ICD-10-CM Codes that Support Medical Necessity, ICD-10-CM Codes that DO NOT Support Medical Necessity, REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; UP TO AND INCLUDING 15 LESIONS, REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY AREA; EACH ADDITIONAL 10 LESIONS, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE), SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 2.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 2.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM, SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER OVER 2.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.5 CM OR LESS, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 0.6 TO 1.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 1.1 TO 2.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 2.1 TO 3.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER 3.1 TO 4.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), TRUNK, ARMS OR LEGS; EXCISED DIAMETER OVER 4.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.5 CM OR LESS, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 0.6 TO 1.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 1.1 TO 2.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 2.1 TO 3.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER 3.1 TO 4.0 CM, EXCISION, BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; EXCISED DIAMETER OVER 4.0 CM, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.5 CM OR LESS, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 0.6 TO 1.0 CM, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 1.1 TO 2.0 CM, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 2.1 TO 3.0 CM, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER 3.1 TO 4.0 CM, EXCISION, OTHER BENIGN LESION INCLUDING MARGINS, EXCEPT SKIN TAG (UNLESS LISTED ELSEWHERE), FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; EXCISED DIAMETER OVER 4.0 CM, DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); FIRST LESION, DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES); SECOND THROUGH 14 LESIONS, EACH (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST LESION), DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES), 15 OR MORE LESIONS, DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); LESS THAN 10 SQ CM, DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); 10.0 TO 50.0 SQ CM, DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, LASER TECHNIQUE); OVER 50.0 SQ CM, DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; UP TO 14 LESIONS, DESTRUCTION (EG, LASER SURGERY, ELECTROSURGERY, CRYOSURGERY, CHEMOSURGERY, SURGICAL CURETTEMENT), OF BENIGN LESIONS OTHER THAN SKIN TAGS OR CUTANEOUS VASCULAR PROLIFERATIVE LESIONS; 15 OR MORE LESIONS, CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE, Hospital Inpatient (Including Medicare Part A), Hospital Inpatient (Medicare Part B only), Operating Room Services - General Classification, Operating Room Services - Other OR Services, Ambulatory Surgical Care - General Classification, Ambulatory Surgical Care - Other Ambulatory Surgical Care, Freestanding Clinic - General Classification, Professional Fees - General Classification, Professional Fees - Other Professional Fee. I have a strange spot growing on my chest that I would like to go to the dermatologist for body screening. Verrucosis of hands and feet in a patient with combined immune deficiency. The removal of a skin lesion can range from a simple biopsy, scraping or shaving of the lesion, to a radical excision that may heal on its own, be closed with sutures (stitches) or require reconstructive techniques involving skin grafts or flaps. Medicare is a U.S. federal. You might like to read: What Is a Medicare Audit? The Part A deductible is $1,484 in 2021 . recommending their use. Medicare does not cover cosmetic surgery procedures. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. Applicable FARS/HHSARS apply. Many doctors have the option to freeze the wart and cut it off. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. Before an LCD becomes final, the MAC publishes Proposed LCDs, which include a public comment period. You agree to take all necessary steps to insure that your employees and agents abide by the terms of this agreement. does medicare cover milia removal. Primary milia in older children and adults Cysts can be found around the eyelids, forehead, and on the. Costs. In some cases, a biopsy of the lesions may be necessary. These products can cause blackheads and even milia to form because of the reaction your skin has to the products. It may be treated with microdermabrasion or topical retinoids, depending what type of treatment your dermatologist deems best. Then your doctor will gently open the milia with a small needle. LCD document IDs begin with the letter "L" (e.g., L12345). These bumps will form when keratin is trapped under the skin, and that gives the bumps the white appearance you see. In no event shall CMS be liable for direct, indirect, special, incidental, or consequential damages arising out of the use of such information or material. LCDs are specific to an item or service (procedure) and they define the specific diagnosis (illness or injury) for which the item or service is covered. In fact I just removed one from my anesthesiologist in the break room between cases yesterday. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. been made to provide accurate and complete information, CMS does not guarantee that there are no errors in the information displayed Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. "JavaScript" disabled. Original Medicare does not pay for routine dermatology care unless medically necessary. So if it comes to the point where the bumps are really bothering someone, they may then decide to go to the doctor to talk about treatment. There are a few things you can do to stop it from coming back so that you dont have to continually have treatments. The Tracking Sheet provides key details about the Proposed LCD, including a summary of the issue, who requested the new/updated policy, links to key documents, important process-related dates, who to contact with questions about the policy, and the history of previous policy considerations. When Medicare covers dermatology services, Part B usually provides. The decision to submit a specimen for pathologic interpretation will be independent of the decision to remove or not remove the lesion. According to some posts from the Realself.com forum, the cost of milia removal is $130 to $160. It is assumed, however, that a tissue