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That is a structural change in the skin, not a surface effect, and it showed up on imaging within 12 weeks

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Section 425.118(b)(1) and (2) authorize ACOs to make additions or deletions to their ACO participant lists, and 425.118(b)(3) authorizes CMS to make annual adjustments based upon ACO participant list additions or deletions for purposes of the ACO's assignment, historical benchmark, financial calculations, and quality reporting