Medicare Coverage of Epoetin Alfa (Procrit) for Preoperative Use

50.5.2.2 - Medicare Coverage of Epoetin Alfa (Procrit) for Preoperative Use (Rev. 1, 10-01-03) PM-AB-99-59, Dated 8/1/99 This instruction pertains exclusively to the preoperative surgical indication of the drug Procrit, in which it is administered to specific patients prior to surgery to reduce risk of transfusion. It does not affect Medicare policies related to other Food and Drug Administration (FDA) approved uses of Procrit. It is not a national coverage decision. Procrit as Preventive Service The A/B MAC (B) may determine that Procrit is covered for individuals who: 1. Are undergoing hip or knee surgery 2. Have an anemia with a hemoglobin between 10 and 13 mg/dL; 3. Are not a candidate for autologous blood transfusion; 4. Are expected to lose more than 2 units of blood; and 5. Have had a workup so that their anemia appears to be that of chronic disease. The preoperative use of Procrit may be afforded to these individuals when A/B MACs (B), exercising their discretion, determine that this treatment is reasonable and necessary. In other cases, Procrit is considered a preventive service and therefore not covered.