US · guidance
CMS Pub. 100-02, ch. 15, § 50.5.2.2
Medicare Coverage of Epoetin Alfa (Procrit) for Preoperative Use
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.
History
(Rev. 1, 10-01-03)
Provenance
- Source
- cms.gov
- Retrieved
- 2026-08-25
- Edition
- iom-2026-08-25
- Content hash
f432bcc46105e9494fb51713ed10b8468b0d649a66efc5b52e97154acdea09f4
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