Home and Community Based Services (HCBS) and Habilitation Billing Code Chart. For most services furnished in a physicians office, Medicare makes payment to physicians and other professionals at a single rate based on the full range of resources involved in furnishing the service. The Indiana Health Coverage Programs (IHCP) Professional Fee Schedule includes reimbursement information for providers that bill services using professional claims or dental claims reimbursed under the fee-for-service (FFS) delivery system. Behavior Analysis Fee Schedule. CMS defines services furnished in whole or in part by PTAs or OTAs as those for which the PTA or OTA time exceeds a de minimis threshold. Definition of split (or shared) E/M visits as E/M visits provided in the facility setting by a physician and an NPP in the same group. revisions to the repayment mechanism arrangement policy to reduce by 50 percent the percentage used in the existing methodology for determining the repayment mechanism amount. Our representatives are ready to assist you. CMS finalized its proposal to revise the current regulatory language for RHC or FQHC mental health visits to include visits furnished using interactive, real-time telecommunications technology. While we implemented this change through our usual change request process, we neglected to update this regulation when the Affordable Care Act amended the statute to except the coinsurance and deductible for preventive services defined under section 1861(ddd)(3) of the Act that have a grade of A or B from the United States Preventive Services Task Force and MNT services received a grade of B. We also finalized modifications to the threshold for determining whether an ACO is required to increase its repayment mechanism amount during its agreement period. lock CMS is making regulatory changes to implement this new reporting requirement. Medicare currently can only make payment to the employer or independent contractor of a PA. Beginning January 1, 2022, PAs may bill Medicare directly for their professional services, reassign payment for their professional services, and. Federal government websites often end in .gov or .mil. Choose an option. Instead, well provide and post to this website a sample data file in Excel .xls file format. Exhibit2 Final EO2 Version. HCPCS: Contractor: Locality: RVU: GPCI (PE) Base Rate: Urban Rate: Rural Rate: Date: Additionally, in order to avoid a significant decrease in the payment amount for methadone that could negatively affect access to methadone for beneficiaries receiving services at OTPs, CMS is issuing an interim final rule with comment to maintain the payment amount for methadone at the CY 2021 rate for the duration of CY 2022. Payment is also made to several types of suppliers for technical services, generally in settings for which no institutional payment is made. When medically necessary, critical care services can be furnished concurrently to the same patient on the same day by more than one practitioner representing more than one specialty, and critical care services can be furnished as split (or shared) visits. The CPI-U for 2022 is 5.4% and the MFP for Calendar Year (CY) 2022 is 0.3%. Practitioners must report modifier -25 on the claim when reporting these critical care services. Exhibit1A Final EO2 Version. website belongs to an official government organization in the United States. Adding a mandatory payment context field for records to teaching hospitals; Adding the option to recertify annually even when no records are being reported; Disallowing record deletions without a substantiated reason; Adding a definition for a physician-owned distributorship as a subset of applicable manufacturers and group purchasing organizations and updating the definition of ownership interest; Requiring reporting entities to update their contact information; Disallowing publication delays for general payment records; Clarifying the exception for short-term loans; and. Additionally, we are adopting coding and payment for a longer virtual check-in service on a permanent basis. See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF)for more information on how we calculate the urban base rate and mileage rate amounts. North Carolina. Ambulance Fee Schedule Clinical Laboratory Fee Schedule DMEPOS Fee Schedule Home Health PPS PC Pricer Hospice Payment Rates Hospice Pricer Tool Opioid Treatment Programs Payment Rates . The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely. identified in a July 2020 OIG report adhere to the lesser of methodology. There is an exception for payment under the FQHC PPS for certain tribal FQHCs in operation on or before April 7, 2000. Coverage and Payment for Medical Nutrition Therapy (MNT) Services and Related Services. We also finalized regulatory text at 410.72(f) to state the requirements for these NPPs to bill on an assignment-related basis by cross-reference