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A B12 deficiency can be difficult to diagnose and is commonly confused with a folate deficiency

To ensure that the estimated CY 2026 aggregate outlier payments would equal 1.0 percent of estimated aggregate total payments under the OPPS, we proposed that the hospital outlier threshold be set so that outlier payments would be triggered when a hospital's cost of furnishing a service exceeds 1.75 times the APC payment amount and exceeds the APC payment amount plus the fixed-dollar threshold

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Add to this the fact the procedure is often traumatic, I dont really like the results on most patients

Initial blood work revealed pancytopenia with a hemoglobin (Hgb) level of 4.9 g/dL and a mean corpuscular volume (MCV) of 80 fL, a WBC count of 2.99x10 3 /L, RBC count of 1.85x10 6 /L and thrombocytopenia with a PLT count of 142x10 3 /L