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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 91899062678 MEDICINE SHOP MS INS SYRINGE 1 ML 30GX1/2" 91899062778 MEDICINE SHOP MS INSUL SYR 0.5 ML 30GX1/2" 91899062878 MEDICINE SHOP MS INSULIN SYRINGE 0.3 ML 91899063078 MEDICINE SHOP MS THIN LANCETS 91899063178 MEDICINE SHOP MS SUPER THIN LANCETS 92896000001 FIFTY50 PHARMAC FIFTY50 INSULIN SYRINGE 1 ML 92896000002 FIFTY50 PHARMAC FIFTY50 INSULIN SYRINGE 0.5 ML 92896000003 FIFTY50 PHARMAC FIFTY50 INSULIN SYRINGE 0.3 ML 92896000008 FIFTY50 PHARMAC FIFTY50 2.0 GLUCOSE METER 92896000009 FIFTY50 PHARMAC FIFTY50 GLUCOSE TEST STRIP 92896000016 FIFTY50 PHARMAC FIFTY50 GLUCOSE CONTROL SOLN 92896000019 FIFTY50 PHARMAC FIFTY50 SAFETY SEAL LANCETS 92896000800 FIFTY50 PHARMAC FIFTY50 LANCING DEVICE 92896000810 FIFTY50 PHARMAC FIFTY50 SAFETY SEAL LANCETS 93351012710 MED.PLASTIC DEV ADJUSTABLE LANCING DEVICE 93815070043 ABBOTT DIABETES MEDISENSE THIN LANCETS 93815070550 ABBOTT DIABETES MEDISENSE H-L CONTROL SOLUTION 93815070551 ABBOTT DIABETES MEDISENSE H-M-L CONTROL SOLN 93815070552 ABBOTT DIABETES MEDISENSE MID CONTROL SOLUTION 93815071041 ABBOTT DIABETES OPTIUM EZ TEST STRIP 93815071042 ABBOTT DIABETES OPTIUM EZ TEST STRIP 93815080063 ABBOTT DIABETES PRECISION PCX PLUS TEST STR 93815080116 ABBOTT DIABETES PRECISION POINT OF CARE STR 93815080138 ABBOTT DIABETES MEDISENSE GLUC-KET CONT SOL 93815080139 ABBOTT DIABETES MEDISENSE GLUC-KET CONT SOL 93815080312 ABBOTT DIABETES MEDISENSE GLUC-KET CONT SOL 93815080339 ABBOTT DIABETES PRECISION PCX PLUS TEST STR 93815097137 ABBOTT DIABETES ULTRATLC LANCETS 93815097138 ABBOTT DIABETES ULTRATLC LANCETS 93815097400 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815097401 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815097411 ABBOTT DIABETES PRECISION CONTROL SOLUTION 93815097432 ABBOTT DIABETES MEDISENSE CONTROL SOLUTION 93815098138 ABBOTT DIABETES ULTRATLC THIN LANCETS 93815098335 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815098336 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815098436 ABBOTT DIABETES PRECISION CONTROL SOLUTION 93815098546 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098547 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098548 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098549 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098550 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098681 ABBOTT DIABETES MEDISENSE THIN LANCETS 93815098682 ABBOTT DIABETES MEDISENSE THIN LANCETS 93815098732 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815098733 ABBOTT DIABETES PRECISION Q-I-D TEST STRIPS 93815098757 ABBOTT DIABETES PRECISION PCX TEST STRIPS 93815098814 ABBOTT DIABETES PRECISION XTRA MONITOR 93815098894 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098895 ABBOTT DIABETES PRECISION SURE DOSE SYRINGE 93815098929 ABBOTT DIABETES PRECISION LINK DIRECT MONIT 