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B12 is needed for mitochondrial energy production, and for detoxification

classified as a compounded drug with active import alerts Human trial evidence / Zero completed Phase II or III RCTs in any condition as of 2025 Tumor-promotion signal / Rat models show accelerated solid-tumor growth at supraphysiologic doses Cardiovascular concern / Dual vasomotor activity reported: hypotension at low doses, hypertension at high doses in rodents Hormonal interference / Modulates dopamine and serotonin pathways

Chen and Zhang 2019

After consideration of the public comments we received, we are finalizing, without modification, our proposal that, effective January 1, 2026, nonexcepted off-campus PBDs use the revised radiation treatment CPT codes described in the CY 2026 PFS proposed rule and append modifier PN to each applicable claim line for nonexcepted items and services

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