26-828sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Date: 07/13/26
Use the updates for dates of service on and after September 15, 2026
The Pharmacy Advisory Committee approved updates to the Injectable Medication HCPCS/Division of Financial Responsibility (DOFR) Crosswalk. The Pharmacy Advisory Committee members include physicians and pharmacists.
The approved updates, effective September 15, 2026, are included in 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:
- 10 new injectable medications to be added to the crosswalk
- 384 updates and changes to current injectable medication procedure codes
- 6 new biosimilars and updates to be added to the crosswalk
- 4 new generic drugs
- 49 corrections on categorization to current injectable medication procedure codes
- 72 administrative changes to current injectable medication procedure codes
- 928 code description updates to current injectable medication procedure codes
Access the complete update for detailed information
For a comprehensive description of the above topics, the complete update, 26-828, 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk (PDF), is available in the Provider Library > select line of business > Provider Updates and Notices > search for 26-828. Providers who do not have access to the internet may request a print copy of the update by emailing Provider Communications.
Need help? Contact us
Relevant sections of the provider operations manuals will be 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.
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.