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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 />
53885041901 LIFESCAN ONE TOUCH ULTRAMINI METER<br />
53885042001 LIFESCAN ONE TOUCH ULTRAMINI METER<br />
53885042101 LIFESCAN ONE TOUCH ULTRAMINI METER<br />
53885044450 LIFESCAN FAST TAKE TEST STRIPS<br />
53885044801 LIFESCAN ONE TOUCH ULTRA 2 GLUCOSE SYST<br />
53885045802 LIFESCAN ONE TOUCH ULTRA CONTROL SOLN<br />
53885052401 LIFESCAN ONE TOUCH ULTRA SMART METER<br />
53885055101 LIFESCAN ONE TOUCH ULTRALINK SYSTEM<br />
53885055201 LIFESCAN ONE TOUCH ULTRALINK SYSTEM<br />
53885063702 LIFESCAN SURESTEP GLUC CONTROL SOLN<br />
53885079325 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885079425 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885079525 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885079750 LIFESCAN SURESTEP PRO TEST STRIPS<br />
53885079805 LIFESCAN SURESTEP PRO LINEARITY KIT<br />
53885085002 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885085002 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885085102 LIFESCAN SURESTEP PRO CONTROL SOLN<br />
53885091101 LIFESCAN ONE TOUCH ULTRAMINI METER<br />
53885091201 LIFESCAN ONE TOUCH ULTRAMINI METER<br />
53885093701 LIFESCAN ONE TOUCH ULTRA CONTROL SOLN<br />
53885099425 LIFESCAN ONE TOUCH ULTRA TEST STRIPS<br />
54569137200 A-S MEDICATION INSULIN SYRINGE 28GX0.5 ML<br />
54569250500 A-S MEDICATION INSULIN U100-1 ML SYRINGE<br />
54569420800 A-S MEDICATION ONE TOUCH TEST STRIPS<br />
54868082400 PHYSICIANS TC. ACCU-CHEK ADVANTAGE STRIPS<br />
54868086300 PHYSICIANS TC. GLUCOSTIX REAGENT STRIPS<br />
54868131100 PHYSICIANS TC. INSULIN SYRINGE 1 ML 28GX1/2"<br />
54868324300 PHYSICIANS TC. ACCU-CHEK COMPACT STRIPS<br />
54868324301 PHYSICIANS TC. ACCU-CHEK COMPACT TEST DRUM<br />
54868359000 PHYSICIANS TC. ACCU-CHEK ACTIVE TEST STRIP<br />
54868493100 PHYSICIANS TC. SOFTCLIX LANCETS<br />
54868526500 PHYSICIANS TC. ONE TOUCH ULTRA TEST STRIPS<br />
54868579600 PHYSICIANS TC. ACCU-CHEK CMFRT CURVE STRIP<br />
54868579700 PHYSICIANS TC. ASCENSIA AUTODISC STRIPS<br />
54868579800 PHYSICIANS TC. ONE TOUCH ULTRASOFT LANCETS<br />
54868580600 PHYSICIANS TC. BD TEST STRIPS<br />
54868580700 PHYSICIANS TC. BD ULTRA FINE LANCETS<br />
56151014201 NIPRO DIAGNOSTIC GENTLE DRAW LANCING DEVICE<br />
56151014260 NIPRO DIAGNOSTIC LANCETS<br />
56151020101 NIPRO DIAGNOSTIC WALGREENS STARTER KIT<br />
56151020160 NIPRO DIAGNOSTIC WALGREENS LANCING DEVICE<br />
56151020201 NIPRO DIAGNOSTIC LEADER STARTER KIT<br />
56151020401 NIPRO DIAGNOSTIC KERR STARTER KIT<br />
56151020801 NIPRO DIAGNOSTIC NAVARRO STARTER KIT<br />
56151020901 NIPRO DIAGNOSTIC EXPRESS MED STARTER KIT<br />
56151021101 NIPRO DIAGNOSTIC GOOD NEIGH STARTER KIT<br />
56151021201 NIPRO DIAGNOSTIC LONG STARTER KIT<br />
56151021301 NIPRO DIAGNOSTIC W-D STARTER KIT<br />
56151021302 NIPRO DIAGNOSTIC WINN DIXIE MEDIC VALUE PACK<br />
56151021401 NIPRO DIAGNOSTIC LIFE MEDICAL STARTER KIT<br />
56151021601 NIPRO DIAGNOSTIC DIABETIC.COM STARTER KIT<br />
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