B12 Injections (Hydroxocobalamin)

If lab shows that it is deficient, it is billable to insurance by the practitioner. Otherwise, $32.44/injection.

Overview: Vitamin B12 is a water-soluble vitamin that is essential for neurological function, red blood cell production, enzyme synthesis and DNA formation. It is used by every cell in the body but many people have deficient or sub-optimal amounts.

Dietary Sources: It is mostly found in a variety of animal and dairy products such as beef liver, fish, milk, clams, eggs and fortified plant foods. Vegetarians and especially vegans are therefore vulnerable to inadequate dietary intake. But even when enough B12 is consumed, deficiency can emerge because of absorption issues.

Successful absorption requires the successful completion of several different steps: The stomach secretes a special molecule called intrinsic factor for the sole purpose of facilitating absorption further down the digestive tract. Various problems with the stomach and small intestine can therefore contribute to the gradual depletion of B12 levels in the body. An inflamed stomach often does not secrete adequate amounts of intrinsic factor. Reduced absorption of the B12-intrinsic factor complex can be caused by various gastrointestinal conditions including Crohn’s disease, celiac disease, intestinal bacterial overgrowth and intestinal parasites. The use of acid-reducing medications is a significant and increasing cause of Vitamin B12 deficiency.

Testing: B12 levels in the body can be determined using a simple blood test. Most labs use a normal range of 200-1200 ng/mL, but reversible symptoms of deficiency can be seen in patients whose blood levels fall within this range.

Signs and symptoms: Many common symptoms can be caused by vitamin B12 deficiency, including weakness, tiredness, lightheadedness, heart palpitations, shortness of breath, pallor (pale skin), diarrhea, decreased appetite, nerve problems like numbness or tingling, visual changes and psycho-emotional problems like depression, memory loss or behavioral changes.

Cost and Coverage: Because the above symptoms are common and sometimes responsive to treatment even when the blood levels could be considered normal, some doctors began administering injections frequently to their patients. This caught the attention of the insurance companies which have mostly stopped covering the cost of B12 injections, sometimes even in the case of unambiguous deficiency that is refractory to oral supplements. For these reasons, the Sound Clinic will only attempt to bill insurance for the cost of a B12 injection if we are in possession of a recent lab result showing a lever of less than 200 ng/mL.

Details and Options: The usual B12 injection is hydroxocobalamin 1 mg (1,000 mcg) administered intramuscularly (IM). Weekly IM administration is sometimes recommended in more severe cases. We also offer a sublingual dissolving tablet that is available as a nutritional supplement. Aggressive oral supplementation can sometimes overcome malabsorption. Nevertheless, injections are still considered a reasonable starting point because they can foster a more rapid recovery and because even a temporary improvement in symptoms can corroborate a presumptive diagnosis.