MedicaidBilling CodesMedium impact
26-018sum Summary Update: 4th Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA · Oncology, Rheumatology, Gastroenterology +7 more·Pharmacy
Effective date
Mar 10, 2026
We identified it
Jun 20, 2026
Summary
Health Net and Community Health Plan of Imperial Valley updated their Injectable Medication HCPCS/Division of Financial Responsibility (DOFR) Crosswalk for Q4 2025, adding 21 new injectable medications, 21 procedure code updates, 8 new biosimilars, 7 new generic drugs, and 3 category changes. This affects how injectable medications are categorized for billing and financial responsibility determination.
Action Required
By March 10, 2026: Billing team must download the complete update 26-018 from the Provider Library (Medi-Cal section > Provider Updates and Notices) and update billing system with new HCPCS codes and DOFR categories for injectable medications. Review all 21 new injectable medications, 21 procedure code changes, 8 biosimilar updates, and 7 new generic drugs to ensure proper billing and financial responsibility assignment.