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This suggests that youth who were not likely ever to smoke have become addicted to nicotine via vapes and other nicotine delivery systems such as nicotine pouches (i.e., Zonnic)

However, a time adjustment of 33 percent is made only for medical direction of two to four cases since that is the only situation where a single practitioner is involved with multiple beneficiaries concurrently, so that counting each service without regard to the overlap with other services would overstate the amount of time spent by the practitioner furnishing these services