MedicaidBilling CodesHigh impact
26-1061sum 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 California has updated the Injectable Medication HCPCS/DOFR (Division of Financial Responsibility) Crosswalk effective November 17, 2026, adding 11 new injectable medications, 15 new biosimilars, 6 new generic medications, and making 27 updates to existing codes with 3 DOFR categorization corrections. Billing teams must obtain and implement the complete crosswalk update (26-1061) to ensure accurate claims processing and proper financial responsibility assignments for injectable medications.
Action Required
By November 17, 2026: Billing team must obtain the complete Injectable Medication HCPCS/DOFR Crosswalk update (26-1061) from the Provider Library and update the billing system with all new codes and DOFR categorizations. Specifically: (1) Add 11 new injectable medications with their HCPCS codes and DOFR assignments to the billing system; (2) Add 15 new biosimilars and their corresponding codes; (3) Add 6 new generic medications; (4) Update 27 existing injectable medication procedure codes with new HCPCS/DOFR mappings; (5) Correct DOFR categorization for 3 current injectable codes; (6) Update 21 code descriptions for accuracy. Verify that all claims for dates of service on or after November 17, 2026 use the updated crosswalk. Claims billed with outdated DOFR assignments or missing new codes will process with incorrect financial responsibility, potentially resulting in denials or payment delays. Providers without internet access should request the print copy from Provider Communications immediately. This applies to all Participating Physician Groups (PPGs) in Fresno, Kings, and Madera counties.