- Complete order
- Patient demographics
- H&P or recent progress notes
- Medication list
- Labs as needed
- Insurance cards
- Additional requirements as noted by insurance (i.e. Medicare requires IVPB
form and documentation stating that patient cannot tolerate or failed
oral iron and the reason why)
Attach the following:
- Iron order set, Blood transfusion order set, Ocrevus order, Remicade order,
rituxan order, and blank order form for anything else (order must have
medication, dose, route, frequency, and administration time if applicable)
- Call office to obtain order sets
Outside Providers (Anyone within the State of California)
If you would like to refer your patient for infusion services we can accommodate
any provider within California by having you sign a Memorandum of Understanding (MOU)
- This is a mutual agreement between us and the ordering provider to administer
medication in collaboration with patient management while our center carries
out their specific orders
- Please call out center for more information
- Our POS (place of service) is outpatient on campus hospital
- We are a department of Kaweah delta and fall under Kaweah deltas NPI and
Tax ID, please call if you need these numbers to obtain authorization.
- Physical address is 325 South Willis Avenue, billing address is 400 W.
Mineral King Avenue - either of the addresses will work when obtaining
Common billing codes needed:
Venofer J1756 qty 1/1mg, Injectafer J1439 qty 1/1mg, Feraheme for ESRD
Q0139 qty 1/1mg , Feraheme for Non ESRD Q0138 qty 1/1mg , Infed J1750
qty 1/50mg , Remicade J1745 qty 1/10mg, Blood Transfusion 36430 qt 1/visit,
Ocrevus J2350 qty 1/1mg Rituxan J9312 qty 1/10mg
Administration codes: 96365 for 1st hour of infusion, 96366 qty 1 for EACH additional hour of infusion, 96374
IV push if purpose of treatment, 96375 if it is in addition to infusion
or separate from initial IV push, 96360 for hydration if it is the only
treatment being prescribed, 96361 for additional hours or if in addition
to infusion or IV push, 96523 for irrigation of implanted port where heparin
or other medication is being used, G0463 for dressing changes or irrigation
without medication. 96413 for chemo infusion 1st hour, 96415 qty 1 for EACH additional hour of chemo infusion. Please call
for clarification on any questions or if you need additional codes.
- Example: Venofer 300mg over 3 hours for 3 doses would need J1756 qty 900,
96365 qty 3, and 96366 qty 6.
- LOA - if your patients insurance is not contracted with Kaweah Delta Medical
center, a Letter of Agreement (LOA) or single case agreement will need
to be requested at the time of authorization. If the insurance company
and our insurance team approve the letter of agreement then we can proceed
with treating the patient here.
HERE for a list of insurances accepted.