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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 />
38396034264 CAN-AM/ACCESS GNP LANCETS<br />
38396034364 CAN-AM/ACCESS GNP LANCETS<br />
38396034464 CAN-AM/ACCESS GNP THIN LANCETS<br />
38396034564 CAN-AM/ACCESS GNP THIN LANCETS<br />
38396035506 CAN-AM/ACCESS PREFERRED PLUS COLORED LANCETS<br />
38396036606 CAN-AM/ACCESS PREFERRED PLUS COLORED LANCETS<br />
38396040102 CAN-AM/ACCESS RELION SYRING 0.3 ML 31GX5/16"<br />
38396040105 CAN-AM/ACCESS QC INSULIN SYRINGE 1 ML<br />
38396040108 CAN-AM/ACCESS LEADER INS SYR 0.5 ML 28GX1/2"<br />
38396040202 CAN-AM/ACCESS RELION SYRING 0.5 ML 31GX5/16"<br />
38396040205 CAN-AM/ACCESS QC INSULIN SYRINGE 0.5 ML<br />
38396040208 CAN-AM/ACCESS LEADER INS SYR 1 ML 28GX1/2"<br />
38396040212 CAN-AM/ACCESS MS INSULIN SYR 0.3 ML 29GX1/2"<br />
38396040218 CAN-AM/ACCESS KROGER INS SYRINGE 3/10 ML<br />
38396040302 CAN-AM/ACCESS RELION INS SYR 1 ML 31GX5/16"<br />
38396040305 CAN-AM/ACCESS QC INSULIN SYRINGE 0.3 ML<br />
38396040308 CAN-AM/ACCESS LEADER INS SYR 0.3 ML 29GX1/2"<br />
38396040318 CAN-AM/ACCESS KROGER INS SYR 0.5 ML 29GX1/2"<br />
38396040325 CAN-AM/ACCESS KMART VALU PLUS SYR 1/2 ML<br />
38396040405 CAN-AM/ACCESS QC INSULIN SYR 1 ML 31GX5/16"<br />
38396040408 CAN-AM/ACCESS LEADER INS SYR 0.5 ML 29GX1/2"<br />
38396040412 CAN-AM/ACCESS MS INS SYR 0.5 ML 29GX1/2"<br />
38396040425 CAN-AM/ACCESS VALUEPLUS SYR 0.3 ML 29GX1/2"<br />
38396040501 CAN-AM/ACCESS FIRST CHOICE SYRINGE 0.5 ML<br />
38396040502 CAN-AM/ACCESS FIRST CHOICE SYRINGE 0.3 ML<br />
38396040503 CAN-AM/ACCESS FIRST CHOICE SYRINGE 0.5 ML<br />
38396040504 CAN-AM/ACCESS FIRST CHOICE SYRINGE 1 ML<br />
38396040505 CAN-AM/ACCESS FIRST CHOICE SYRINGE 1 ML<br />
38396040506 CAN-AM/ACCESS FIRST CHOICE SYRINGE 1 ML<br />
38396040507 CAN-AM/ACCESS FIRST CHOICE SYRINGE 0.5 ML<br />
38396040508 CAN-AM/ACCESS LEADER INS SYR 1 ML 29GX1/2"<br />
38396040512 CAN-AM/ACCESS MS INS SYR 1 ML 29GX1/2"<br />
38396040518 CAN-AM/ACCESS KROGER INS SYR 1 ML 29GX1/2"<br />
38396040525 CAN-AM/ACCESS KMART VALU PLUS SYRINGE 1 ML<br />
38396040605 CAN-AM/ACCESS QC INSUL SYR 0.5 ML 31GX5/16"<br />
38396040608 CAN-AM/ACCESS LEADER INSULIN SYRINGE 0.3 ML<br />
38396040612 CAN-AM/ACCESS MS INSULIN SYRINGE 0.3 ML<br />
38396040618 CAN-AM/ACCESS KROGER INSULIN SYRINGE 1 ML<br />
38396040625 CAN-AM/ACCESS KMART VALU PLUS SYRINGE 1 ML<br />
38396040708 CAN-AM/ACCESS LEADER INS SYR 0.5 ML 30GX1/2"<br />
38396040712 CAN-AM/ACCESS MS INSUL SYR 0.5 ML 30GX1/2"<br />
38396040718 CAN-AM/ACCESS KROGER SYR 0.5 ML 30GX5/16"<br />
38396040725 CAN-AM/ACCESS KMART VALU PLUS SYR 1/2 ML<br />
38396040801 CAN-AM/ACCESS PREFERRED PLUS SYRINGE 0.5 ML<br />
38396040802 CAN-AM/ACCESS PREFERRED PLUS SYRINGE 0.3 ML<br />
38396040803 CAN-AM/ACCESS PREFERRED PLUS 0.5 ML 29GX1/2"<br />
38396040804 CAN-AM/ACCESS PREFERRED PLUS SYRINGE 1 ML<br />
38396040805 CAN-AM/ACCESS PREF PLUS SYRING 1 ML 29GX1/2"<br />
38396040806 CAN-AM/ACCESS PREFPLS INS SYR 1 ML 30GX5/16"<br />
38396040807 CAN-AM/ACCESS PREF PLUS SYR 0.5 ML 30GX5/16"<br />
38396040808 CAN-AM/ACCESS PREFERRED PLUS 0.3 ML 30GX5/16<br />
38396040812 CAN-AM/ACCESS MS INS SYRINGE 1 ML 30GX1/2"<br />
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