Revised South Carolina Medicaid Diabetic Meters and Strips Program

 

Effective immediately the following National Drug Codes (NDCs) may be billed through the Point of Sale (POS) system and do not require Prior Authorization: 

 

METERS

Manufacturer

Product Name

NDC

ABBOTT

FREESTYLE LITE

99073-0708-05

ABBOTT

FREESTYLE FREEDOM LITE

99073-0709-14

ABBOTT

FREESTYLE INSULINX

99073-0711-43

ABBOTT

PRECISION XTRA

57599-8814-01

LIFESCAN

ONE TOUCH ULTRA

53885-0247-01

LIFESCAN

ONE TOUCH ULTRA MINI

53885-0208-01

LIFESCAN

ONE TOUCH ULTRA MINI

53885-0419-01

LIFESCAN

ONE TOUCH ULTRA MINI

53885-0420-01

LIFESCAN

ONE TOUCH ULTRA2

53885-0448-01

LIFESCAN

ONE TOUCH ULTRAMINI

53885-0911-01

LIFESCAN

ONE TOUCH ULTRAMINI

53885-0912-01

LIFESCAN

ONE TOUCH ULTRASMART

53885-0524-01

LIFESCAN

ONE TOUCH ULTRA MINI

53885-0421-01

ROCHE

ACCU-CHECK COMPACT PLUS

50924-0019-01

ROCHE

ACCU-CHECK ACTIVE

50924-0477-01

ROCHE

ACCU-CHEK ADVANTAGE

50924-0860-01

ROCHE

ACCU-CHEK AVIVA

65702-0101-10

ROCHE

ACCU-CHEK NANO SMARTVIEW

65702-0483-10

 

 

 

 

 

 

 

 

 

STRIPS

Manufacturer

Product Name

NDC

ABBOTT

FREESTYLE

99073-0120-50

ABBOTT

FREESTYLE

99073-0121-01

ABBOTT

FREESTYLE LITE

99073-0708-22

ABBOTT

FREESTYLE LITE

99073-0708-27

ABBOTT

FREESTYLE INSULINX

99073-0712-31

ABBOTT

FREESTYLE INSULINX

99073-0712-27

ABBOTT

PRECISION XTRA

57599-9728-04

ABBOTT

PRECISION XTRA

57599-9877-05

LIFESCAN

ONE TOUCH ULTRA

53885-0244-50

LIFESCAN

ONE TOUCH ULTRA

53885-0245-10

LIFESCAN

ONE TOUCH ULTRA

53885-0994-25

LIFESCAN

ONE TOUCH VERIO 25’S

53885-0270-25

LIFESCAN

ONE TOUCH VERIO 50’S

53885-0271-50

LIFESCAN

ONE TOUCH VERIO 100’S

53885-0272-10

ROCHE

ACCU-CHEK COMFORT CURVE

50924-0373-50

ROCHE

ACCU-CHEK COMFORT CURVE

50924-0381-10

ROCHE

ACCU-CHEK ACTIVE

50924-0475-50

ROCHE

ACCU-CHEK COMPACT

50924-0884-01

ROCHE

ACCU-CHEK COMPACT

50924-0988-50

ROCHE

ACCU-CHEK AVIVA

65702-0103-10

ROCHE

ACCU-CHEK AVIVA

65702-0104-10

ROCHE

ACCU-CHEK AVIVA PLUS

65702-0407-10

ROCHE

ACCU-CHEK AVIVA PLUS

65702-0408-10

ROCHE

ACCU-CHEK NANO SMARTVIEW

65702-0492-10

ROCHE

ACCU-CHEK NANO SMARTVIEW

65702-0493-10

 

 

All other NDCs will be denied through the POS system but may be billed as a Durable Medical Equipment (DME) service via a CMS 1500 claim.  These changes do not apply to Medicaid beneficiaries enrolled with a Managed Care Organization (MCO).  Claims for services rendered to beneficiaries enrolled with a MCO should be filed to the MCO.  Questions regarding this bulletin should be directed to Magellan Medicaid Administration’s Call Center at 866-254-1669.

                                                                                                                                               

                                                                                   

 

                                                                                    /s/

Anthony E. Keck

                                                                                    Director

 

NOTE:   To receive Medicaid bulletins by email, please register at http://bulletin.scdhhs.gov/.

            To sign up for Electronic Funds Transfer of your Medicaid payment, please go to

            http://www.scdhhs.gov/openpublic/hipaa/index.aspand select “Electronic Funds Transfer

            (EFT)” for instructions.

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