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In addition, section 1833(t)(1)(B)(v) of the Act does not include applicable items and services (as defined in subparagraph (A) of paragraph (21)) that are furnished on or after January 1, 2017, by an off-campus outpatient department of a provider (as defined in subparagraph (B) of paragraph (21))

Hepatocellular injury, meaning damage to liver cells, releases stored vitamin B12 into the blood, and chronic liver disease reduces the clearance that normally keeps levels in check

The key vitamin B12 is significant in the energy production and health of nerves and red blood cells