25-1112sum Summary Update: 3rd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Date: 10/31/25
Use the updates for dates of service on and after January 8, 2026
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 January 8, 2026, 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:
- 18 new injectable medications to be added to the crosswalk
- 9 new biosimilars and updates to be added to the crosswalk
- 3 new generic drugs
- 45 updates and changes to current injectable medication procedure codes
- 4 category changes
To obtain a comprehensive description of the above topics, the complete update, 25-1112, 3rd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library.
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.