25-1017sum Summary Update: 2nd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Date: 09/25/25
Use the updates for dates of service on and after December 2, 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 December 2, 2025, are listed on pages 2-6 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:
- 16 new injectable medications to be added to the DOFR crosswalk
- 40 updates and changes to current injectable medication procedure codes
- 15 new biosimilars and updates to be added to the DOFR Crosswalk
- 3 updates for new generic drugs
To obtain a comprehensive description of the above topics, the complete update, 25-1017, 2nd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library.
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 on Health Net’s provider portal.
If you have questions regarding the information contained in this update, contact the Health Net Provider Services Center by email, by telephone or through the Health Net provider portal.
Provider Service
Line of business | Phone number | |
|---|---|---|
Ambetter from Health Net IFP Ambetter PPO | ||
Ambetter HMO | ||
Health Net Employer Group HMO, POS, & PPO | ||
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.