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Treatments to reduce the burden of mast cells in angiolipomas such as histamine 1 and/or histamine 2 receptor blockers, montelukast, non-steroidal anti-inflammatory drugs, antihistaminergic bioflavonoids such as quercetin or pycnogenol, amphetamines, and possibly stronger immunosuppressants that have been used for mastocytosis such as sunitinib (208) or mast cell activation syndrome such as tofacitinib (209) or imatinib (210) may provide benefit for pain and growth of angiolipomas

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Response: While we understand the commenters' concerns, section 1833(t)(3)(F)(i) of the Act requires that after determining the OPD fee schedule increase factor under subparagraph (C)(iv), the Secretary shall reduce such increase factor by the productivity adjustment described in section 1886(b)(3)(B)(xi) of the Act