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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 />
47884017250 OAK TREE INTERN EASYMAX GLUCOSE TEST STRIPS<br />
47884017300 OAK TREE INTERN EASYMAX L GLUCOSE SYSTEM KIT<br />
47884017301 OAK TREE INTERN EASYMAX L BLOOD GLUCOSE SYSTEM<br />
47884017500 OAK TREE INTERN EASYMAX N GLUCOSE SYSTEM KIT<br />
47884017501 OAK TREE INTERN EASYMAX N BLOOD GLUCOSE SYSTEM<br />
47884017525 OAK TREE INTERN EASYMAX GLUCOSE TEST STRIPS<br />
47884017540 OAK TREE INTERN EASYMAX NORMAL CONTROL SOLN<br />
47884017541 OAK TREE INTERN EASYMAX HIGH CONTROL SOLN<br />
47884017542 OAK TREE INTERN EASYMAX LOW CONTROL SOLN<br />
47884017550 OAK TREE INTERN EASYMAX GLUCOSE TEST STRIPS<br />
49348095050 MCKESSON CORPORATION VALU-RITE V-R GLUCOSE TEST STRIP<br />
49614000011 MEDICINE SHOPPE INTERNATIONAL, BLOOD INC. GLUCOSE TEST STRIPS<br />
49614000012 MEDICINE SHOPPE INTERNATIONAL, BLOOD INC. GLUCOSE TEST STRIPS<br />
49614000113 MEDICINE SHOPPE INTERNATIONAL, BLOOD INC. GLUCOSE SYSTEM PAK<br />
49614062678 MEDICINE SHOPPE INTERNATIONAL, ULTRA INC. COMFORT 1 ML SYRINGE<br />
49614062778 MEDICINE SHOPPE INTERNATIONAL, ULTRA INC. COMFORT 0.5 ML SYRINGE<br />
49614062878 MEDICINE SHOPPE INTERNATIONAL, ULTRA INC. COMFORT 3/10 ML SYR<br />
49614063081 MEDICINE SHOPPE INTERNATIONAL, LANCETS INC.<br />
50081000300 ENTRA HEALTH SYSTEM MYGLUCOHEALTH MONITORING KIT<br />
50081000301 ENTRA HEALTH SYSTEM MYGLUCOHEALTH TEST STRIPS<br />
50081000303 ENTRA HEALTH SYSTEM MYGLUCOHEALTH 30G LANCETS<br />
50428001771 CVS CVS THIN LANCETS<br />
50428001772 CVS CVS THIN LANCETS<br />
50428001773 CVS CVS LANCETS<br />
50428008873 CVS CVS LANCING DEVICE<br />
50428008873 CVS CVS LANCING DEVICE<br />
50428147530 CVS CVS BLOOD GLUCOSE TEST SRIP<br />
50428194178 CVS CVS BLOOD GLUCOSE STRIPS<br />
50428235155 CVS CVS ULTRA THIN LANCETS<br />
50428235157 CVS CVS ULTRA THIN LANCETS<br />
50924001901 ROCHE DIAGNOSTI ACCU-CHEK COMPACT PLUS KIT<br />
50924004301 ROCHE DIAGNOSTI COAGUCHEK LANCETS<br />
50924007920 ROCHE DIAGNOSTI ACCU-CHEK SAFE-T-PRO LANCETS<br />
50924013024 ROCHE DIAGNOSTI SOFTCLIX LANCETS<br />
50924014110 ROCHE DIAGNOSTI ACCU-CHEK SIMPLICITY STRIPS<br />
50924030201 ROCHE DIAGNOSTI ACCU-CHEK SIMPLICITY KIT<br />
50924030202 ROCHE DIAGNOSTI ACCU-CHEK COMPACT GLUCOSE SOL<br />
50924031410 ROCHE DIAGNOSTI ACCU-CHEK SIMPLICITY STRIPS<br />
50924035706 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE SOLN<br />
50924036550 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE STRIP<br />
50924037350 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE STRIP<br />
50924038110 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE STRIP<br />
50924039002 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE SOLN<br />
50924039002 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE SOLN<br />
50924040303 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE SOLN<br />
50924041102 ROCHE DIAGNOSTI ACCU-CHEK CMFRT CURVE SOLN<br />
50924044601 ROCHE DIAGNOSTI ACCU-CHEK MULTICLIX LANCET KIT<br />
50924044601 ROCHE DIAGNOSTI ACCU-CHEK MULTICLIX LANCET KIT<br />
50924045001 ROCHE DIAGNOSTI ACCU-CHEK MULTICLIX LANCET<br />
50924047550 ROCHE DIAGNOSTI ACCU-CHEK ACTIVE TEST STRIP<br />
50924047602 ROCHE DIAGNOSTI ACCU-CHEK ACTIVE GLUCOSE SOL<br />
50924047701 ROCHE DIAGNOSTI ACCU-CHEK ACTIVE CARE KIT<br />
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