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Elevated MMA levels in patients with vitamin B12 deficiency can contribute to myelin damage (myelopathy) and, consequently, peripheral and autonomic neuropathy ( Cobalamin deficiency can lead to neurological manifestations such as progressive axonal demyelination, impaired peripheral and sensory nerve function, areflexia, loss of proprioception and vibration sensitivity, and subacute combined spinal cord degeneration (70)

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Commenters explained that the resulting decrease in payment would not cover the costs to provide the service, especially because the modeling service described by HCPCS code G0562 happens on a different day than the treatment, but on the same high-cost device as the treatment