When is Procrit covered for a patient?
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.