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.

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