23-1003sum Summary Update: Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table- 2nd Quarter 2023

Date: 09/08/23

Use the updates for dates of service on and after November 14, 2023

On April 11, 2023, the 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 are effective November 14, 2023. Injectable medications are placed in DOFR categories that mirror the DOFR matrix categories in the Health Net Provider Participation Agreement (PPA).

The update includes:

• 14 new injectable medications to be added to the DOFR crosswalk.
• 22 updates and changes to injectable medication procedure codes.
• 11 updates for new generic drugs.

The complete update, 23-1003, Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table – 2nd Quarter 2023 (PDF), is a comprehensive description of the above topic. Providers who do not have access to the internet may request a print copy of update 23-1003 by contacting the Provider Communications Department by email.

Additional information

Relevant sections of the provider operations manuals have been revised to reflect the information contained in this update as applicable. Provider operations manuals are available electronically in the Provider Library on the provider portal > Quick Links.

If you have questions regarding the information contained in this update, contact CalViva Health at 888-893-1569.

 

This information applies to Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Fresno, Kings and Madera counties.