to our general assignment regulation at 424.55. Section 122 of the CAA reduces, over time, the amount of coinsurance a beneficiary will pay for such services. In the PFS final rule, we are implementing the second phase of this mandate by finalizing in regulation certain exceptions to the EPCS requirement. For many diagnostic tests and a limited number of other services under the PFS, separate payment may be made for the professional and technical components of services. Durable Medical Equipment Fee Schedule - Excel: XLSX: 99: 01/01/2023 : Durable Medical Equipment Fee Schedule - PDF: PDF: 789.5: . Mental Health Services Furnished via Telecommunications Technologies for RHCs and FQHCs. the prescriber and dispensing pharmacy are the same entity; issues 100 or fewer controlled substance prescriptions for Part D drugs per calendar year, the prescriber is in the geographic area of an emergency or disaster declared by a federal, state or local government entity, or. Note: For additional information regarding Medicare payment for Medicare covered ambulance transportation services, please contact your local MAC. They are extended through December 31, 2024. The temporary add-on payment includes a 22.6% increase in the base rate for ground ambulance transports that originate in an area thats within the lowest 25th percentile of all rural areas arrayed by population density (known as the super rural bonus). the prescriber has been granted a CMS-approved waiver based on extraordinary circumstances, such as technological failures or cybersecurity attacks or other emergency. Some drugs approved through the pathway established under section 505(b)(2) of the Federal Food, Drug, and Cosmetic Act share similar labeling and uses with generic drugs that are assigned to multiple source drug codes. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Since January 1, 2002, registered dietitians and nutrition professionals have been recognized to provide and bill for MNT services, meaning nutritional diagnostic, therapeutic, and counseling services. Promulgated Fee Schedule 2022. [CR 12488] 2022 Medicare ambulance fee schedule -- Puerto Rico Modified: 11/18/2021 Overall, the de minimis standard would continue to be applicable in the following scenarios: Billing for Physician Assistant (PA) Services. FQHCs are paid under the FQHC Prospective Payment System (PPS) under Medicare Part B based on the lesser of the FQHC PPS rate or their actual charges. Effective January 1 of the year following the year in which the PHE ends, the payment rate for COVID-19 vaccine administration will be set at a rate to align with the payment rate for the administration of other Part B preventive vaccines. CMS finalized its proposal to allow RHCs and FQHCs to bill for TCM and other care management services furnished for the same beneficiary during the same service period, provided all requirements for billing each code are met. Payments are based on the relative resources typically used to furnish the service. Secure .gov websites use HTTPSA In addition to cases where one unit of a multi-unit therapy service remains to be billed, we revised the de minimis policy that would apply in a limited number of cases where there are two 15-minute units of therapy remaining to be billed. This content is for AAA members only. An exception will apply if a prescriber meets any of the following: We are allowing prescribers to request a waiver where circumstances beyond the prescribers control prevent the prescriber from being able to electronically prescribe controlled substances covered by Part D. CMS is also delaying the start date for compliance actions to January 1, 2023, in response to stakeholder feedback. For CY 2022, in response to numerous stakeholder questions and to promote proper therapy care, CMS is revising the policy for the de minimis standard. We are also finalizing delaying the increase in the quality performance standard ACOs must meet to be eligible to share in savings until PY 2024, by maintaining the 30th percentile of the MIPS quality performance category score for PY 2023, and additional revisions to the quality performance standard to encourage ACOs to report all-payer measures. CMS received a request from American Indian and Alaska Native communities to amend its Medicare regulations to make all IHS- and tribally-operated outpatient facilities/clinics eligible for payment at the Medicare outpatient per visit/AIR, if they were owned, operated, or leased by IHS. See Related Links below for information about each specific fee schedule. The purpose of the meeting is to obtain advice from CAC members and subject matter experts (SMEs) regarding the strength of published evidence on remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices and any compelling clinical data to assist in defining meaningful and measurable patient outcomes CMS finalized revisions to the repayment