Addition to lower extremity, pelvic and thoracic control, gluteal pad, each
Coverage Code: Carrier judgment
Action Code: No maintenance for this code
Date Added: January 1, 1986
Effective Date: January 1, 1996
Termination Date:
Coverage Code: Carrier judgment
Action Code: No maintenance for this code
Date Added: January 1, 1986
Effective Date: January 1, 1996
Termination Date: