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 NetMedicaid · Billing Codes · Pharmacy · CA · PharmacyHigh impact

26-1062sum 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/Community Health Plan of Imperial Valley 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, plus 3 DOFR categorization corrections. Billing teams must obtain and implement the complete crosswalk update (26-1062) to ensure accurate coding and financial responsibility assignment for all injectable medication claims.

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 · 9 steps
01Billing team must access the complete Injectable Medication HCPCS/DOFR Crosswalk update (26-1062) from the Provider Library (Medi-Cal > Provider Updates and Notices) and implement all changes in the billing system, including.
02Add 11 new injectable medications with correct HCPCS codes and DOFR categories.
03Update 27 existing injectable medication procedure codes with new DOFR assignments.
04Add 15 new biosimilars and their crosswalk mappings.
05Add 6 new generic medications.
06Correct DOFR categorization for 3 existing injectable codes.
07Update 21 code descriptions.
08Update all billing software, fee schedules, and encounter templates to reflect the new crosswalk before processing claims with service dates on or after November 17, 2026.
09Providers without internet access should email Provider Communications to request a print copy.
If missed: Failure to implement these changes will result in incorrect DOFR assignment, potential claim denials, and billing delays for injectable medications.

Original notice

26-1062sum 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 · Pharmacy26-1060sum 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