25-021sum 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 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 Health Net* and Community Health Plan of Imperial Valley 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, 25-021, 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 25-021. Providers who do not have access to the internet may request a print copy of update 25-021 by emailing Provider Communications.

Additional information

Relevant sections of the Plan’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 Community Health Plan of Imperial Valley at 833-236-4141.

 

This information applies to Participating Physician Groups (PPGs).

This information applies to Medi-Cal in Imperial county.