CommercialBilling CodesMedium impact
20-172 New Updates to the Injectable Medication HCPCS/DOFR Crosswalk Reference Table – 1st Quarter 2020
Health Net·CA · Oncology, Hematology, Ophthalmology +2 more·Prior Authorization
Effective date
May 4, 2020
We identified it
Jun 20, 2026
Summary
Health Net updated their Injectable Medication HCPCS/DOFR Crosswalk Reference Table, adding 12 new injectable medications with specific HCPCS codes, updating 3 existing procedure codes, and changing DOFR categories for 14 medications. This affects billing and division of financial responsibility for participating physician groups.
Action Required
By May 4, 2020: Billing team must update HCPCS code assignments for injectable medications in billing system. Replace J3590 with J9199 for Infugem, J9999 with J0642 for Khapzory, and J3490 with C9055 for Zulresso. Add 12 new injectable medication codes to system with correct DOFR categories. Update 14 existing medications to include Home Health/Infusion secondary category when administered by nurse in home setting.