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B12 Injections

Medicare Benefit Policy Manual (CMS Pub. 100-02, Ch. 7 §40.1.2.4A)External PDF

The services of a nurse to administer the vitamin B-12 injection safely and effectively may be covered if they are reasonable and necessary to the treatment of the following specific conditions:

Specified anemias: Specified gastrointestinal disorders: Certain neuropathies:
  • Pernicious anemia
  • Megaloblastic anemias
  • Macrocytic anemias
  • Fish tapeworm anemia
  • Gastrectomy
  • Malabsorption syndromes
  • Surgical and mechanical disorders such as resection of the small intestine, strictures, anastomosis and blind loop syndrome
  • Posterolateral sclerosis
  • Other neuropathies associated with pernicious anemia
  • During the acute phase or an acute exacerbation of a neuropathy due to malnutrition and alcoholism

The accepted reasonable and necessary dosage schedule for maintenance treatment for a patient with pernicious anemia caused by a B-12 deficiency is no more than once a month for an intramuscular or subcutaneous injection of vitamin B-12 at a dose of from 100 to 1000 micrograms. More frequent injections would be appropriate in the initial or acute phase of the disease until it has been determined through laboratory tests that the patient can be sustained on a maintenance dose.

Updated: 07.30.12

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