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Formulary Product File Valid Values

HCPCS Description

  • A4206 = Insulin Syringes
  • A4215 = Insulin Needles
  • A4253 = Diabetic Test Strips
  • A4258 = Spring Powered Device for Lancet
  • A4259 = Diabetic Lancets
  • A4627 = Aerosol Holding Chamber
  • A9275 = Diabetic Monitor & Test Strips
  • B4103 = Oral Electrolyte
  • E2100 = Diabetic Monitor (talking)
  • T1999 = Hypertonic Saline