Pharmacy Question for the Week of February 4, 2019

Question:

When is Procrit covered for a patient?

Answer:

A Medicare Part B contractor may determine that Procrit is covered for individuals who:

Are undergoing hip or knee surgery
Have an anemia with a hemoglobin between 10 and 13 mg/dL
Are not a candidate for autologous blood transfusion
Expected to lose more than 2 units of blood and
Have had a workup so that their anemia appears to be that of chronic disease.

In other cases, Procrit is considered a preventive service and therefore not covered.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

CPT is a registered trademark of the American Medical Association.

Pharmacy Question for the Week of February 4, 2019

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