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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 />
86227062035 ALLISON MEDICAL SURE COMFORT 3/10 ML SYRINGE<br />
86227062055 ALLISON MEDICAL SURE COMFORT 0.5 ML SYRINGE<br />
86227062105 ALLISON MEDICAL SURE COMFORT 1 ML SYRINGE<br />
86227065035 ALLISON MEDICAL SURE COMFORT 3/10 ML SYRINGE<br />
86227065045 ALLISON MEDICAL SURE COMFORT 0.3 ML SYRINGE<br />
86227065055 ALLISON MEDICAL SURE COMFORT 0.5 ML SYRINGE<br />
86227065105 ALLISON MEDICAL SURE COMFORT 1 ML SYRINGE<br />
86227070035 ALLISON MEDICAL SURE COMFORT 3/10 ML SYRINGE<br />
86227070055 ALLISON MEDICAL SURE COMFORT 0.5 ML SYRINGE<br />
86227070105 ALLISON MEDICAL SURE COMFORT 1 ML SYRINGE<br />
86227080055 ALLISON MEDICAL SURE COMFORT 0.5 ML SYRINGE<br />
86227080105 ALLISON MEDICAL SURE COMFORT 1 ML SYRINGE<br />
86227090035 ALLISON MEDICAL SURE COMFORT 3/10 ML SYRINGE<br />
86227090055 ALLISON MEDICAL SURE COMFORT 0.5 ML SYRINGE<br />
86227090105 ALLISON MEDICAL SURE COMFORT 1 ML SYRINGE<br />
86227921625 ALLISON MEDICAL PUB INSUL SYR 0.5 ML 30GX1/2"<br />
86227921635 ALLISON MEDICAL PUB INSUL SYR 0.3 ML 31GX5/16"<br />
86227921645 ALLISON MEDICAL PUB INSUL SYR 0.5 ML 31GX5/16"<br />
86227921655 ALLISON MEDICAL PUB INSULIN SYR 1 ML 31GX5/16"<br />
87701033674 BRITE LIFE BL TEST STRIPS<br />
87701039908 BRITE LIFE GNP SUPER THIN LANCETS<br />
87701039972 BRITE LIFE GNP INSUL SYR 0.5 ML 31GX5/16"<br />
87701039973 BRITE LIFE GNP INSULIN SYR 1 ML 31GX5/16"<br />
87701039974 BRITE LIFE GNP INSUL SYR 0.3 ML 31GX5/16"<br />
87701044288 BRITE LIFE BL INSULIN 0.3 ML SYRINGE<br />
87701044671 BRITE LIFE GNP THIN LANCETS<br />
87701052620 BRITE LIFE GNP LANCING SYSTEM DEVICE<br />
87701057044 BRITE LIFE GNP LANCETS<br />
87701057046 BRITE LIFE GNP LANCETS<br />
87701057048 BRITE LIFE BL LANCETS<br />
87701065329 BRITE LIFE BL INSULIN 1 ML SYRINGE<br />
87701065340 BRITE LIFE BL INSULIN 0.5 ML SYRINGE<br />
87701065343 BRITE LIFE GNP ULTRA COMFORT 1 ML SYRINGE<br />
87701065352 BRITE LIFE GNP ULTRA COMFORT 0.5 ML SYR<br />
87701065354 BRITE LIFE GNP ULTRA COMFORT 3/10 ML SYR<br />
87701066838 BRITE LIFE BL REAGENT STRIPS<br />
87701066840 BRITE LIFE BL REAGENT STRIPS<br />
87701074702 BRITE LIFE GNP ULTRA COMFORT 0.5 ML SYR<br />
87701074723 BRITE LIFE GNP ULTRA COMFORT 1 ML SYRINGE<br />
87701074725 BRITE LIFE GNP ULTRA COMFORT 3/10 ML SYR<br />
87701074728 BRITE LIFE GNP ULTRA COMFORT 0.5 ML SYR<br />
87701074745 BRITE LIFE GNP ULTRA COMFORT 1 ML SYRINGE<br />
87701083729 BRITE LIFE BL THIN LANCETS<br />
87701088246 BRITE LIFE GNP COLOR LANCETS<br />
87701095986 BRITE LIFE GNP THIN LANCETS<br />
89105200001 MPA-DIABETIC CHOICEDM CLARUS TEST STRIPS<br />
89105200002 MPA-DIABETIC CHOICEDM CLARUS CONTROL SOLN<br />
89105200008 MPA-DIABETIC CHOICEDM CLARUS MONITOR SYSTEM<br />
89123700113 HOME AIDE DIAGN EASY CHECK CONTROL SOLN HIGH<br />
89123700114 HOME AIDE DIAGN EASY CHECK CONTROL SOLN LOW<br />
89123700118 HOME AIDE DIAGN EASY STEP BLOOD GLUCOSE METER<br />
89123700121 HOME AIDE DIAGN EASY STEP GLUCOSE SYSTEM KIT<br />
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