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Is Dexcom covered by Medicare?

Dexcom is now shipping the Dexcom G5® Continuous Glucose Monitoring (CGM) System to Medicare patients. 

We have contracted with Ascensia to provide the Contour® Next One blood glucose meter in the bundle of products covered by Medicare for Dexcom G5. 

 

I’m a Medicare patient. How do I know if I’m covered?

 Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy who meet the following criteria may now be able to obtain reimbursement: 

  • The beneficiary requires a therapeutic CGM. The beneficiary has diabetes mellitus; and,
  • The beneficiary has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing; and,
  • The beneficiary is insulin-treated with 3 or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump; and,
  • The beneficiary's insulin treatment regimen requires frequent adjustments by the beneficiary on the basis of therapeutic CGM testing results.
  • Within six (6) months prior to ordering the CGM, the beneficiary had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria are met; and,
  • Every six (6) months following the initial prescription of the CGM, the beneficiary has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

 

How can I view my glucose data?

According to the CMS policy, Medicare patients are permitted to use a smart device in conjunction with the Dexcom G5 Receiver to view glucose data.

 

CMS Policy

Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. There is no Medicare benefit for supplies used with equipment that is not classified as DME. However, Medicare coverage is available for the CGM system supplies and accessories if a non-DME device (smartphone, tablet, etc.) is used in conjunction with the durable CGM receiver. Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. If a beneficiary intends to never use a receiver classified as DME as the display device, the supplies and accessories are not covered by Medicare. 

A couple of examples of how a Medicare beneficiary may use a smart device in conjunction with their receiver are: 

  • A patient uses both a receiver and a smart phone throughout the day
  • A patient uses a receiver some days of the week and their smart phone other days of the week

Beneficiaries should reach out to 1-800-MEDICARE with any questions about the Medicare requirements for Dexcom CGM. 

 

I have a compatible smart device. How do I use my smart device to see my Dexcom G5 readings?

1. Go to the App Store or Google Play store from your smart device. Search for “Dexcom G5 Mobile”. Download and open the app.

2. Create account or log in using your Dexcom account. For example, a Dexcom Clarity account.

3. Follow the instructions in the app. When asked, enter the serial number (SN) of the transmitter you’re wearing. This can be found on the transmitter box, back of the transmitter or in your Receiver Settings.

4. Your app joins your current sensor session.

 

How do I set up Dexcom Share?

Dexcom Share is a feature of the Dexcom G5 Mobile app. To set up Dexcom Share, press the Share icon (triangle in upper right hand of screen) and follow the instructions. The app will walk you through sending invitations to up to 5 Followers. Your Followers will need to download the Dexcom Follow app. 

 

Are other CGM products covered as well?

The ruling specifically states that only CGM products labeled as a replacement of fingerstick blood glucose testing for diabetes treatment decisions by the FDA and referred to in the ruling as “therapeutic CGM” will be covered. 

 

How do I get my Dexcom G5 CGM System?

New patients should contact Dexcom by visiting www.dexcom.com/medicare-coverage and submitting a Dexcom G5 CGM interest form. Priority will be given to existing Dexcom CGM patients followed by new patients in the order they were originally received. As our sales representatives work through the queue, patients can expect to hear from Dexcom or an authorized Dexcom distributor about getting started. This will be a slow process and we appreciate everyone's ongoing patience during this process.  

 

Who will send me my Dexcom G5 CGM System?

Dexcom is now shipping G5 CGM supplies directly to eligible Medicare fee-for-service coverage. We have contracted with Ascensia to provide the Contour® Next One blood glucose meter in the bundle of products covered by Medicare. Today, we are not licensed to service all 50 states, so we will also be using Medicare distributors to support us.

 

How much can I expect to pay for my Dexcom G5 CGM System?

Patients who are covered by Medicare can expect to cover 20% of the costs, although this additional amount may be covered by secondary insurance. Medicare will cover the remaining 80%. 

 

I am using a Dexcom G4 PLATINUM CGM. How will this affect me?

The ruling specifically states that only CGM products approved by the FDA as a replacement of fingerstick blood glucose testing for diabetes treatment decisions (therapeutic) would be covered, so the Dexcom G4 PLATINUM will not apply. Currently, only the Dexcom G5 CGM System meets this criteria and would be eligible for Medicare coverage. Patients using Dexcom G4 PLATINUM may want to talk to their physicians or Dexcom to see if they would be eligible for Dexcom G5 CGM System. 

 

Is the Dexcom G6 covered by Medicare?

The Dexcom G6 is currently not available for Medicare patients.  Until it is, Medicare users can use the Dexcom G5. 

 

How do I know if my smart device is compatible with the Dexcom G5 CGM System?

For a list of compatible devices, visit www.dexcom.com/compatibility.

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