A4724 Dialys sol fld vol > 3999cc

Dialysate solution, any concentration of dextrose, fluid volume greater than 3999 cc but less than or equal to 4999 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