Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing
Medicare coverage: Special coverage instructions apply
Status: active (July 2026 file)
MUE: max 0 units per day (practitioner), rationale: CMS Policy