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Oregon Health Authority Division of Medical Assistance Programs Allowable NDCs for Diabetic Supply Billing - Effective 8/1/2011 For billing guidelines and examples: Refer to OAR 410-122-0520 (Glucose Monitors and Diabetic Supplies) and the Diabetic Supply Billing Examples at www.dhs.state.or.us/policy/healthplan/guides/dme/main.html. NDC Code Labeler Name Label Name Desc 60171097001 ENTRA HEALTH SYSTEM MYGLUCOHEALTH MONITORING KIT 60171097003 ENTRA HEALTH SYSTEM MYGLUCOHEALTH TEST STRIPS 61059000419 OWEN MUMFORD US UNILET GP LANCET 61059000751 OWEN MUMFORD US UNISTIK 2 NORMAL 0.81MM DEVICE 61059000751 OWEN MUMFORD US UNISTIK 2 NORMAL 0.81MM DEVICE 61059000851 OWEN MUMFORD US UNISTIK 2 EXTRA 0.81 MM DEVICE 61059000851 OWEN MUMFORD US UNISTIK 2 EXTRA 0.81 MM DEVICE 61059000914 OWEN MUMFORD US UNILET GP LANCET 61059001119 OWEN MUMFORD US UNILET GP LANCET SUPERLITE 61059001515 OWEN MUMFORD US UNILET GP LANCET SUPERLITE 61059002116 OWEN MUMFORD US UNILET LANCET 61059003113 OWEN MUMFORD US UNILET LANCET SUPERLITE 61059003519 OWEN MUMFORD US UNILET LANCET SUPERLITE 61059005301 OWEN MUMFORD US UNILET EXCELITE II LANCET 61059005351 OWEN MUMFORD US UNILET EXCELITE II LANCET 61059005711 OWEN MUMFORD US UNISTIK 2.4 MM DEVICE 61059005711 OWEN MUMFORD US UNISTIK 2.4 MM DEVICE 61059006718 OWEN MUMFORD US UNISTIK 3 MM DEVICE 61059006718 OWEN MUMFORD US UNISTIK 3 MM DEVICE 61059007517 OWEN MUMFORD US UNISTIK 2 2.4 MM DEVICE 61059007517 OWEN MUMFORD US UNISTIK 2 2.4 MM DEVICE 61059007715 OWEN MUMFORD US UNISTIK 2 2.4 MM DEVICE 61059007715 OWEN MUMFORD US UNISTIK 2 2.4 MM DEVICE 61059008514 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059008514 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059008712 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059008712 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059009511 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059009511 OWEN MUMFORD US UNISTIK-2 3 MM DEVICE 61059010111 OWEN MUMFORD US AUTOLET MKII CLINISAFE DEVICE 61059012313 OWEN MUMFORD US AUTOLET LITE CLINISAFE DEV 61059015714 OWEN MUMFORD US DR LANCET 61059025714 OWEN MUMFORD US ULTRA THIN LANCETS 61059025735 OWEN MUMFORD US ULTRA THIN 28G LANCETS 61059025736 OWEN MUMFORD US 1ST TIER COMFORTOUCH LANCET 61059026013 OWEN MUMFORD US AUTOLET MINI LANCING DEVICE 61059026013 OWEN MUMFORD US AUTOLET MINI LANCING DEVICE 61059026518 OWEN MUMFORD US AUTOLET MINI LANCING DEVICE 61059026518 OWEN MUMFORD US AUTOLET MINI LANCING DEVICE 61059027010 OWEN MUMFORD US AUTOLET IMPRESSION LANCING DEV 61059027119 OWEN MUMFORD US AUTOLET IMPRESSION LANCING DEV 61059035714 OWEN MUMFORD US DR ULTRA THIN LANCET 61059035726 OWEN MUMFORD US LIVE BETTER ULTRA THIN LANCET 61059043514 OWEN MUMFORD US ALTERNATE SITE LANCETS 61059046011 OWEN MUMFORD US UNILET COMFORTOUCH LANCET 61059046516 OWEN MUMFORD US UNILET COMFORTOUCH LANCET 61059051015 OWEN MUMFORD US UNILET EXCELITE LANCET 61059051510 OWEN MUMFORD US UNILET EXCELITE LANCET 61059065711 OWEN MUMFORD US COMFORT LANCETS 61059065714 OWEN MUMFORD US SUPER THIN LANCETS 61059065726 OWEN MUMFORD US LIVE BETTER SUPER THIN LANCET 61059065735 OWEN MUMFORD US SUPER THIN 30G LANCETS Page 38 of 48
