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Oregon Health Authority<br />
Division of Medical Assistance Programs<br />
Allowable NDCs <strong>for</strong> Diabetic Supply Billing - Effective 8/1/2011<br />
For <strong>billing</strong> guidelines and examples:<br />
Refer to OAR 410-122-0520 (Glucose Monitors and Diabetic Supplies) and the Diabetic Supply<br />
Billing Examples at www.dhs.state.or.us/policy/healthplan/guides/dme/main.html.<br />
NDC Code Labeler Name Label Name Desc<br />
15127099120 SELECT BRAND DISTRIBUTORS SB LANCETS ULTRA THIN<br />
15482033005 HYPOGUARD QUICKTEK CONTROL SOLUTION<br />
15482033050 HYPOGUARD QUICKTEK TEST STRIPS<br />
15482033100 HYPOGUARD QUICKTEK TEST STRIPS<br />
15482033110 HYPOGUARD QUICKTEK KIT<br />
15482041005 HYPOGUARD ADVANCE MICRO-DRAW CONTRL SOLN<br />
15482041012 HYPOGUARD HYPOLANCE AST LANCING KIT<br />
15482041012 HYPOGUARD HYPOLANCE AST LANCING KIT<br />
15482041050 HYPOGUARD ADVANCE MICRO-DRAW TEST STRIPS<br />
15482041100 HYPOGUARD ADVANCE MICRO-DRAW TEST STRIPS<br />
15482042000 HYPOGUARD ADVANCE INTUITION METER<br />
15482042005 HYPOGUARD ADVANCE NORMAL CONTROL SOLN<br />
15482042050 HYPOGUARD ADVANCE TEST STRIPS<br />
15482042110 HYPOGUARD ADVANCE INTUITION METER<br />
15482046001 HYPOGUARD ASSURE PRO METER<br />
15482046050 HYPOGUARD ASSURE PRO TEST STRIPS<br />
15482046060 HYPOGUARD ASSURE PRO CONTROL SOLUTION<br />
15482046060 HYPOGUARD ASSURE PRO CONTROL SOLUTION<br />
15482046100 HYPOGUARD ASSURE PRO TEST STRIPS<br />
15482050001 HYPOGUARD ASSURE PLATINUM GLUCOSE METER<br />
15482050005 HYPOGUARD ASSURE DOSE CONTROL SOLUTION<br />
15482050006 HYPOGUARD ASSURE DOSE CONTROL SOLUTION<br />
15482050006 HYPOGUARD ASSURE DOSE CONTROL SOLUTION<br />
15482050050 HYPOGUARD ASSURE PLATINUM TEST STRIPS<br />
15482050100 HYPOGUARD ASSURE PLATINUM TEST STRIPS<br />
15482055006 HYPOGUARD ASSURE 3 CONTROL SOLUTION<br />
15482055006 HYPOGUARD ASSURE 3 CONTROL SOLUTION<br />
15482055050 HYPOGUARD ASSURE 3 TEST STRIPS<br />
15482055100 HYPOGUARD ASSURE 3 TEST STRIPS<br />
15482056001 HYPOGUARD ASSURE 4 BLOOD GLUCOSE METER<br />
15482056006 HYPOGUARD ASSURE 4 CONTROL SOLUTION<br />
15482056050 HYPOGUARD ASSURE 4 TEST STRIPS<br />
15482056100 HYPOGUARD ASSURE 4 TEST STRIPS<br />
15482063005 HYPOGUARD POCKETCHEM EZ CONTROL SOLUTION<br />
15482063050 HYPOGUARD POCKETCHEM EZ TEST STRIPS<br />
15482063110 HYPOGUARD POCKETCHEM EZ METER KIT<br />
15482066015 HYPOGUARD MULTI-LANCET DEVICE<br />
15482066600 HYPOGUARD SELECT-LITE LANCING DEVICE<br />
15482072001 HYPOGUARD GLUCOCARD 01 BLOOD GLUCOSE MTR<br />
15482072005 HYPOGUARD GLUCOCARD 01 CONTROL SOLUTION<br />
15482072050 HYPOGUARD GLUCOCARD 01 SENSOR TEST STRIP<br />
15482072110 HYPOGUARD GLUCOCARD 01 METER KIT<br />
15482073110 HYPOGUARD GLUCOCARD 01-MINI METER KIT<br />
15482074006 HYPOGUARD GLUCOCARD 01 CONTROL SOLUTION<br />
15482074006 HYPOGUARD GLUCOCARD 01 CONTROL SOLUTION<br />
15482074050 HYPOGUARD GLUCOCARD 01 SENSOR TEST STRIP<br />
15482074110 HYPOGUARD GLUCOCARD 01 METER KIT<br />
15482075005 HYPOGUARD GLUCOCARD X-METER CONTROL SOLN<br />
15482075050 HYPOGUARD GLUCOCARD X-SENSOR TEST STRIPS<br />
15482075110 HYPOGUARD GLUCOCARD X-METER SYSTEM KIT<br />
15482075205 HYPOGUARD GLUCOCARD X-SENSOR TEST STRIPS<br />
15482076050 HYPOGUARD GLUCOCARD VITAL SENSOR STRIP<br />
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