mechanism arrangement policy to reduce by 50 percent the percentage used in the existing methodology for determining the repayment mechanism amount. Secure .gov websites use HTTPSA All official fee schedule files that are used to process Medicare claims are maintained by the Medicare Administrative Contractors (MACs) and could vary slightly from the amounts referenced in these files. You can decide how often to receive updates. ( Fee Schedule: PDF: 683.4: 10/01/2022 : Zipped Fee Schedules - 3rd Quarter 2022: ZIP: . The addition of this regulation parallels the regulations in place for other types of NPPs listed at section 1842(b)(18)(C) of the Act. It can be seen at: Noridian Medicare JF Part A Fee Schedules. For CY 2022, in response to stakeholder concerns about parity of registered dietitians and nutrition professionals with other types of NPPs, we established regulations at 410.72 to describe their services. Critical care services are defined in the CPT Codebook prefatory language for the code set. Connecticut Provider Fee Schedule End User License Agreements. Section 405 of the CAA requires the Office of Inspector General (OIG) to conduct periodic studies on non-covered, self-administered versions of drugs or biologicals that are included in the calculation of payment under section 1847A of the Social Security Act. In-Home Administration of COVID-19 Vaccines. CMS is engaged in an ongoing review of payment for E/M visit code sets. On November 01, 2022, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates and policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, effective on or after January 1, 2023. CMS is implementing section 403 of the CAA, which authorizes Medicare to make direct payment to PAs for professional services that they furnish under Part B beginning January 1, 2022. Welfare and Institutions Code (W&I) Section 14105.191 mandates the application of the 1% and 5% reduction with certain exceptions as noted therein. Also beginning April 1, 2021, section 130 as amended requires that a payment limit per-visit be established for most provider-based RHCs in a hospital with fewer than 50 beds enrolled before January 1, 2021 be subject to a payment limit based on their 2020 per-visit rate, updated annually by the percentage increase in MEI. By 2023, the substantive portion of the visit will be defined as more than half of the total time spent. Current and Historical Fee Schedules Ambulatory Surgical Center (ASC) AzEIP Speech Therapy Behavioral Health Inpatient Behavioral Health Outpatient Clinical Laboratory (CLAB) Dental Dialysis Durable Medical Equipment FQHC and RHC Per Visit PPS Rates Home & Community Based Services (HCBS) Hospice Hospital-Based Freestanding Emergency Departments https:// The PFS conversion factor reflects the statutory update of zero percent and the adjustment necessary to account for changes in relative value units and expenditures that would result from our finalized policies. Under our existing regulations, if a resident participates in a service furnished in a teaching setting, a teaching physician can bill for the service only if they are present for the key or critical portion of the service. In the CY 2022 PFS final rule, we are establishing the following: For critical care services, we are refining our longstanding policies, establishing that: The AMA CPT office/outpatient E/M visit coding framework that CMS finalized for CY 2021 provides that practitioners can select the office/outpatient E/M visit level to bill based either on either the total time personally spent by the reporting practitioner or medical decision making (MDM). That is, the Medicare payment limit for the drug or biological billing code would be the lesser of: (1) the payment limit determined using the current methodology (where the calculation includes the ASPs of the self-administered versions), or (2) the payment limit calculated after excluding the non-covered, self-administered versions. Heres how you know. Although the increased specimen collection fees for COVID-19 CDLTs will end at the termination of the COVID-19 PHE, in the CY 2022 PFS proposed rule, we sought comments on our policies for specimen collection fees and the travel allowance as we consider updating these policies in the future through notice and comment rulemaking. The fee schedule applies to all ambulance services, including volunteer, municipal, private, independent, and institutional providers, hospitals, critical access hospitals (except when it is the only ambulance service within 35 miles), and skilled nursing facilities. For consistency in our regulations, we made conforming amendments to our regulations regarding assignment requirements for PAs, nurse practitioners, clinical nurse specialists, and certified nurse mid-wives at 410.74(d)(2), 410.75(e)(2), 410.76(e)(2) and 410.77(d)(2), respectively. CY 2022 PFS Ratesetting and Conversion Factor. Attachment