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

26-828sum 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

Effective September 15, 2026, Health Net/CalViva Health updated the Injectable Medication HCPCS/DOFR (Division of Financial Responsibility) Crosswalk with 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, and 1,139 total updates/corrections to existing injectable medication codes and categorizations. Billing teams must obtain and implement the complete policy update to ensure accurate coding and proper financial responsibility assignment for all injectable medications.

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What to do

by Sep 15, 2026 · 5 steps
01Billing team must access the complete policy update (26-828) from the Provider Library and implement all HCPCS code and DOFR categorization changes for injectable medications.
02Update billing software, fee schedules, and claims submission protocols to reflect the 1,139 updates including 10 new medications, 6 biosimilars, 4 generics, 49 recategorizations, and 928 code description updates.
03Verify that all injectable medication claims for dates of service on or after September 15, 2026 are submitted with correct HCPCS codes and assigned to the appropriate DOFR category per the updated crosswalk.
04Failure to implement these changes will result in claim denials, payment delays, and incorrect financial responsibility assignments.
05For questions, contact CalViva Health at 888-893-1569 or request printed documentation from Provider Communications if internet access is unavailable.

Original notice

26-828sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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