Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 48 sq. in., without adhesive border, each dressing
Short Description: Gauze > 48 in no w/sal w/o b
Coverage Code: Special coverage instructions apply
Action Code: No maintenance for this code
Date Added: January 1, 1997
Effective Date: January 1, 2009
Termination Date: