MedicaidPrior AuthHigh impact
25-1019sum Summary Update: 2nd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA·Prior Authorization
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
Health Net updated their Injectable Medication HCPCS/DOFR Crosswalk for Q2 2025, adding 16 new injectable medications, updating 40 existing procedure codes, adding 15 new biosimilars, and 3 new generic drugs. These changes affect prior authorization requirements and billing procedures for injectable medications.
Action Required
By December 2, 2025: Billing team must download the complete update document (25-1019) from the Provider Library to review all 74 changes to injectable medication codes and prior authorization requirements. Update billing system with new HCPCS codes for 16 new injectable medications and 15 new biosimilars. Verify prior authorization requirements for updated procedure codes before submitting claims. Contact Community Health Plan at 833-236-4141 with questions.