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20-891 Updates to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 4th Quarter 2020

Health Net·CA · Oncology, Hematology, Rheumatology +2 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 effective January 21, 2021, adding 12 new injectable medications with specific HCPCS codes and updating 26 existing medication procedure codes. Many older medications are no longer manufactured and several codes have been deleted or replaced with new ones.

Action Required

Action needed
By January 21, 2021: Billing team must update billing software and encounter forms to include 12 new HCPCS codes for injectable medications (including C9399 for Blenrep, Monjuvi, Phesgo, Viltepso, Zepzelca; J9145 for Darzalex; J0517 for Fasenra; etc.) and remove or update 26 discontinued/changed codes. Stop using deleted codes like J0886 for Epogen and replace with updated codes like J3111 for Evenity (replaces J3590) and J3032 for Vyepti. Verify DOFR categories are correctly assigned for therapeutic injections, self-injections, and chemotherapy treatments.

Affected Billing Codes

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