A4720 Dialysat sol fld vol > 249cc

Dialysate solution, any concentration of dextrose, fluid volume greater than 249 cc, but less than or equal to 999 cc, for peritoneal dialysis

• Medicare coverage: Special coverage instructions apply
• Status: active (July 2026 file)
• MUE: max 0 units per day (practitioner), rationale: CMS Policy