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Three things aren’t included and must be billed separately: the medication injected (billed via HCPCS J-codes), ultrasound guidance (if used, switch to CPT 20611 with permanent recording and reporting), and a separately identifiable evaluation and management service when a distinct clinical problem is addressed with modifier 25
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Once administered intramuscularly—typically into the deltoid or gluteal muscle—hydroxocobalamin (the form most commonly used in the UK) enters the bloodstream rapidly
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