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20-892 Updates to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 4th Quarter 2020

Health Net·CA · Oncology, Hematology, Rheumatology +6 more·Pharmacy
Effective date
Jan 21, 2021
We identified it
Jun 20, 2026
Days to comply

Summary

Health Net updated their Injectable Medication HCPCS/DOFR Crosswalk Reference Table, adding 12 new injectable medications with their HCPCS codes and updating 26 existing medication procedure codes. Many legacy medications are being discontinued while new codes are being assigned for newer drugs, effective January 21, 2021.

Action Required

Action needed
By January 21, 2021: Billing team must update billing system with 12 new injectable medication HCPCS codes and discontinue billing for 26 legacy codes that are no longer manufactured. Update code crosswalk reference tables to reflect new DOFR categories for therapeutic injections, chemotherapy drugs, and self-injections. Replace superseded codes (Q2044 with J0490 for Benlysta, J3590 with J3111 for Evenity, J3590 with J3032 for Vyepti, C9055 with J1632 for Zulresso). Verify all injectable medication claims use current active codes to prevent denials.

Affected Billing Codes

C9399
J9145
J0517
J3590
J3490
J9227
J9999
90685
90687
J7196
90371
90385
J2788
J2790
J1670
J0490
J3120
J3121
J3130
J0886
J3111
90662
90694
J7192
J7190
J7194
Q5105
Q5106
J7197
J3032
J1632
Q2044
Q4081
C9055