26-016sum Summary Update: 4th Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Date: 01/02/26
Use the updates for dates of service on and after March 10, 2026
The Health Net Pharmacy Advisory Committee approved updates to the Injectable Medication HCPCS/Division of Financial Responsibility (DOFR) Crosswalk on November 25, 2025. The Pharmacy Advisory Committee members include physicians and pharmacists.
The approved updates, effective March 10, 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* Provider Participation Agreement (PPA).
The update includes:
- 21 new injectable medications to be added to the crosswalk
- 21 updates and changes to current injectable medication procedure codes
- 8 new biosimilars and updates to be added to the crosswalk
- 7 new generic drugs
- 3 category changes
For a comprehensive description of the above topics, the complete update, 26-016, 4th Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library > select line of business > Provider Updates and Notices > search for the provider update number. Providers who do not have access to the internet may request a print copy of the update by emailing Provider Communications.
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If you have questions regarding the information contained in this update, contact the applicable Health Net Provider Services Center.
Provider Services
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.