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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 />
40986001676 CHAIN DRUG CONS<br />
PV TRUETRACK SMART SYSTEM<br />
40986001677 CHAIN DRUG CONS<br />
PV TRUETRACK SMART SYS STRIPS<br />
40986001678 CHAIN DRUG CONS<br />
PV TRUETRACK SMART SYS STRIPS<br />
40986002136 CHAIN DRUG CONS<br />
PV INSULIN SYRINGE 0.5 ML<br />
40986002137 CHAIN DRUG CONS<br />
PV INSULIN SYRINGE 1 ML<br />
40986002138 CHAIN DRUG CONS<br />
PV INSULIN SYRINGE 0.5 ML<br />
40986002139 CHAIN DRUG CONS<br />
PV INS SYRIN 1 ML 29GX1/2"<br />
40986002140 CHAIN DRUG CONS<br />
PV INSULIN SYRINGE 0.5 ML<br />
40986002141 CHAIN DRUG CONS<br />
PV INSULIN SYRINGE 1 ML<br />
40986002142 CHAIN DRUG CONS<br />
PV INSUL SYR 0.3 ML 31GX5/16"<br />
40986002143 CHAIN DRUG CONS<br />
PV INSUL SYR 0.5 ML 31GX5/16"<br />
40986002144 CHAIN DRUG CONS<br />
PV INSULIN SYR 1 ML 31GX5/16"<br />
41163026310 EQUALINE VITAMI EQL INS SYR 0.3 ML 29GX1/2"<br />
41163026311 EQUALINE VITAMI EQL INS SYR 0.5 ML 29GX1/2"<br />
41163026312 EQUALINE VITAMI EQL INSULIN SYR 1 ML 29GX1/2"<br />
41163026313 EQUALINE VITAMI EQL INS SYR 0.3 ML 30GX5/16"<br />
41163026314 EQUALINE VITAMI EQL INS SYR 0.5 ML 30GX5/16"<br />
41163026315 EQUALINE VITAMI EQL INSULIN SYR 1 ML 30GX5/16"<br />
41163040141 EQUALINE VITAMI INSULIN SYRINGE 1 ML 31GX5/16"<br />
41163040241 EQUALINE VITAMI INSULIN SYRIN 0.5 ML 31GX5/16"<br />
41163040341 EQUALINE VITAMI EQL INSUL SYR 0.3 ML 31GX5/16"<br />
41163042682 EQUALINE VITAMI EQL INSUL SYR 0.5 ML 31GX5/16"<br />
41163042683 EQUALINE VITAMI EQL INSULIN SYR 1 ML 31GX5/16"<br />
41163042684 EQUALINE VITAMI EQL INSUL SYR 0.3 ML 31GX5/16"<br />
41163263109 EQUALINE VITAMI INSULIN SYRIN 0.3 ML 29GX1/2"<br />
41163402203 EQUALINE VITAMI INSULIN SYRIN 0.5 ML 29GX1/2"<br />
41163402205 EQUALINE VITAMI INSULIN SYRINGE 1 ML 29GX1/2"<br />
41163402206 EQUALINE VITAMI INSULIN SYRINGE 1 ML 30GX5/16"<br />
41163402207 EQUALINE VITAMI INSULIN SYRIN 0.5 ML 30GX5/16"<br />
41163402208 EQUALINE VITAMI INSULIN SYRIN 0.3 ML 30GX5/16"<br />
41250036930 MEIJER INC. MEIJER SUPER THIN LANCETS<br />
41250088304 MEIJER INC. MEIJER LANCETS<br />
41250088305 MEIJER INC. MEIJER THIN GAUGE LANCETS<br />
41250088306 MEIJER INC. MEIJER THIN GAUGE LANCETS<br />
41280021545 MEIJER INC. OSCO LANCETS<br />
41280021546 MEIJER INC. OSCO LANCETS<br />
41280021547 MEIJER INC. OSCO LANCETS<br />
41318071768 ULTIMED INC SCHNUCKS SYR 0.5 ML 29GX1/2"<br />
41318071769 ULTIMED INC SCHNUCKS SYR 0.5 ML 30GX5/16"<br />
41405129301 ULTIMED INC GLUCOPRO INSULIN SYR U100 1 ML<br />
41405129310 ULTIMED INC GLUCOPRO INSULIN SYR U100 1 ML<br />
41405129350 ULTIMED INC GLUCOPRO U100 INSULIN 1 ML SYR<br />
41405130301 ULTIMED INC GLUCOPRO INSULIN SYR 1 ML<br />
41405130310 ULTIMED INC GLUCOPRO INSULIN SYR 1 ML<br />
41405130350 ULTIMED INC GLUCOPRO INSULIN SYR 1 ML<br />
41405130801 ULTIMED INC GLUCOPRO SYRINGE U100 1 ML<br />
41405130810 ULTIMED INC GLUCOPRO INSULIN SYR U100 1 ML<br />
41405130850 ULTIMED INC GLUCOPRO INSULIN SYR U100 1 ML<br />
41405131810 ULTIMED INC GLUCOPRO INSULIN SYR 1 ML<br />
41405131850 ULTIMED INC GLUCOPRO INSULIN SYR 1 ML<br />
41405329301 ULTIMED INC GLUCOPRO U100 INSUL SYR 0.3 ML<br />
41405329310 ULTIMED INC GLUCOPRO U100 INSUL SYR 0.3 ML<br />
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