CMS Granulocyte Transfusions Form

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/mm³ whole blood. Accepted indications for granulocyte transfusions include:

• Granulocytopenia with evidence of gram negative sepsis; and
• Granulocytopenia in febrile patients with local progressive infections unresponsive to appropriate antibiotic therapy, thought to be due to gram negative organisms.