25-1018sum 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 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 and CalViva Health 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, 25-1018, 2nd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library.
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 on the provider portal.
Providers are encouraged to access the provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.
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.