23-199sum 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 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, are listed on pages 2-6 of this Provider 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:

• 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, 23-199, 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 the Plan’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 the provider website > Provider Library under 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.