diagnosis will be part of the medical record when an ultimately benign lesion is removed based on physician uncertainty as to the final clinical diagnosis. Revision Explanation: Annual Review, no changes were made. For inpatient hospital claims, the admitting diagnosis is required and should be recorded in FL 69. Medicare Part A hospital insurance covers inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. This email will be sent from you to the Some cases of this condition will be severe enough to warrant ongoing prescriptions for topical retinoids, but other cases may be minor enough that you can treat it without a prescription. No fee schedules, basic unit, relative values or related listings are included in CPT. Medicare Advantage products: The following National Coverage Determination . Lesion clinically restricts eye function, for example, but not limited to: lesion causes misdirection of eyelashes or eyelid. However, Medicare pays for skin exams following a biopsy because it is not a routine service. However, finding the answer Can You Be Denied a Medicare Supplement Plan? You may wish to contact your doctor first, though, if you dont want to wait for the options at the drug store to work. We will answer your questions and compare rates at no cost to you. CPT codes, descriptions and other data only are copyright 2022 American Medical Association. Copyright © 2022, the American Hospital Association, Chicago, Illinois. In most instances Revenue Codes are purely advisory. Doing so will ensure coverage of services and confirm costs. Billing and Coding articles provide guidance for the related Local Coverage Determination (LCD) and assist providers in submitting correct claims for payment. will not infringe on privately owned rights. However, Medicare will cover the cost of cyst removal when medically necessary. The views and/or positions Procedures it does not cover. Compare rates side by side with plans & carriers available in your area. Paying for medical procedures out of pocket can seem expensive, but if you want to take good care of your skin and have it looking its best then this investment may be the best option for your health in the long run. Does Medicare Cover Mole Removal? If a doctor performs a skin cancer screening, Medicare Part B may cover some costs. Marcil I, Stern RS. CPT is a trademark of the American Medical Association (AMA). Keratin provides resistance to the skin, nails, and hair. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt. PDF Benign Skin Lesion Removal - Paramount Health Care The physician should explain to the patient, in advance, that Medicare will not cover cosmetic cutaneous surgery and that the beneficiary will be liable for the cost of the service. Use is limited to use in Medicare, Medicaid or other programs administered by the Centers for Medicare and Medicaid Services (CMS). Original Medicare will cover allergy tests given to treat a specific allergen. Instructions for enabling "JavaScript" can be found here. Specialists may remove a mole, whether it is cancerous or for appearance-related reasons. The views and/or positions presented in the material do not necessarily represent the views of the AHA. copied without the express written consent of the AHA. If you are acting on behalf of an organization, you represent that you are authorized to act on behalf of such organization and that your acceptance of the terms of this agreement creates a legally enforceable obligation of the organization. If a doctor orders a thyroid test while a person is an inpatient, Medicare Part A covers the cost after a person has met their deductible. The license granted herein is expressly conditioned upon your acceptance of all terms and conditions contained in this agreement. All Rights Reserved (or such other date of publication of CPT). June 22, 2022; justin jefferson under armour contract; guardala mouthpiece history; does medicare cover milia removal . Please do not use this feature to contact CMS. The patient's medical record must contain documentation that fully supports the medical necessity for services included within this LCD. CMS DISCLAIMS RESPONSIBILITY FOR ANY LIABILITY ATTRIBUTABLE TO END USER USE OF THE CPT. What Are Milia? - American Academy of Ophthalmology: Protecting Sight The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. Some cosmetic procedures that Medicare generally doesn't cover include hair loss treatment and cosmetic surgery. Any information we provide is limited to those plans we do offer in your area. Harrisons Practice; Kasper, Braunwald, Fauci, Hauser, Longo, Jameson (eds). Revision Explanation: Annual Review, no changes made. Medicare Advantage Plans Reimbursement is allowed for procedures 11200 and 11201 according to CMS local coverage determination. They are also popularly called fat spots. authorized with an express license from the American Hospital Association. copied without the express written consent of the AHA. an effective method to share Articles that Medicare contractors develop. Your MCD session is currently set to expire in 5 minutes due to inactivity. closing in garage door opening ideas Uncategorized does medicare cover milia removal. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Posted by June 8, 2022 real police badge vs fake on does medicare cover milia removal June 8, 2022 real police badge vs fake on does medicare cover milia removal presented in the material do not necessarily represent the views of the AHA. There are different article types: Articles are often related to an LCD, and the relationship can be seen in the "Associated Documents" section of the Article or the LCD. End User Point and Click Amendment: This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. Although it can be tempting as a milia removal option, this skin trauma increases the risk of infection and can lead to scarring. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. special, incidental, or consequential damages arising out of the use of such information, product, or process. Original Medicare will cover allergy tests given to treat a specific allergen. Please visit the. This page displays your requested Local Coverage Determination (LCD). To submit a comment or question to CMS, please use the Feedback/Ask a Question link available at the bottom Please do not use this feature to contact CMS. Karagas MR, Stukel TA, Greenberg ER, Baron JA, Mott LA, Stern RS. Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. If you decide that you want to go through with having the treatment at your doctors office, you may be wondering exactly what is going to happen and what to expect when going to the office. The code lists in the article help explain which services (procedures) the related LCD applies to, the diagnosis codes for which the service is covered, or for which the service is not considered reasonable and necessary and therefore not covered. Draft articles are articles written in support of a Proposed LCD. such information, product, or processes will not infringe on privately owned rights. Please review and accept the agreements in order to view Medicare Coverage documents, which may include licensed information and codes. Neither the United States Government nor its employees represent that use of As used herein, "you" and "your" refer to you and any organization on behalf of which you are acting. Reproduced with permission. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. An asterisk (*) indicates a Wart removals is not considered cosmetic when guidelines above are met or if any of the following clinical circumstances are present: Periocular warts associated with chronic recurrent conjunctivitis thought secondary to lesion virus shedding, Warts showing evidence of spread from one body area to another, particularly in immunosuppressed patients or warts of recent origin in an immunocompromised patients, Lesions are condyloma acuminata or molluscum contagiosum, Cervical dysplasia or pregnancy is associated with genital warts. 7500 Security Boulevard, Baltimore, MD 21244, Find a Medicare Supplement Insurance (Medigap) policy. Medical records maintained by the physician must clearly document the medical necessity for the lesion removal(s) if Medicare is billed for the service. Applicable FARS\DFARS Restrictions Apply to Government Use. Screening procedures are for asymptomatic conditions, which Original Medicare does not cover. does medicare cover milia removal - kaoparts.com on this web site. You might also like our articles about the cost of sebaceous cyst removal, acne treatments, or mole removal.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'thepricer_org-box-4','ezslot_3',137,'0','0'])};__ez_fad_position('div-gpt-ad-thepricer_org-box-4-0');if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[300,250],'thepricer_org-box-4','ezslot_4',137,'0','1'])};__ez_fad_position('div-gpt-ad-thepricer_org-box-4-0_1');.box-4-multi-137{border:none!important;display:block!important;float:none!important;line-height:0;margin-bottom:7px!important;margin-left:auto!important;margin-right:auto!important;margin-top:20px!important;max-width:100%!important;min-height:250px;padding:0;text-align:center!important}. Does Medicare cover thyroid tests? - Medical News Today In: Subject to the terms and conditions contained in this Agreement, you, your employees and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. If you have had this condition for a while, or youre prone to it recurring, then you may be looking for a way to treat it on your own instead of having to go to your doctors every few months. All Rights Reserved. This revision is not a restriction to the coverage determination; and, therefore not all the fields included on the LCD are applicable as noted in this policy. Applications are available at the American Dental Association web site. Drawings or diagrams to describe the precise anatomical location of the lesion are helpful. The Tracking Sheet modal can be closed and re-opened when viewing a Proposed LCD. Sometimes, a large group can make scrolling thru a document unwieldy. In this sense, it is recommended to request an opinion from a specialist in chemical peels, taking into account the type of product used. Cosmetic procedures are services that enhance the appearance of the individual undergoing treatment. Eczema, psoriasis, cutaneous infections, acne, and other common skin disorders. You can use the Contents side panel to help navigate the various sections. You'll have to pay for the items and services yourself unless you have other insurance. Any questions pertaining to the license or use of the CPT should be addressed to the AMA. lesion restricts lacrimal puncta and interferes with tear flow; Clinical uncertainty as to the likely diagnosis, particularly where malignancy is a realistic consideration based on lesion appearance. The CMS.gov Web site currently does not fully support browsers with For this reason, it's very unlike that insurance (even private insurance) will cover the cost to do it. A Draft article will eventually be replaced by a Billing and Coding article once the Proposed LCD is released to a final LCD. Skin cleansing treatments should be used to avoid clogging pores (steam treatments, facial cleansing, peeling, etc. For some people, they are just more prone to having it due to extra keratin building up on their skin and clogging their pores. Usually, this procedure is not covered by health insurance because it isnt considered a medical necessity, but a cosmetic one. The intrinsic nature of the lesion will determine whether more frequent treatments are required.This utilization guideline applies to all conditions within this LCD other than actinic keratosis. Article document IDs begin with the letter "A" (e.g., A12345). Produced by NetOn-Line Services. Continue with Recommended Cookies. Save my name, email, and website in this browser for the next time I comment. Instructions for enabling "JavaScript" can be found here. The AMA assumes no liability for data contained or not contained herein. not endorsed by the AHA or any of its affiliates. Guttman C. Routine destruction of AKs called unnecessary. Proposed LCD document IDs begin with the letters "DL" (e.g., DL12345). Your email address will not be published. Stephen Mandy, MD, says that the price for removing milia depends on the treatment you choose and its effectiveness. Euvrard S, Lanitakis J, Decullier E, et al. LCDs outline how the contractor will review claims to ensure that the services provided meet Medicare coverage requirements. Typically, you will be at your doctors office for about 30 to 45 minutes per session, and you may need multiple sessions to clear up the condition. The diagnostic procedures will likely be covered by Medicare Part B. does medicare cover milia removal - s227879.gridserver.com He went the extra mile. and/or making any commercial use of UB‐04 Manual or any portion thereof, including the codes and/or descriptions, is only The program covers drugs that are furnished "incident-to" a physician's service provided that the drugs are not "usually self-administered" by the patient.
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