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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 />
08326280002 BOCA MEDICAL ULTILET LANCETS<br />
08326281001 BOCA MEDICAL ULTILET CLASSIC 28G LANCETS<br />
08326281002 BOCA MEDICAL ULTILET CLASSIC 28G LANCETS<br />
08326281101 BOCA MEDICAL PUBLIX 28G LANCET<br />
08326281102 BOCA MEDICAL PUBLIX 28G LANCET<br />
08326284001 BOCA MEDICAL ULTILET CLASSIC 28G LANCETS<br />
08326284101 BOCA MEDICAL ULTILET CLASSIC 28G LANCETS<br />
08326290110 BOCA MEDICAL INSULIN SYRINGE 1 ML<br />
08326290130 BOCA MEDICAL INSULIN SYRINGE 0.3 ML<br />
08326290150 BOCA MEDICAL INSULIN SYRINGE 0.5 ML<br />
08326290310 BOCA MEDICAL ULTILET INSULIN SYRINGE 1 ML<br />
08326290330 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.3 ML<br />
08326290350 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.5 ML<br />
08326300001 BOCA MEDICAL ULTILET 30G LANCETS<br />
08326300110 BOCA MEDICAL INSULIN SYRINGE 1 ML<br />
08326300130 BOCA MEDICAL INSULIN SYRINGE 0.3 ML<br />
08326300150 BOCA MEDICAL INSULIN SYRINGE 0.5 ML<br />
08326300210 BOCA MEDICAL INSULIN SYRINGE 1 ML<br />
08326300230 BOCA MEDICAL INSULIN SYRINGE 0.3 ML<br />
08326300310 BOCA MEDICAL ULTILET INSULIN SYRINGE 1 ML<br />
08326300330 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.3 ML<br />
08326300350 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.5 ML<br />
08326301001 BOCA MEDICAL ULTILET CLASSIC 30G LANCETS<br />
08326302001 BOCA MEDICAL ULTILET BASIC 30G LANCETS<br />
08326304001 BOCA MEDICAL ULTILET CLASSIC 30G LANCETS<br />
08326304101 BOCA MEDICAL ULTILET CLASSIC 30G LANCETS<br />
08326310310 BOCA MEDICAL ULTILET INSULIN SYRINGE 1 ML<br />
08326310330 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.3 ML<br />
08326310350 BOCA MEDICAL ULTILET INSULIN SYRINGE 0.5 ML<br />
08326412801 BOCA MEDICAL ULTILET 28G LANCETS<br />
08327048609 MEDLINE INDUS. EVENCARE MONITORING SYSTEM<br />
08327048629 MEDLINE INDUS. EVENCARE GLUCOSE TST STRIPS<br />
08327048692 MEDLINE INDUS. EVENCARE CONTROL SOLUTION<br />
08327048692 MEDLINE INDUS. EVENCARE CONTROL SOLUTION<br />
08327052029 MEDLINE INDUS. EVENCARE TEST STRIPS<br />
08367010102 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 1CC<br />
08367010202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSULIN SYR 1CC<br />
08367011102 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSULIN SYR 1CC<br />
08367011202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 1CC<br />
08367012202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 1CC<br />
08367013202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 1CC<br />
08367033202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 0.3CC<br />
08367050102 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 0.5CC<br />
08367050202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSULIN SYR 0.5CC<br />
08367051102 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 1/2CC<br />
08367051202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSUL SYR 0.5CC<br />
08367052202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INSULIN SYR 0.5CC<br />
08367053202 RX HOLDINGS, LLC (DBA RX ELITE) ELITE-THIN INS SYR 0.5CC<br />
08396705014 CAN-AM CARE RA HEALTH CARE LANCING DEVICE<br />
08396705014 CAN-AM CARE RA HEALTH CARE LANCING DEVICE<br />
08396800100 CAN-AM CARE ULTRA COMFORT 0.5 ML 28GX1/2"<br />
08396800200 CAN-AM CARE ULTRA COMFORT 1 ML 28GX1/2"<br />
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