25-019sum Summary Update: 4th Quarter 2024 Injectable Medication HCPCS/DOFR Crosswalk
Date: 01/10/25
Use the updates for dates of service on and after March 18, 2025
The Health Net Pharmacy Advisory Committee approved updates to the Injectable Medication Healthcare Common Procedure Coding System (HCPCS)/Division of Financial Responsibility (DOFR) Crosswalk. The Pharmacy Advisory Committee members include physicians and pharmacists.
The approved updates, effective March 18, 2025, 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 Provider Participation Agreement (PPA).
The update includes:
- 23 new injectable medications to be added to the DOFR crosswalk.
- 11 updates and changes to current injectable medication procedure codes.
- 2 updated categories.
- 7 updates for new generic drugs.
To obtain a comprehensive description of the above topics, the complete update, 25-019, New: 4th Quarter 2024 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library > select line of business > Updates and Letters > search for provider update 25-019. Providers who do not have access to the internet may request a print copy of update 25-019 by emailing Provider Communications.
Additional information
Relevant sections of Health Net’s provider operations manuals have been revised to reflect the information contained in this update as applicable.
If you have questions regarding the information contained in this update, contact the applicable Provider Services Center.
Provider Services
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
Medicare (Individual & Employer Group) (Wellcare By Health Net) | ||
Medi-Cal (including CS and ECM providers) | N/A |
This information applies to Participating Physician Groups (PPGs).
For Medi-Cal, this information applies to Amador, Calaveras, Inyo, Los Angeles, Molina, Mono, Sacramento, San Joaquin, Stanislaus, Tulare and Tuolumne counties.