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Some commenters suggested CMS consider all care coordination services as health promotion services and stated that these services are not subject to copayments

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Haematological symptoms are among the earliest manifestations and include: Fatigue and generalised weakness Pallor due to anaemia (which may be macrocytic, though this is not universal) Shortness of breath on exertion Palpitations or tachycardia Neurological symptoms can be particularly concerning and may include: Peripheral neuropathy with tingling, numbness, or burning sensations in the hands and feet (paraesthesia) Loss of vibration sense and proprioception Ataxia and difficulty with balance or coordination Cognitive impairment, including memory problems and difficulty concentrating Mood disturbances, including depression and irritability In patients with diabetes, distinguishing between diabetic neuropathy and B12 deficiency-related neuropathy can be challenging, as both conditions may coexist

Administer 1 to 3 days after birth