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Using J3490 for cyanocobalamin is a coding error that typically results in a denial or claim delay, since payers expect J3420 for this drug

Very low or high blood levels of homocysteine can indicate a B12, folate, and/or B6 deficiency (21)

When neurological symptoms are present, more intensive treatment is required: 1 mg hydroxocobalamin on alternate days until no further improvement occurs, followed by maintenance therapy every two months

When administered by qualified healthcare professionals using sterile equipment, Vitamin B12 injections have an excellent safety profile

Fortunately, this condition is very rare

A missing FDA listing does not prove that a product is safe, effective, legal for personal use, or made to drug-quality standards