to Order: Excerpt of CMS Ambulance Fee Schedule Public Use Files web page (including file layout and formula) Regulation sections 9789.70 & 9789.110 & 9789.111; Centers for Medicare and Medicaid Services CY 2021 Ambulance Fee Schedule File, which contains the following electronic files - Effective January 1, 2021: CY 2021 File (ZIP) Lastly, section 130 of the CAA subjects all newly enrolled RHCs (as of January 1, 2021, and after), both independent and provider-based, to a national payment limit per-visit. At present, the addition of any procedure beyond the planned colorectal screening (for which there is no coinsurance) results in a beneficiarys having to pay coinsurance. When both the PTA/OTA and the PT/OT each furnish less than 8 minutes for the final 15-minute unit of a billing scenario (the 10 percent standard applies). Ambulance Fee Schedule Public Use Files These AFS Public Use Files (PUFs) are for informational purposes only. When the PTA/OTA furnishes 8 minutes or more of the final 15-minute unit of a billing scenario in which the PT/OT furnishes less than eight minutes of the same service. CMS has released the "CY 2023 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicare and Medicaid Provider Enrollment Policies, Including for Skilled Nursing Facilities; Conditions of Payment for Suppliers of Durable Medicaid Equipment, Prosthetics, We finalized coverage for outpatient pulmonary rehabilitation services, paid under Medicare Part B, to beneficiaries who have had confirmed or suspected COVID-19 and experience persistent symptoms that include respiratory dysfunction for at least four weeks. These changes will result in lower required initial repayment mechanism amounts and less frequent repayment mechanism amount increases during an ACOs agreement period, thereby lowering potential barriers for ACOs participation in two-sided models and increasing available resources for investment in care coordination and quality improvement activities. Hours of Operation: Monday-Friday (Excluding Holidays) 7:45am - 4:30pm The reduction over time of the coinsurance percentage holds true regardless of the code that is billed for establishment of a diagnosis, for removal of tissue or other matter, or for another procedure that is furnished in connection with and in the same clinical encounter as the screening. Thus, beginning CY 2022, the coinsurance required of Medicare beneficiaries for planned colorectal cancer screening tests that result in additional procedures furnished in the same clinical encounter will be gradually reduced, and beginning January 1, 2030, will be zero percent. ACOs accepting performance-based risk must establish a repayment mechanism (i.e., escrow, line of credit, surety bond) to assure CMS that they can repay losses for which they may be liable upon reconciliation. On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. Ambulance Fee Schedule (Effective 1-1-23) APC/OPPS Rates (Effective 1 -1-23) ASC Fee Schedule (Effective 1-1 -23) Clinical Lab Fee Schedule (Effective 1-1-23) Critical Care Access Hospitals Fee Schedule (Effective 1-1-23) (Effective 2 -1-23) Dental Fee Schedule (Effective 1-1-23) Dialysis Fee Schedule (Effective 1-1-23) Section 3713 of the CARES Act established Medicare Part B coverage and payment for a COVID-19 vaccine and its administration. Exhibit4 Final EO2 Version. The Center of Medicare and Medicaid Services (CMS) requested that HHSC make modifications to the Ambulance UC protocol to restrict the ability of providers to claim costs in excess of those for direct medical care associated with uninsured charity care. Requiring Certain Manufacturers to Report Drug Pricing Information for Part B. The visit is billed by the physician or practitioner who provides the substantive portion of the visit. While we implemented this change through our usual change request process, we neglected to update this regulation when the Affordable Care Act amended the statute to except the coinsurance and deductible for preventive services defined under section 1861(ddd)(3) of the Act that have a grade of A or B from the United States Preventive Services Task Force and MNT services received a grade of B. Electronic Prescribing of Controlled Substances-Section 2003 of the SUPPORT Act. For the AFS public use files for calendar years 2004-2017, viewarchive and legacy files. A modifier is required on the claim to identify these services to inform policy and help ensure program integrity. For these limited cases, CMS is allowing one 15-minute unit to be billed with the CQ/CO modifier and one 15-minute unit to be billed without the CQ/CO modifier in billing scenarios where there are two 15-minute units left to bill when the PT/OT and the PTA/OTA each provide between 9 and 14 minutes of the same service when the total time is at least 23 minutes and no more than 28 minutes. or Catherine Howden, DirectorMedia Inquiries Form