93815099121 ABBOTT DIABETES PRECISION CONTROL SOLUTION Page 44 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 93815099134 ABBOTT DIABETES OPTIUM TEST STRIP 93815099135 ABBOTT DIABETES OPTIUM TEST STRIP 93815099565 ABBOTT DIABETES PRECISION PCX TEST STRIPS 93815099694 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815099695 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815099728 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815099837 ABBOTT DIABETES PRECISION XTRA MONITOR 93815099838 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815099877 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815099878 ABBOTT DIABETES PRECISION XTRA TEST STRIPS 93815974116 ABBOTT DIABETES PRECISION CONTROL SOLUTION 94030000201 OMNIS HEALTH EMBRACE BLOOD GLUCOSE SYSTEM 94030000202 OMNIS HEALTH EMBRACE TEST STRIPS 94030000207 OMNIS HEALTH EMBRACE GLUC CONTROL SOLN LOW 94030000209 OMNIS HEALTH VICTORY BLOOD GLUCOSE MONITOR 94030000210 OMNIS HEALTH VICTORY GLUCOSE TEST STRIPS 94030000211 OMNIS HEALTH VICTORY HIGH-LOW CONTROL SOLN 94030000211 OMNIS HEALTH VICTORY HIGH-LOW CONTROL SOLN 94030201001 OMNIS HEALTH EMBRACE BLOOD GLUCOSE SYSTEM 94030201003 OMNIS HEALTH EMBRACE TEST STRIPS 94030201006 OMNIS HEALTH EMBRACE GLUC CONTROL SOLN LOW 94046000100 DIABETIC SUPPLY ADVOCATE TEST STRIP 94046000101 DIABETIC SUPPLY ADVOCATE CONTROL SOLUTION LOW 94046000102 DIABETIC SUPPLY ADVOCATE BLOOD GLUCOSE MONITOR 94046000103 DIABETIC SUPPLY ADVOCATE BLOOD GLUCOSE MONITOR 94046000104 DIABETIC SUPPLY ADVOCATE CONTROL SOLUTION HIGH 94046000105 DIABETIC SUPPLY ADVOCATE LANCING DEVICE 94046000106 DIABETIC SUPPLY ADVOCATE LANCET 94046000107 DIABETIC SUPPLY ADVOCATE BLOOD GLUCOSE MONITOR 94046000109 DIABETIC SUPPLY ADVOCATE LANCETS 94046000111 DIABETIC SUPPLY ADVOCATE REDI-CODE GLU MONITOR 94046000113 DIABETIC SUPPLY ADVOCATE REDI-CODE TEST STRIP 94046000118 DIABETIC SUPPLY ADVOCATE LANCETS 94046000124 DIABETIC SUPPLY ADVOCATE REDI-CODE TEST STRIP 94046000126 DIABETIC SUPPLY ADVOCATE REDI-CODE TEST STRIP 94046000133 DIABETIC SUPPLY ADVOCATE BLOOD GLUCOSE MONITOR 94046000134 DIABETIC SUPPLY ADVOCATE BLOOD GLUCOSE MONITOR 94046000135 DIABETIC SUPPLY ADVOCATE REDI-CODE GLU MONITOR 94046000136 DIABETIC SUPPLY ADVOCATE REDI-CODE GLU MONITOR 94046000139 DIABETIC SUPPLY ADVOCATE REDI-CODE TEST STRIP 94046000140 DIABETIC SUPPLY ADVOCATE CONTROL SOLUTION LOW 94046000141 DIABETIC SUPPLY ADVOCATE TEST STRIP 94441021545 SAV-ON SAV-ON LANCETS 94441021546 SAV-ON SAV-ON LANCETS 94441021547 SAV-ON SAV-ON LANCETS 96295010295 LEADER LEADER COLORED LANCETS 96295010494 LEADER LEADER INS SYR 0.5 ML 28GX1/2" 96295010495 LEADER LEADER INS SYR 1 ML 28GX1/2" 96295010496 LEADER LEADER INS SYR 0.5 ML 29GX1/2" 96295010497 LEADER LEADER INS SYR 1 ML 29GX1/2" 96295010498 LEADER LEADER INS SYR 0.3 ML 29GX1/2" 96295010629 LEADER LEADER INSULIN SYRINGE 0.3 ML Page 45 of 48
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