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MedicaidBilling CodesMedium impact

22-068 Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 1st Quarter 2022

Health Net·CA · Oncology, Family Medicine, Internal Medicine +3 more·Pharmacy
Effective date
Apr 18, 2022
We identified it
Jun 20, 2026
Days to comply

Summary

Health Net updated their Injectable Medication HCPCS/DOFR Crosswalk Reference Table, adding 11 new injectable medications, updating 16 existing medication procedure codes, and making 1 DOFR category change. This affects billing for injectable medications, vaccines, and chemotherapy drugs for Health Net participating physician groups and specific Medi-Cal counties.

Action Required

Action needed
Before April 18, 2022: Billing team must update billing software and fee schedules with the new HCPCS codes for 11 new injectable medications (including Camcevi, Prevnar 20, Rylaze) and modify existing codes for 16 medications. Update encounter forms to reflect new codes J1952, C9087, J3590, J2046, 90677, J9021, C9086, Q0247, 90671, J1445, J3490. Replace outdated codes (J2430, J0890, J2940, J2941, J3315, J7310 are no longer manufactured). Contact Health Net Provider Services within 60 days if clarification needed.

Affected Billing Codes

J1952
C9087
J3590
J2046
90677
J9021
C9086
Q0247
90671
J1445
J3490
Q2055
J0172
J1426
J2430
J9269
J9272
C9085
J2506
J0890
J2940
J9061
J2941
J3315
J7310
J2357