Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing
Short Description: Gauze >16<=48 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: