Gauze, non-impregnated, non-sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., without adhesive border, each dressing
Short Description: Non-sterile gauze>16<=48 sq Coverage Code: Special coverage instructions apply
Action Code: No maintenance for this code
Date Added: January 1, 1997
Effective Date: January 1, 2003
Termination Date: