3490 | Oxlumo™ | Injection, lumasiran, 0.5 mg | Therapeutic injection |
|
J3590 | Panzyga® | Immune globulin intravenous, human - ifas 10% Liquid Preparation | Therapeutic injection | Home Health/Infusion** |
J9999 | Pepaxto® | Melphalan flufenamide For IV, 20 MG | Therapeutic injection | Chemotherapy* |
C9399 | Riabni™ | Rituximab-arrx IV soln 100 mg/10ml (10 mg/ml) | Therapeutic injection | Chemotherapy* |
J0122 | Xerava™ | Eravacycline for injection, for intravenous use | Therapeutic injection |
|
Updates/changes to injectable medication procedure codes or medications
Updates to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table are based on changes or updates to HCPCS codes or changes in medication descriptions or availability. The following are changes to injectable medications currently listed in the crosswalk.
HCPCS | Drug name | Generic name | Comment |
|---|---|---|---|
J1554 | Asceniv™ | Injection, immune globulin, intravenous, non-lyophilized liquid | Code change from J9399 |
Q0239 | Bamlanivimab | Injection, bamlanivimab-xxxx, 700 mg | Code change from C0239 |
J9037 | Blenrep™ | Belantamab mafodotin-blmf for IV soln 100 mg | Code change from J9399 |
J9349 | Monjuvi® | Tafasitamab-cxix For IV Soln 200 MG | Code change from J9399 |
J7401 | Propel® | Mometasone furoate sinus implant, 10 micrograms | Code Change from J7401 |
J7402 | Sinuva™ | Mometasone furoate sinus implant, 10 micrograms | Code change from C9122 |
C9073 | Tecartus™ | Brexucabtagene autoleucel suspension for IV Infusion | New code replaces J9999 |
J1823 | Uplizna® | Inebilizumab-cdon injection, for intravenous use | New code replaces J3590 |
J1427 | Viltepso® | Viltolarsen, 10 mg injection, for intravenous use | Code change from J9399 |
HCPCS codes were taken from the Centers for Medicare & Medicaid Services HCPCS website.
* If associated with a cancer diagnosis- ICD-10 codes between C00.0-C79.9, C7A.00-C7B.8, C80.0-C96.9, D00.0-D09.9
** When administered by a nurse in a home setting
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update. If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center within 60 days at:
| Line of Business | Telephone Number | Email Address |
|---|---|---|
| Cal Mediconnect – Los Angeles County | 1-855-464-3571 | provider_services@healthnet.com |
| Cal Mediconnect – San Diego County | 1-855-464-3572 | provider_services@healthnet.com |