MedicaidBilling CodesHigh impact
26-829sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA · Pharmacy, Oncology, Rheumatology +2 more·Pharmacy
Effective date
Sep 15, 2026
We identified it
Jul 14, 2026
Summary
Community Health Plan of Imperial Valley has updated the Injectable Medication HCPCS/DOFR Crosswalk effective September 15, 2026, with 1,459 total changes including 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, 49 categorization corrections, 72 administrative changes, and 928 code description updates. Billing teams must verify all injectable medication codes against the updated crosswalk to ensure correct DOFR categorization and reimbursement.
Action Required
By September 15, 2026: Billing team must access the complete policy update 26-829 from the Provider Library and review all injectable medication HCPCS codes used in your practice. Update billing software, superbills, and encounter templates to reflect the new/updated codes, categorizations, and DOFR assignments. Coordinate with pharmacy and clinical staff to identify which injectable medications your practice uses and verify their new codes in the crosswalk. Establish a process to validate injectable medication claims against the updated DOFR matrix before submission to Community Health Plan of Imperial Valley. Failure to use correct codes and DOFR categorization will result in claim denials or rejections. Contact Community Health Plan of Imperial Valley at 833-236-4141 with questions.