CommercialBilling CodesHigh impact
26-1060sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
Health Net·CA · Pharmacy·Pharmacy
Effective date
Nov 17, 2026
We identified it
Sep 12, 2026
Summary
Health Net's Pharmacy Advisory Committee has updated the Injectable Medication HCPCS/DOFR Crosswalk effective November 17, 2026, adding 11 new injectable medications, 15 new biosimilars, 6 new generic medications, and making 27 updates to existing codes. The update includes 3 DOFR categorization corrections, 2 administrative changes, and 21 code description updates that will affect how injectable medications are billed and assigned to financial responsibility categories under the Health Net Provider Participation Agreement.
Action Required
By November 17, 2026: Billing team must access the complete policy update 26-1060 from the Provider Library to identify all specific injectable medication HCPCS codes affected (11 new codes, 27 updated codes, 15 new biosimilar codes, and 6 new generic codes). Update the billing system and charge master with the new and revised HCPCS codes and their corresponding DOFR category assignments to ensure claims are routed to the correct division of financial responsibility. Verify that all injectable medication billing reflects the correct DOFR categorization per the updated crosswalk. Failure to implement these changes will result in claims being billed to incorrect financial responsibility categories and potential claim denials or payment delays. Notify all providers and clinical staff of code changes impacting their specialties.