25-337sum Summary Update: 1st Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Date: 04/11/25
Use the updates for dates of service on and after June 16, 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 June 16, 2025, are listed on pages 2-7 of the complete update. Injectable medications are placed in DOFR categories that mirror the DOFR matrix categories in the Health Net and CalViva Health/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 to be added to the DOFR Crosswalk
- 7 updates for new generic drugs
- 1 category update
To obtain a comprehensive description of the above topics, the complete update, 25-337, 1st 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.
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.