MaineCare Diagnosis Codes DIAG CODE DIAGNOSIS DRUG 0 Standard Claim (No Diagnosis) Legend Drug 1 Sinusitis Legend Drug & Cold Prep 2 Otitis Media Legend Drug & Cold Prep 3 Emphysema Legend Drug & Cold Prep 4 Asthma Legend Drug & Cold Prep Methylphenedate / Dextroamphetamine / Adderall / Ritalin / 5 Attention Deficit Disorder, Narcolepsy Concerta 6 Megaloblastic and Pernicious Anemia B-12 7 Arthritis Aspirin *10/08/02 removed the quantity = to a 1000 8 Dialysis (Renal Failure) See Chart Below 9 Quadraplegia / Paraplegia See Chart Below 10 Cystic Fibrosis Multi-Vitamins & Vitamin E 11 Reserved 12 Drug Dependence Methadone 13 Reserved 14 Gestational Diabetes Test Strips (6 Months) P Pregnancy / Post (3 Months) Prenatal Vitamins (Days Supply Not to Exceed 100) I Infant Vitamin Drops (3 and Under) LF Liver Failure Lactulose CA Cancer See PA Chart NF Nursing Facility See PA Chart TO Titration Override Neurontin

DIAG 8 DIAG 9 DIAG 10 Aluminum Carb Gel Nephrocaps Agoral Mineral Oil Adeks Multivitamins Aluminum Hydroxide Nephron Fa Tabs Antacids Multivitamins Multiple Vitamins Berocca Neutra-Phos Ascorbic Acid Nephrocaps Cap Multivitamins Niferex / Niferex 150 Bisacodyl Caps Bisacoldyl Poly-Vi-Sol Drop Vitamin E Calcium Oyster Shell Oscal Calcium Oyster Shell Povidone Iodine Gel Calderol Phos - Ex Docusate 12/29/95 Psyllium Hydro Mucil DHT (Dihydrotach) Phoslo Docusate Potassium Senna Docusate Calcium Psyllium Hydro Mucil Docusate Sodium Senokot Docusate Sodium Riopan Docusate w/ can Stress Vitamins DSS With Casanthronol Rocaltrol DSS W/ Cassanthranol Vitamins C & D Ergocalciferol Senna Fleet Biasco Enema Ferro - Folic Tab 500 Thiamin Fleet Enemas Ferro-DSS Tab Triniscon Glycerin Suppositories Folic Vitamin C & D Lube Jelly IBC Folic Iron Multivitamins p/mepop/diagnosis codes for the web