Provider Information

Referral information

• Requirements:

  • Complete order

  • Authorization

  • 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)

Insurance for providers

• Our POS(place of service) is outpatient on campus hospital (22)

• We are a department of Kaweah Health and fall under Kaweah Health NPI and Tax ID, please call if you need these numbers to obtain authorization.

• Physical address is 325 South Willis Avenue, Visalia. Billing address is 400 West Mineral King Avenue, Visalia

  • Either of the addresses will work when obtaining authorization.

• Common billing codes needed:
  • Administration codes: 96365 for 1^st 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 1^st 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 co and our insurance team approve the letter of agreement then we can proceed with treating the patient here.
  • 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