23-198sum Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 1st Quarter 2023

Date: 03/01/23

Use the updates for dates of service on and after May 3, 2023

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 are effective May 3, 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:

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

The complete update, 23-198, Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table – 1st Quarter 2023, is a comprehensive description of the above topics.

Additional information

Relevant sections of Health Net’s* 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 after logging in to Health Net’s provider website > Provider Library under Quick Links, or go directly to provider library.

If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email within 60 days, by phone or through the Health Net provider website.

This information applies to Participating Physician Groups (PPGs).

For Medi-Cal, this information applies to Kern, Los Angeles, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, Stanislaus, and Tulare counties.