24-174sum Summary Update: 1st Quarter 2024 Injectable Medication HCPCS/DOFR Crosswalk

Date: 02/16/24

Use the updates for dates of service on and after April 22, 2024

On January 9, 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 April 22, 2024, are listed on pages 2-5 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:

• 20 new injectable medications to be added to the DOFR crosswalk.
• 17 updates and changes to injectable medication procedure codes.
• 1 update category
• 12 updates for new generic drugs.

The complete update, 24-174, New: 1st Quarter 2024 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is a comprehensive description of the above topics.

Additional information

Relevant sections of the provider operations manual 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 portal.

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.