Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Health NetCommercial · Billing Codes · Pharmacy · CA · PharmacyHigh impact

26-1060sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk

Act
by Nov 17, 2026
Effective date
Nov 17, 2026
Identified
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.

Get alerts when payers change rules like this one

We check Health Net and other payers every day and email you when a change matches your specialty and state.

Get Health Net alertsPolicy Monitoring is free. No card required.

What to do

by Nov 17, 2026 · 5 steps
01Billing 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).
02Update 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.
03Verify that all injectable medication billing reflects the correct DOFR categorization per the updated crosswalk.
04Failure to implement these changes will result in claims being billed to incorrect financial responsibility categories and potential claim denials or payment delays.
05Notify all providers and clinical staff of code changes impacting their specialties.

Original notice

26-1060sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR Crosswalk
providerlibrary.healthnetcalifornia.com · Always check the source before changing claims.
View original ↗

Related changes

See all Health Net changes →
26-1061sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR CrosswalkHighEffective Nov 17, 2026 · Pharmacy26-1062sum Summary Update: 3rd Quarter 2026 Injectable Medication HCPCS/DOFR CrosswalkHighEffective Nov 17, 2026 · Pharmacy26-827sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR CrosswalkHighEffective Sep 15, 2026 · Pharmacy26-828sum Summary Update: 2nd Quarter 2026 Injectable Medication HCPCS/DOFR CrosswalkHighEffective Sep 15, 2026 · PharmacyBrowse every Health Net change in the policy list

Related policy hubs

Health Net policiesCA policy changesPharmacy

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account