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Interestingly, it can take years for B12 stores to deplete to a point where a deficiency becomes apparent: Vitamin B12 deficiency affects multiple systems, and sequelae vary in severity from mild fatigue to severe neurologic impairment

Microdosing exists as a practitioner-directed modification based on clinical judgment, not regulatory endorsement

Comment: A commenter sought CMS guidance on its plans to ensure consistency across the Medicare Shared Savings Program (MSSP) in applying the revised definitions, providing updated technical specifications and training resources, and monitoring the impact of these changes on MSSP performance scores