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CMS states that healthcare providers should apply modifier 25 to evaluation and management services only when there exists an important and distinct service which needs evaluation on the same day

Pale or Jaundiced Skin: Due to reduced red blood cell production

But, what we do know from our own personal experience with thousands of customers, is that normal usage (drawing from an aluminum-wrapped vial, and injecting within a minute or two) does not render the B12 even remotely ineffective

**Anemia:** Management of certain types of anemia, particularly those related to vitamin B12 or folate deficiency

[DOI] [PMC free article] [PubMed] [Google Scholar] 82.Zhu, Y., Liu, J., Park, J., Rai, P

If you are experiencing symptoms of fatigue, weakness, or have concerns about your vitamin levels, our providers will work with you to determine if B12 testing or supplementation is appropriate