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Further, since the adjustment for SAHS billing activity would occur prior to the issuance of an initial determination, we would not reopen an initial determination to adjust for payment amounts excluded under the SAHS billing activity policy

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For people with already adequate B12 levels, additional B12 supplementation provides minimal benefit since the body simply excretes what it does not need

Second, it argues against a pure placebo effect, because placebo responses tend to diminish more gradually