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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 />
89123700141 HOME AIDE DIAGN EASY TRAK BLOOD GLUCOSE METER<br />
89123700142 HOME AIDE DIAGN EASY TRAK GLUCOSE TEST STRIP<br />
89123700143 HOME AIDE DIAGN EASY TRAK CONTROL SOLN NORMAL<br />
89123700144 HOME AIDE DIAGN EASY TRAK GLUCOSE SYSTEM KIT<br />
89123700145 HOME AIDE DIAGN EASY TRAK CONTROL SOLN HIGH<br />
89123700146 HOME AIDE DIAGN EASY TRAK CONTROL SOLN LOW<br />
89123700147 HOME AIDE DIAGN EASY TALK BLOOD GLUCOSE METER<br />
89123700148 HOME AIDE DIAGN EASY TALK GLUCOSE TEST STRIP<br />
89123700149 HOME AIDE DIAGN EASY TALK CONTROL SOLN LOW<br />
89123700151 HOME AIDE DIAGN EASY TALK GLUCOSE SYSTEM KIT<br />
89123700152 HOME AIDE DIAGN EASY TALK HIGH CONTROL SOLN<br />
90166005015 GLOBAL DIABETIC INSULIN SYRINGE 1 ML 30GX1/2"<br />
90166005035 GLOBAL DIABETIC INSULIN SYRIN 0.3 ML 30GX1/2"<br />
90166005055 GLOBAL DIABETIC INSULIN SYRIN 0.5 ML 30GX1/2"<br />
90166005615 GLOBAL DIABETIC INSULIN SYRINGE 1 ML 30GX5/16"<br />
90166005635 GLOBAL DIABETIC INSULIN SYRIN 0.3 ML 30GX5/16"<br />
90166005655 GLOBAL DIABETIC INSULIN SYRIN 0.5 ML 30GX5/16"<br />
90166012102 GLOBAL DIABETIC E-Z PULL & CLICK LANCING DEV<br />
90166012804 GLOBAL DIABETIC INJECT EASE 28G LANCETS<br />
90166013004 GLOBAL DIABETIC INJECT EASE 30G LANCETS<br />
90166015615 GLOBAL DIABETIC INSULIN SYRINGE 1 ML 31GX5/16"<br />
90166015635 GLOBAL DIABETIC INSULIN SYRIN 0.3 ML 31GX5/16"<br />
90166015655 GLOBAL DIABETIC INSULIN SYRIN 0.5 ML 31GX5/16"<br />
90166085015 GLOBAL DIABETIC INSULIN SYRINGE 1 ML 28GX1/2"<br />
90166085055 GLOBAL DIABETIC INSULIN SYRIN 0.5 ML 28GX1/2"<br />
90166095015 GLOBAL DIABETIC INSULIN SYRINGE 1 ML 29GX1/2"<br />
90166095035 GLOBAL DIABETIC INSULIN SYRIN 0.3 ML 29GX1/2"<br />
90166095055 GLOBAL DIABETIC INSULIN SYRIN 0.5 ML 29GX1/2"<br />
91237000100 HOME AIDE DIAGN EASY CHECK GLUCOSE METER<br />
91237000101 HOME AIDE DIAGN EASY CHECK GLUCOSE TEST STRIP<br />
91237000102 HOME AIDE DIAGN EASY CHECK GLUCOSE CNTRL SOLN<br />
91237000104 HOME AIDE DIAGN EASY TOUCH LANCETS<br />
91237000105 HOME AIDE DIAGN EASY CLICK LANCING DEVICE<br />
91237000108 HOME AIDE DIAGN EASY COMFORT INSULIN 1 ML SYR<br />
91237000109 HOME AIDE DIAGN EASY COMFORT 0.5 ML SYRINGE<br />
91237000110 HOME AIDE DIAGN EASY COMFORT 0.3 ML SYRINGE<br />
91237000112 HOME AIDE DIAGN EASY CHECK BLOOD GLUCOSE SYS<br />
91237000113 HOME AIDE DIAGN EASY CHECK CONTROL SOLN HIGH<br />
91237000114 HOME AIDE DIAGN EASY CHECK CONTROL SOLN LOW<br />
91237000115 HOME AIDE DIAGN EASY TOUCH LANCETS<br />
91237000116 HOME AIDE DIAGN EASY TOUCH LANCETS<br />
91237000118 HOME AIDE DIAGN EASY STEP BLOOD GLUCOSE METER<br />
91237000121 HOME AIDE DIAGN EASY STEP GLUCOSE SYSTEM KIT<br />
91899001884 MEDICINE SHOP MS E-ZJECT LANCETS<br />
91899042912 MEDICINE SHOP MS INSUL SYR 0.3 ML 31GX5/16"<br />
91899043012 MEDICINE SHOP MS INSUL SYR 0.5 ML 31GX5/16"<br />
91899043112 MEDICINE SHOP MS INSULIN SYR 1 ML 31GX5/16"<br />
91899060778 MEDICINE SHOP MS INS SYR 0.5 ML 29GX1/2"<br />
91899060878 MEDICINE SHOP MS INS SYR 1 ML 29GX1/2"<br />
91899060978 MEDICINE SHOP MS INSULIN SYR 0.3 ML 29GX1/2"<br />
91899062178 MEDICINE SHOP MS LANCETS<br />
91899062181 MEDICINE SHOP MS LANCETS<br />
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