COVID-19 Antibody Infusion Therapy Fee Schedule: PDF - Excel . Private Nursing Care (per hour) Exhibit3 Final EO2 Version. Effective January 1, 2022, CMS will pay $30 per dose for the administration of the influenza, pneumococcal and hepatitis B virus vaccines. The professional fee schedule format lists procedure codes . Under the exception, grandfathered tribal FQHCs bill as if they were provider-based to an Indian Health Service (IHS) hospital and are paid the Medicare outpatient per visit rate, also referred to as the IHS all-inclusive rate (AIR). Modified: 1/10/2023. Author: Noridian Healthcare Solutions Last modified by: Shannon Suhonen Created Date: 1/3/2014 12:10:02 AM Other titles: AK AZ ID MT ND OR 01 OR 99 SD UT WA 02 WA 99 WY Company: In contrast, PFS rates paid to physicians and other billing practitioners in facility settings, such as a hospital outpatient department (HOPD) or an ASC, reflect only the portion of the resources typically incurred by the practitioner in the course of furnishing the service. Get fee schedule for an ambulance service code: State: Get Fee Schedule Payment rates are calculated to include an overall payment update specified by statute. Department of Vermont Health Access. Tribal FQHC Payments Comment Solicitation. Section 130 of the CAA as amended by section 2 of Pub. To date, manufacturers without such agreements have had the option to voluntarily submit ASP data. Revisions to the Medicare Ground Ambulance Data Collection Instrument. Section 1834 (l) (3) (B) of the Social Security Act mandates that the Medicare Ambulance Fee Schedule be updated each year to reflect inflation. See 42 CFR 414.610(c)(5)(i) for more information. Specifically, CMS revised policy would allow a 15-minute timed service to be billed without the CQ/CO modifier in cases when a PTA/OTA participates in providing care to a patient, independent from the PT/OT, but the PT/OT meets the Medicare billing requirements for the timed service on their own, without the minutes furnished by the PTA/OTA, by providing more than the 15-minute midpoint (that is, 8 minutes or more also known as the 8-minute rule). Medicare Ambulance Fee Schedule Rate Calculation The American Ambulance Association is pleased to announce the release of its updated 2022 Medicare Rate Calculator. Drug manufacturers with Medicaid Drug Rebate Agreements are required to submit Average Sales Price (ASP) data for their Part B products in order for their covered outpatient drugs to be payable under Part B. Rule 59G-4.002, Provider Reimbursement Schedules and Billing Codes. The updated definition will be applicable for determining beneficiary assignment beginning with PY 2022. That is, for services furnished on or after January 1, 2022, the coinsurance amount paid for planned colorectal cancer screening tests that require additional related procedures shall be equal to a specified percent (i.e., 20 percent for CY 2022, 15 percent for CYs 2023 through 2026, 10 percent for CYs 2027 through 2029, and zero percent beginning CY 2030) of the lesser of the actual charge for the service or the amount determined under the fee schedule that applies to the test. Posted in Government Affairs, Medicare, Member-Only, Reimbursement. 202-690-6145. Since 1992, Medicare payment has been made under the PFS for the services of physicians and other billing professionals. We also finalized. This provision permits CMS to apply a payment limit calculation methodology (the lesser of methodology) to applicable billing codes, if deemed appropriate. CMS is completing implementation of section 53107 of the Bipartisan Budget Act of 2018, which requires CMS, through the use of new modifiers (CQ and CO), to identify and make payment at 85 percent of the otherwise applicable Part B payment amount for physical therapy and occupational therapy services furnished in whole or in part by physical therapist assistants (PTAs) and occupational therapy assistants (OTAs) when they are appropriately supervised by a physical therapist (PT) or occupational therapist (OT), respectively for dates of service on and after January 1, 2022. Section 405 of the CAA also requires that beginning July 1, 2021, the ASP-based payment limit for billing codes representing Cimzia (certolizumab pegol) and Orencia (abatacept) as identified in a July 2020 OIG report adhere to the lesser of methodology. Effective for services rendered on or after January 1, 2023, the maximum reasonable fees for ambulance services shall not exceed 120% of the applicable California fees (as determined by the applicable locality / Geographic Area) set forth in the calendar year 2023 Medicare Ambulance Fee Schedule (AFS) File, and based upon the documents incorporated by reference. FQHC PPS Calculator . means youve safely connected to the .gov website. ) The following provisions demonstrate CMS commitment to addressing health equities in rural and vulnerable