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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 />
96295010643 LEADER LEADER INS SYR 0.5 ML 30GX1/2"<br />
96295010645 LEADER LEADER INS SYR 1 ML 30GX1/2"<br />
96295010677 LEADER LEADER THIN LANCETS<br />
96295010841 LEADER LEADER THIN LANCETS<br />
96295010948 LEADER LEADER STARTER KIT<br />
96295011105 LEADER LEADER SUPER THIN LANCETS<br />
96295011261 LEADER LEADER SYRING 0.5 ML 31GX5/16"<br />
96295011262 LEADER LEADER INS SYR 1 ML 31GX5/16"<br />
96295011263 LEADER LEADER SYRING 0.3 ML 31GX5/16"<br />
96295011503 LEADER LEADER E-ZJECT LANCETS<br />
96295011708 LEADER LANCING DEVICE<br />
98302000100 SIMPLE DIAGNOST<br />
SIMPLE DIAGNSTIC LANCET DEVICE<br />
98302000102 SIMPLE DIAGNOST<br />
CLEVER CHEK TEST STRIPS<br />
98302000103 SIMPLE DIAGNOST<br />
CLEVER CHEK CONTROL SOLUTION<br />
98302000104 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE 30G LANCETS<br />
98302000106 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE 28G LANCETS<br />
98302000107 SIMPLE DIAGNOST<br />
CLEVER CHEK BLOOD GLUCOSE SYST<br />
98302000108 SIMPLE DIAGNOST<br />
CLEVER CHEK TEST STRIPS<br />
98302000109 SIMPLE DIAGNOST<br />
CLEVER CHEK CONTROL SOLUTION<br />
98302000110 SIMPLE DIAGNOST<br />
CLEVER CHEK CONTROL SOLUTION<br />
98302000111 SIMPLE DIAGNOST<br />
CLEVER CHEK BLOOD GLUCOSE SYST<br />
98302000112 SIMPLE DIAGNOST<br />
CLEVER CHEK BLOOD GLUCOSE SYST<br />
98302000115 SIMPLE DIAGNOST<br />
CLEVER CHEK ULTRA THIN LANCETS<br />
98302000116 SIMPLE DIAGNOST<br />
CLEVER CHEK BLOOD GLUCOSE SYST<br />
98302000118 SIMPLE DIAGNOST<br />
CLEVER CHEK TEST STRIPS<br />
98302000120 SIMPLE DIAGNOST<br />
CLEVER CHEK TEST STRIPS<br />
98302000121 SIMPLE DIAGNOST<br />
CLEVER CHEK BLOOD GLUCOSE SYST<br />
98302000125 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE 30G LANCETS<br />
98302000126 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE 28G LANCETS<br />
98302000127 SIMPLE DIAGNOST<br />
CLEVER CHEK 30G LANCETS<br />
98302000128 SIMPLE DIAGNOST<br />
CLEVER CHOICE PRO TEST STRIP<br />
98302000129 SIMPLE DIAGNOST<br />
CLEVER CHOICE PRO GLUCOSE MTR<br />
98302000131 SIMPLE DIAGNOST<br />
CLEVER CHOICE GLUCOSE MONITOR<br />
98302000132 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE GLUCOSE SYS<br />
98302000133 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE TEST STRIPS<br />
98302000160 SIMPLE DIAGNOST<br />
PHARMACIST CHOICE 31G LANCETS<br />
98302000170 SIMPLE DIAGNOST<br />
CLEVER CHOICE MICRO TEST STRIP<br />
98302000180 SIMPLE DIAGNOST<br />
CLEVER CHOICE MICRO MONITOR<br />
98939000200 FOR A CARE INC. FORA D10 BLOOD GLUCOSE SYSTEM<br />
98939000201 FOR A CARE INC. FORA D10 GLUCOSE TEST STRIPS<br />
98939000204 FOR A CARE INC. FORA HIGH CONTROL SOLUTION<br />
98939000205 FOR A CARE INC. FORA LOW CONTROL SOLUTION<br />
98939000206 FOR A CARE INC. FORA NORMAL CONTROL SOLUTION<br />
98939000207 FOR A CARE INC. FORA V12 BLOOD GLUCOSE SYSTEM<br />
98939000209 FOR A CARE INC. FORA V10 BLOOD GLUCOSE SYSTEM<br />
98939000210 FOR A CARE INC. FORA V10 GLUCOSE TEST STRIP<br />
98939000212 FOR A CARE INC. FORA D15C GLUCOSE TEST STRIPS<br />
98939000216 FOR A CARE INC. FORA D15Z GLUCOSE TEST STRIPS<br />
98939000217 FOR A CARE INC. FORA V20 BLOOD GLUCOSE SYSTEM<br />
98939000218 FOR A CARE INC. FORA V20 GLUCOSE TEST STRIPS<br />
98939000219 FOR A CARE INC. FORA V22 BLOOD GLUCOSE SYSTEM<br />
98939000220 FOR A CARE INC. FORA V22 GLUCOSE TEST STRIP<br />
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