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MedicaidBilling CodesMedium impact

20-648 New Updates to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table - 3rd Quarter 2020

Health Net·CA · Oncology, Hematology, Rheumatology +5 more·Pharmacy
Effective date
Nov 3, 2020
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, updating 18 existing medication codes, and changing 1 DOFR category. These changes affect billing and coverage determination for injectable medications administered to Health Net members.

Action Required

Action needed
By November 3, 2020: Billing team must update billing system with 12 new injectable medication HCPCS codes and their assigned DOFR categories. Update 18 existing HCPCS codes with new descriptions and category assignments. Verify proper DOFR category billing for Adakveo (J0791) which now includes Home Health/Infusion as secondary category. Download updated Injectable Medication HCPCS/DOFR Crosswalk Reference Table from Health Net Provider Library.

Affected Billing Codes

C9059
J3490
Q5121
A9590
J7204
A9513
J1201
C9399
J9999
J7333
J0691
J1815
J0791
J9245
J7169
J9246
J9358
J0223
J9198
J9177
J0742
J0896
Q5119
C9122
C9061
J1429
J1558
Q5120
J3399