Attention: DME Providers Upcoming DME Changes to the Roche Rebate Program for Preferred Roche Diabetic Supplies

Beginning April 1, 2018, diabetic testing supplies will be transitioned to the North Carolina Medicaid and NC Health Choice Preferred Drug List (PDL) and Roche diabetic testing supplies will remain preferred. DME providers will no longer receive two separate payments for claims for Roche diabetic testing supplies. Instead, providers will receive one payment based on a State Maximum Allowable Cost (SMAC).

The DME fee schedule will be updated to reflect the NDC-associated rates shown in the table below. Non-preferred brand diabetic testing supplies will continue to require prior authorization (PA) and will be reimbursed at the current SMAC rates.

Note: This is a republication from the March 2018 Medicaid Bulletin.

The following chart outlines the Roche diabetic testing supplies with their corresponding preferred NDC number and CPT code, specific reimbursement amounts and current rates for non-preferred brand diabetic testing supplies.

Product

NDC Number

 

 

 

CPT Code

 

 

 

NC Medicaid SMAC Rate

 

 

 

ACCU-CHEK AVIVA PLUS 50 ct Test Strips

 

 

65702-0407-10

 

 

A4253

 

 

$79.63/box of 50

 

 

ACCU-CHEK SMARTVIEW 50 ct Test Strips

 

 

65702-0492-10

 

 

A4253

 

 

$79.63/box of 50

 

 

ACCU-CHEK COMPACT

51 ct Test Strips

 

 

50924-0988-50

 

 

A4253

 

 

$81.67/box of 51

 

 

ACCU-CHEK GUIDE 50 ct Test Strips

 

 

65702-0711-10

 

 

A4253

 

 

$21.56/box of 50

 

 

Non-preferred Brand 50 ct Test Strips

 

 

N/A

 

 

A4253

 

 

$29.46/box of 50

 

 

ACCU-CHEK SOFTCLIX Lancing Device Kit (Black)

 

 

65702-0400-10

 

 

A4258

 

 

$22.63 each

 

 

ACCU-CHEK FASTCLIX Lancing Device Kit

 

 

65702-0481-10

 

 

A4258

 

 

$17.55 each

 

 

Non-preferred Brand Spring-powered Device for Lancet, Each

 

 

N/A

 

 

A4258

 

 

$17.55 each

 

 

ACCU-CHEK MULTICLIX 102 ct Lancets

 

 

50924-0450-01

 

 

A4259

 

 

$15.68/box of 102

 

 

ACCU-CHEK SOFTCLIX

100 ct Lancets

 

 

50924-0971-10

 

 

A4259

 

 

$13.93/box of 100

 

 

ACCU-CHEK FASTCLIX

102 ct Lancets

 

 

65702-0288-10

 

 

A4259

 

 

$13.68/box of 102

 

 

Non-preferred Brand Lancets, 100 per Box

 

 

N/A

 

 

A4259

 

 

$10.69/box of 100

 

 

ACCU-CHEK AVIVA Glucose Control Solution (2 levels)

 

 

65702-0107-10

 

 

A4256

 

 

$11.13/bottle

 

 

ACCU-CHEK COMPACT PLUS CLEAR Glucose Control Solution (2 levels)

 

 

65702-0468-10

 

 

A4256

 

 

$11.13/bottle

 

 

ACCU-CHEK GUIDE Glucose Control Solution (2 levels)

 

 

65702-0713-10

 

 

A4256

 

 

$11.13/bottle

 

 

ACCU-CHEK

 

® SMARTVIEW Glucose Control Solution

(2 levels)

 

 

65702-0488-10

 

 

A4256

 

 

$11.13/bottle

 

 

Non-preferred Brand Calibrator Solution/Chips, Each

 

 

N/A

 

 

A4256

 

 

$11.13/bottle