MedicaidPrior AuthMedium impact
25-1018sum Summary Update: 2nd Quarter 2025 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA · Oncology, Rheumatology, Gastroenterology +3 more·Prior Authorization
Effective date
Dec 2, 2025
We identified it
Jun 20, 2026
Summary
CalViva Health updated their Injectable Medication HCPCS/Division of Financial Responsibility (DOFR) Crosswalk for Q2 2025, adding 16 new injectable medications, 40 code updates, 15 new biosimilars, and 3 generic drug updates. This affects prior authorization requirements and billing procedures for injectable medications in Fresno, Kings, and Madera counties.
Action Required
Before December 2, 2025: Billing team must download the complete policy update (25-1018) from the CalViva Health Provider Library to review all 74 injectable medication code changes and updates. Update billing system and prior authorization workflows for affected HCPCS codes. Review provider operations manuals for revised sections. Contact CalViva Health at 888-893-1569 with questions.