Oregon Health Authority Division of Medical Assistance Programs Allowable NDCs for Diabetic Supply Billing - Effective 8/1/2011 For billing guidelines and examples: Refer to OAR 410-122-0520 (Glucose Monitors and Diabetic Supplies) and the Diabetic Supply Billing Examples at www.dhs.state.or.us/policy/healthplan/guides/dme/main.html. NDC Code Labeler Name Label Name Desc 61059065736 OWEN MUMFORD US 1ST TIER COMFORTOUCH LANCET 61059070726 OWEN MUMFORD US LIVE BETTER ADVANCED LANCING 61059070726 OWEN MUMFORD US LIVE BETTER ADVANCED LANCING 61059074212 OWEN MUMFORD US UNISTIK 2 1.8 MM DEVICE 61059074212 OWEN MUMFORD US UNISTIK 2 1.8 MM DEVICE 61059076216 OWEN MUMFORD US UNISTIK 2 NEONATAL DEVICE 61059076216 OWEN MUMFORD US UNISTIK 2 NEONATAL DEVICE 61059100219 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 61059100219 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 61059104217 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 61059104217 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 61059106211 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 61059106211 OWEN MUMFORD US UNISTIK 3 1.8 MM LANCING DEVIC 63323090490 APP PHARMACEUTICALS, LLC. FLOW-EZE VENTED NEEDLE 63706001110 MEDTRONIC MINIM MINILET THIN LANCETS 65702010110 ROCHE DIAGNOSTI ACCU-CHEK AVIVA MONITORING KIT 65702010210 ROCHE DIAGNOSTI ACCU-CHEK AVIVA METER 65702010310 ROCHE DIAGNOSTI ACCU-CHEK AVIVA TEST STRIPS 65702010410 ROCHE DIAGNOSTI ACCU-CHEK AVIVA TEST STRIPS 65702010610 ROCHE DIAGNOSTI ACCU-CHEK AVIVA TEST STRIPS 65702010710 ROCHE DIAGNOSTI ACCU-CHEK AVIVA SOLUTION 65702010710 ROCHE DIAGNOSTI ACCU-CHEK AVIVA SOLUTION 65702012410 ROCHE DIAGNOSTI ACCU-CHEK SOFTCLIX LANCETS 65702015610 ROCHE DIAGNOSTI ACCU-CHEK SOFTCLIX LANCETS 65702021210 ROCHE DIAGNOSTI ACCU-CHEK AVIVA TEST STRIPS 65702021510 ROCHE DIAGNOSTI ACCU-CHEK COMFORT CURVE STRIP 65702022310 ROCHE DIAGNOSTI ACCU-CHEK COMPACT STRIPS 65702027410 ROCHE DIAGNOSTI ACCUTREND GLUCOSE TEST STRIP 65702027510 ROCHE DIAGNOSTI ACCUTREND GLUCOSE CONTROL 65702027510 ROCHE DIAGNOSTI ACCUTREND GLUCOSE CONTROL 65702036910 ROCHE DIAGNOSTI ACCU-CHEK COMPACT BLUE CONTROL 65702036910 ROCHE DIAGNOSTI ACCU-CHEK COMPACT BLUE CONTROL 65702040010 ROCHE DIAGNOSTI ACCU-CHECK SOFTCLIX LANCET KIT 65702040010 ROCHE DIAGNOSTI ACCU-CHECK SOFTCLIX LANCET KIT 66004005501 SOLARTEK PROD.I ULTIMA MONITOR KIT 66004012104 SOLARTEK PROD.I ULTIMA TEST STRIPS 66004012205 SOLARTEK PROD.I ULTIMA TEST STRIPS 66004085004 SOLARTEK PROD.I BLOOD GLUCOSE TEST STRIPS 66004085105 SOLARTEK PROD.I BLOOD GLUCOSE TEST STRIPS 66004097309 SOLARTEK PROD.I RELION ULTIMA TEST STRIPS 66852000490 AMIRA MEDICAL AT-LAST BLOOD GLUCOSE SYSTM 66852000539 AMIRA MEDICAL AT-LAST LANCETS 66852000547 AMIRA MEDICAL AT-LAST TEST STRIPS 66852001171 AMIRA MEDICAL AT-LAST TEST STRIPS 68016001670 CHAIN DRUG CONSORTIUM, LLC PV LANCING DEVICE 68016001676 CHAIN DRUG CONSORTIUM, LLC PV TRUETRACK SMART SYSTEM 68016001677 CHAIN DRUG CONSORTIUM, LLC PV TRUETRACK SMART SYS STRIPS 68016001678 CHAIN DRUG CONSORTIUM, LLC PV TRUETRACK SMART SYS STRIPS 68016030554 CHAIN DRUG CONSORTIUM, LLC PV ULTRA THIN LANCETS 68016030754 CHAIN DRUG CONSORTIUM, LLC PV ULTRA THIN LANCETS 68016051054 CHAIN DRUG CONSORTIUM, LLC PV LANCING DEVICE 68016065035 CHAIN DRUG CONSORTIUM, LLC PV INSUL SYR 0.3 ML 31GX5/16" Page 39 of 48
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