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Response: As discussed in the previous response, we stated in the CY 2023 PFS final rule (87 FR 69711 through 69720) that the burden of the JW and JZ modifier requirements is not a recent occurrence, as the JW modifier policy has been in place since 2017 and was codified in the CY 2023 final rule without change

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The importance of fumarate hydratase mutation for cancer survival and growth is being studied in depth to completely understand the role of fumarate as a tumorigenic oncometabolite

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