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Health NetMedicaid · Billing Codes · Pharmacy · CA · Pharmacy, Oncology, Rheumatology +2 moreHigh impact

26-829sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

Act
by Sep 15, 2026
Effective date
Sep 15, 2026
Identified
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.

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What to do

by Sep 15, 2026 · 6 steps
01Billing team must access the complete policy update 26-829 from the Provider Library and review all injectable medication HCPCS codes used in your practice.
02Update billing software, superbills, and encounter templates to reflect the new/updated codes, categorizations, and DOFR assignments.
03Coordinate with pharmacy and clinical staff to identify which injectable medications your practice uses and verify their new codes in the crosswalk.
04Establish a process to validate injectable medication claims against the updated DOFR matrix before submission to Community Health Plan of Imperial Valley.
05Failure to use correct codes and DOFR categorization will result in claim denials or rejections.
06Contact Community Health Plan of Imperial Valley at 833-236-4141 with questions.

Original notice

26-829sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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Related changes

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