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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 96295010643 LEADER LEADER INS SYR 0.5 ML 30GX1/2" 96295010645 LEADER LEADER INS SYR 1 ML 30GX1/2" 96295010677 LEADER LEADER THIN LANCETS 96295010841 LEADER LEADER THIN LANCETS 96295010948 LEADER LEADER STARTER KIT 96295011105 LEADER LEADER SUPER THIN LANCETS 96295011261 LEADER LEADER SYRING 0.5 ML 31GX5/16" 96295011262 LEADER LEADER INS SYR 1 ML 31GX5/16" 96295011263 LEADER LEADER SYRING 0.3 ML 31GX5/16" 96295011503 LEADER LEADER E-ZJECT LANCETS 96295011708 LEADER LANCING DEVICE 98302000100 SIMPLE DIAGNOST SIMPLE DIAGNSTIC LANCET DEVICE 98302000102 SIMPLE DIAGNOST CLEVER CHEK TEST STRIPS 98302000103 SIMPLE DIAGNOST CLEVER CHEK CONTROL SOLUTION 98302000104 SIMPLE DIAGNOST PHARMACIST CHOICE 30G LANCETS 98302000106 SIMPLE DIAGNOST PHARMACIST CHOICE 28G LANCETS 98302000107 SIMPLE DIAGNOST CLEVER CHEK BLOOD GLUCOSE SYST 98302000108 SIMPLE DIAGNOST CLEVER CHEK TEST STRIPS 98302000109 SIMPLE DIAGNOST CLEVER CHEK CONTROL SOLUTION 98302000110 SIMPLE DIAGNOST CLEVER CHEK CONTROL SOLUTION 98302000111 SIMPLE DIAGNOST CLEVER CHEK BLOOD GLUCOSE SYST 98302000112 SIMPLE DIAGNOST CLEVER CHEK BLOOD GLUCOSE SYST 98302000115 SIMPLE DIAGNOST CLEVER CHEK ULTRA THIN LANCETS 98302000116 SIMPLE DIAGNOST CLEVER CHEK BLOOD GLUCOSE SYST 98302000118 SIMPLE DIAGNOST CLEVER CHEK TEST STRIPS 98302000120 SIMPLE DIAGNOST CLEVER CHEK TEST STRIPS 98302000121 SIMPLE DIAGNOST CLEVER CHEK BLOOD GLUCOSE SYST 98302000125 SIMPLE DIAGNOST PHARMACIST CHOICE 30G LANCETS 98302000126 SIMPLE DIAGNOST PHARMACIST CHOICE 28G LANCETS 98302000127 SIMPLE DIAGNOST CLEVER CHEK 30G LANCETS 98302000128 SIMPLE DIAGNOST CLEVER CHOICE PRO TEST STRIP 98302000129 SIMPLE DIAGNOST CLEVER CHOICE PRO GLUCOSE MTR 98302000131 SIMPLE DIAGNOST CLEVER CHOICE GLUCOSE MONITOR 98302000132 SIMPLE DIAGNOST PHARMACIST CHOICE GLUCOSE SYS 98302000133 SIMPLE DIAGNOST PHARMACIST CHOICE TEST STRIPS 98302000160 SIMPLE DIAGNOST PHARMACIST CHOICE 31G LANCETS 98302000170 SIMPLE DIAGNOST CLEVER CHOICE MICRO TEST STRIP 98302000180 SIMPLE DIAGNOST CLEVER CHOICE MICRO MONITOR 98939000200 FOR A CARE INC. FORA D10 BLOOD GLUCOSE SYSTEM 98939000201 FOR A CARE INC. FORA D10 GLUCOSE TEST STRIPS 98939000204 FOR A CARE INC. FORA HIGH CONTROL SOLUTION 98939000205 FOR A CARE INC. FORA LOW CONTROL SOLUTION 98939000206 FOR A CARE INC. FORA NORMAL CONTROL SOLUTION 98939000207 FOR A CARE INC. FORA V12 BLOOD GLUCOSE SYSTEM 98939000209 FOR A CARE INC. FORA V10 BLOOD GLUCOSE SYSTEM 98939000210 FOR A CARE INC. FORA V10 GLUCOSE TEST STRIP 98939000212 FOR A CARE INC. FORA D15C GLUCOSE TEST STRIPS 98939000216 FOR A CARE INC. FORA D15Z GLUCOSE TEST STRIPS 98939000217 FOR A CARE INC. FORA V20 BLOOD GLUCOSE SYSTEM 98939000218 FOR A CARE INC. FORA V20 GLUCOSE TEST STRIPS 98939000219 FOR A CARE INC. FORA V22 BLOOD GLUCOSE SYSTEM 98939000220 FOR A CARE INC. FORA V22 GLUCOSE TEST STRIP Page 46 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 