Levocarnitine for use in the Treatment of Carnitine Deficiency in ESRD Patients

Intravenous levocarnitine is covered for ESRD patients on dialysis (minimum 3 months) when there is documented carnitine deficiency and when used for erythropoietin-resistant anemia or intradialytic hypotension that interferes with dialysis (hypotension occurring ≥2 treatments in 30 days). Continued coverage requires documented pre-dialysis plasma free carnitine levels and physician certification (including that levels would fall below 40 µmol/L and symptoms would recur if stopped), and treatment must show improvement within 6 months or it will not be covered. All other indications for levocarnitine in the ESRD population are non-covered.

"Intravenous levocarnitine is covered for ESRD patients on dialysis who have documented carnitine deficiency (documented plasma free carnitine level per medical record)."

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