MedicaidBilling CodesHigh impact
26-1062sum 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/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.
Action Required
By November 17, 2026: Billing 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: (1) Add 11 new injectable medications with correct HCPCS codes and DOFR categories; (2) Update 27 existing injectable medication procedure codes with new DOFR assignments; (3) Add 15 new biosimilars and their crosswalk mappings; (4) Add 6 new generic medications; (5) Correct DOFR categorization for 3 existing injectable codes; (6) Update 21 code descriptions. Update 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. Providers without internet access should email Provider Communications to request a print copy. Failure to implement these changes will result in incorrect DOFR assignment, potential claim denials, and billing delays for injectable medications.