98939000226 FOR A CARE INC. FORA V12 BLOOD GLUCOSE SYSTEM 98939000227 FOR A CARE INC. FORA V12 GLUCOSE TEST STRIP 98939000229 FOR A CARE INC. FORA G30A BLOOD GLUCOSE SYSTEM 98939000231 FOR A CARE INC. FORA G30A GLUCOSE TEST STRIP 98939000233 FOR A CARE INC. FORA G20 BLOOD GLUCOSE SYSTEM 98939000234 FOR A CARE INC. FORA G20 GLUCOSE TEST STRIPS 98939000235 FOR A CARE INC. FORA V10 BLOOD GLUCOSE SYSTEM 98939000236 FOR A CARE INC. FORA V10 GLUCOSE TEST STRIP 98939000238 FOR A CARE INC. FORA D15G GLUCOSE TEST STRIPS 98939000244 FOR A CARE INC. FORA D20 BLOOD GLUCOSE SYSTEM 98939000245 FOR A CARE INC. FORA D20 GLUCOSE TEST STRIPS 98939000246 FOR A CARE INC. FORA G90 BLOOD GLUCOSE SYSTEM 98939000247 FOR A CARE INC. FORA G90 GLUCOSE TEST STRIP 98939000256 FOR A CARE INC. FORA G71A BLOOD GLUCOSE SYSTEM 98939000257 FOR A CARE INC. FORA G71A GLUCOSE TEST STRIPS 98939000258 FOR A CARE INC. FORA LANCING DEVICE 98939000259 FOR A CARE INC. FORA V30A BLOOD GLUCOSE SYSTEM 98939000260 FOR A CARE INC. FORA V30A GLUCOSE TEST STRIP 98939000261 FOR A CARE INC. FORA LANCETS 98939000265 FOR A CARE INC. FORA G71A BLOOD GLUCOSE SYSTEM 98939000266 FOR A CARE INC. FORA G71A BLOOD GLUCOSE SYSTEM 98939000267 FOR A CARE INC. FORA G71A BLOOD GLUCOSE SYSTEM 99073011001 ABBOTT DIABETES FREESTYLE SYSTEM KIT 99073011004 ABBOTT DIABETES FREESTYLE SYSTEM KIT 99073012050 ABBOTT DIABETES FREESTYLE TEST STRIPS 99073012051 ABBOTT DIABETES FREESTYLE SIDEKICK II VALPK 99073012101 ABBOTT DIABETES FREESTYLE TEST STRIPS 99073012301 ABBOTT DIABETES FREESTYLE TEST STRIPS 99073012401 ABBOTT DIABETES FREESTYLE TEST STRIPS NFRS 99073012450 ABBOTT DIABETES FREESTYLE TEST STRIPS NFRS 99073013001 ABBOTT DIABETES FREESTYLE LANCETS 99073014001 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073014002 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073014003 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073014003 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073017001 ABBOTT DIABETES FREESTYLE FLASH SYSTEM KIT 99073070428 ABBOTT DIABETES FREESTYLE UNISTIK 2 LANCETS 99073070432 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073070432 ABBOTT DIABETES FREESTYLE CONTROL SOLUTION 99073070683 ABBOTT DIABETES FREESTYLE NAVIGATOR SENSOR KIT 99073070792 ABBOTT DIABETES FREESTYLE TEST STRIPS 99073070804 ABBOTT DIABETES FREESTYLE LITE METER NFRS 99073070805 ABBOTT DIABETES FREESTYLE LITE METER 99073070819 ABBOTT DIABETES FREESTYLE LITE TEST STRIP NFRS 99073070822 ABBOTT DIABETES FREESTYLE LITE TEST STRIP 99073070823 ABBOTT DIABETES FREESTYLE LITE TEST STRIP NFRS 99073070827 ABBOTT DIABETES FREESTYLE LITE TEST STRIP 99073070847 ABBOTT DIABETES FREESTYLE FREEDOM KIT 99073070914 ABBOTT DIABETES FREESTYLE FREEDOM LITE METER 99073070920 ABBOTT DIABETES FREESTYLE FREEDOM LITE NFRS 99073071097 ABBOTT DIABETES FREESTYLE PREC 1 ML 30GX5/16" 99073071098 ABBOTT DIABETES FREESTYLE PREC 0.5 ML 30GX5/16 Page 47 of 48
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