Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 cc, for peritoneal dialysis
Short Description: Dialys sol fld vol > 3999cc
Coverage Code: Special coverage instructions apply
Action Code: No maintenance for this code
Date Added: January 1, 2002
Effective Date: January 1, 2015
Termination Date: