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After reviewing literature and conducting a two-round Delphi survey with 42 experts, a consensus emerged that emphasizes prioritizing clinical symptoms in diagnosis, with serum B12 as a screening marker supported by methylmalonic acid or homocysteine levels for additional confirmation

Therefore, utilizing this methodology, we finalized in the CY 2025 OPPS/ASC final rule with comment period (89 FR 93977 through 93980) our policy to reduce the CY 2024 target PCR of 0.88 by 1 percentage point and finalized a cancer hospital target PCR of 0.87 for CY 2025