A4723

Dialysate solution, any concentration of dextrose, fluid volume greater than 2999 cc but less than or equal to 3999 cc, for peritoneal dialysis

Short Description: Dialys sol fld vol > 2999cc

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:

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