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One may be a fully FDA-approved prescription drug used daily in hospitals, while another is an unapproved substance sold online with disclaimers placing all risk on the end user

For instance, in cases where an investigation, settlement agreement, or judgment has determined inaccurate use of a higher paying code [597] that is reflected in payment amounts used in Shared Savings Program calculations, we may identify use of a code with lower reimbursement within a HCPCS or CPT code category that would result in a more precise adjustment to the ACO's payment determination