populations. Section 4103(2) of the Consolidated Appropriations Act, 2023 includes an extension of the temporary add-on payments under section 1834 (l)(13)(A) of the Social Security Act (the Act) that were set to expire on December 31, 2022. You can decide how often to receive updates. Promulgated Fee Schedule 2022. CMS finalized its proposal to implement section 132 of the CAA, which makes FQHCs and RHCs eligible to receive payment for hospice attending physician services when provided by a FQHC/RHC physician, nurse practitioner, or physician assistant who is employed or working under contract for an FQHC or RHC, but is not employed by a hospice program, starting January 1, 2022. Specifically, we requested comments regarding the nominal specimen collection fees related to the calculation of costs for transportation and personnel expenses for trained personnel to collect specimens from homebound patients and inpatients (not in a hospital), how specimen collection practices may have changed because of the PHE, and what additional resources might be needed for specimen collection for COVID-19 CDLTs and other tests after the PHE ends. Determination of ASP for Certain Self-administered Drug Products. Fee Schedule. We are implementing these statutory amendments, and finalizing that an in-person, non-telehealth visit must be furnished at least every 12 months for these services, that exceptions to the in-person visit requirement may be made based on beneficiary circumstances (with the reason documented in the patients medical record), and that more frequent visits are also allowed under our policy, as driven by clinical needs on a case-by-case basis. Make sure to check the Updates & Corrections tab for any changes to the Fee schedules. 7500 Security Boulevard, Baltimore, MD 21244, An official website of the United States government, Medicare Ground Ambulance Data Collection System, Ambulance Reasonable Charge Public Use Files, See the AFS final rule published in the Federal Register on February 27, 2002 (67 FR 9100) (PDF), See 42 CFR 414.610(c)(5)(i) for more information. This approach would be applied to section 505(b)(2) drug products where a billing code descriptor for an existing multiple source code describes the product and other factors, such as the products labeling and uses, are similar to products already assigned to the code. 2023 Medicare Part B physician fee schedule - Florida Loc 99 (01/02) downloadable version. We also finalized removing. Physician Fee Schedule Tool View and download fees, indicators, and descriptors. File specifications for FFS medical-dental fee schedule. They are extended through December 31, 2024. 2022 Ohio Ambulance Fee Schedule License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition End User/Point and Click Agreement: CPT codes, descriptions and other data only are copyright 2009 American Medical Association (AMA). In addition, CMS will maintain the current payment rate of $40 per dose for the administration of the COVID-19 vaccines through the end of the calendar year in which the ongoing PHE ends. Ambulance Fee Schedule A mbulance Fee Schedule Effective 4/1/23 - 3/31/24. Fee Schedules 2022 Fee Schedules Effective July 1, 2022 This site contains the policies, payment methods, billing codes, and maximum fees used to pay health care and vocational providers who treat injured workers. Section 2003 of the SUPPORT Act requires electronic prescribing of controlled substances (EPCS) for schedule II, III, IV, and V controlled substances covered through Medicare Part D. The statute provides the Secretary with discretion on whether to grant waivers or exceptions to the EPCS requirement and specifies several types of exceptions that may be considered. or D.O.). incorporate with other PAs and bill Medicare for PA services. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. Share sensitive information only on official, secure websites. Previously, the payment penalty phase of the AUC program was set to begin January 1, 2022. Removing the option to submit and attest to general payment records with an Ownership Nature of Payment category. If care is fully transferred from the surgeon to an intensivist (and the critical care is unrelated), the appropriate modifiers must also be reported to indicate the transfer of care. The IME Provider Fee Schedules are outlined below. Georgia Medicaid offers benefits on a Fee-for-Service (FFS) basis or through managed care plans. An official website of the United States government. We finalized that we will extend, through the end of CY 2023, the inclusion on the Medicare telehealth services list of certain services added temporarily to the telehealth services list that would otherwise have been removed from the list as of the later of the end of the COVID-19 PHE or December 31, 2021.
2022 medicare ambulance fee schedule
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