23-1319sum Summary Update: New: 4th Quarter 2023 Injectable Medication HCPCS/DOFR Crosswalk

Date: 12/01/23

Use the updates for dates of service on and after February 7, 2024

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, effective February 7, 2024, are listed on pages 2-4 of the complete update. Injectable medications are placed in DOFR categories that mirror the DOFR matrix categories in the Health Net and CalViva Health Provider Participation Agreement (PPA).

The update includes:

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

The complete update, 23-1319, New: 4th Quarter 2023 Injectable Medication HCPCS/DOFR Crosswalk (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 23-1319 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 > Provider Library under Quick Links, or go directly provider library.

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.