LCD/NCD Portal

NCD110.5

 

GRANULOCYTE TRANSFUSIONS

 

Effective Date of this Version

• This is a longstanding national coverage determination. The effective date of this version has not been posted.

 

Benefit Category

• Inpatient Hospital Services.

• Outpatient Hospital Services Incident to a Physician's Service.

• Physicians' Services.

• Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.

 

Indications and Limitations of Coverage

• Granulocyte transfusions to patients suffering from severe infection and granulocytopenia are a covered service under Medicare.

• Granulocytopenia is usually identified as fewer than 500 granulocytes/mm 3 whole blood.

• Accepted indications for granulocyte transfusions include:

o Granulocytopenia with evidence of gram negative sepsis.

o Granulocytopenia in febrile patients with local progressive infections unresponsive to appropriate antibiotic therapy, thought to be due to gram negative organisms.

 

Medicare NCD Link