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MedicaidBilling CodesHigh impact

21-582 Stay Current with the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 3rd Quarter 2021

Health Net·CA · Oncology, Hematology, Infectious Disease +4 more·Prior Authorization
Effective date
Oct 21, 2021
We identified it
Jun 20, 2026
Days to comply

Summary

Health Net updated their injectable medication HCPCS/DOFR crosswalk reference table with 10 new injectable medications, 19 procedure code updates/changes, and 2 DOFR category changes. The updates include new chemotherapy drugs, code replacements for existing medications, and removal of one FDA-discontinued drug.

Action Required

Action needed
By October 21, 2021: Billing team must update billing system with all new HCPCS codes and replace outdated codes per the crosswalk table. Update encounter forms to reflect new injectable medication codes. Verify DOFR categories for prior authorization requirements. Remove discontinued Bamlanivimab (Q0239) from system as it's no longer FDA-approved.

Affected Billing Codes

J9999
J3490
J3590
J9348
J1951
J9353
Q0243
C9075
J1943
J1944
Q0239
C9076
C9077
C9078
J9144
C9079
J1561
J1557
J9281
J7168
J0224
J1599
C9080
J9314
J2350
J1303