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Health NetMedicare Advantage · Billing Codes · Pharmacy · CA · PharmacyHigh impact

26-827sum 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

Health Net updated its Injectable Medication HCPCS/DOFR Crosswalk effective September 15, 2026, affecting 10 new injectable medications, 6 new biosimilars, 4 new generic drugs, and 384 updates to existing injectable medication codes. The billing team must obtain and implement the complete crosswalk update to ensure accurate code mapping and proper Division of Financial Responsibility categorization for all injectable medications.

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What to do

by Sep 15, 2026 · 3 steps
01Billing team must download the complete Policy 26-827 from Health Net Provider Library (Provider Updates and Notices section) and update all billing system configuration files, EMR templates, and charge masters to reflect the new injectable medication HCPCS codes and their corresponding DOFR categorizations.
02Verify that the 10 new medications, 6 biosimilars, 4 generics, and all 384 code updates are properly mapped in your system before the effective date.
03For each line of business (Ambetter IFP/PPO, Ambetter HMO, Health Net Employer Group, Medi-Cal), coordinate with the respective Health Net Provider Services Center to clarify any code categorization questions.
If missed: Failure to update codes and DOFR mappings will result in claim denials or improper reimbursement under the new crosswalk structure.

Original notice

26-827sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
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