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Geographic GPCI adjustments at the MAC level modify both rates from the national averages listed above

Oral B12 supplementation: High-dose oral cyanocobalamin (10002000 micrograms daily) represents an alternative for patients with dietary deficiency or those without severe deficiency or neurological symptoms, and for those unable or unwilling to receive injections

In the CY 2017 OPPS/ASC final rule with comment period (81 FR 79796), we clarified that the reporting ratio does not apply to codes with status indicator Q4 because services and procedures coded with status indicator Q4 are either packaged or paid through the Clinical Laboratory Fee Schedule and are never paid separately through the OPPS

If absorption is a concern, consider B12 Boost by Lipo Naturals