CommercialBilling CodesMedium impact
26-016sum Summary Update: 4th Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA · Oncology, Rheumatology, Endocrinology +4 more·Pharmacy
Effective date
Mar 10, 2026
We identified it
Jun 20, 2026
Summary
Health Net 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. These changes affect how injectable medications are categorized and billed under Health Net's provider participation agreement.
Action Required
Before March 10, 2026: Billing team must download the complete update 26-016 from Health Net's Provider Library to review the specific HCPCS codes and DOFR category changes for injectable medications. Update billing system with new codes for the 21 new injectable medications, 8 biosimilars, and 7 generic drugs. Review and implement the 21 procedure code updates and 3 category changes to ensure proper billing alignment with Health Net's DOFR matrix.