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Is Dexcom covered by Medicare?

June 13, 2017

Important information regarding the recent Medicare announcement

Last month an LCD (Local Coverage Decision) was issued, further defining the requirements for therapeutic CGM. Since then, we’ve been working diligently to identify a distribution channel to provide Medicare customers with access to the Dexcom G5 Mobile. We believe we are very close to a solution and are tirelessly working through final steps now. We hope to begin shipping to customers in the coming weeks, although it will take some time to work through the entire queue.

What does this ruling mean? Who is covered?
The ruling means 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.

Note: The beneficiary may NOT use their phone either as a primary receiver or as a secondary device and still be eligible for Therapeutic CGM.

 

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. Thus, Dexcom G5 Mobile is the only therapeutic CGM on the market set to be covered by Medicare at this time.

 

How do I get my Dexcom G5 Mobile?
New patients should contact Dexcom by visiting Dexcom.com/medicare and submitting a Dexcom G5 Mobile CGM interest form. Last month an LCD (Local Coverage Decision) was issued, further defining the requirements for therapeutic CGM. Since then, we’ve been working diligently to identify a distribution channel to provide Medicare customers with access to the Dexcom G5 Mobile. 

 

Who will send me my Dexcom G5 Mobile?
Last month an LCD (Local Coverage Decision) was issued, further defining the requirements for therapeutic CGM. Since then, we’ve been working diligently to identify a distribution channel to provide Medicare customers with access to the Dexcom G5 Mobile. We will continue to communicate with our patients as the rules become clear and our Dexcom G5 Mobile CGM Medicare patients can start receiving covered product. 

 

How much can I expect to pay for my Dexcom G5 Mobile?
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 would be covered, so the Dexcom G4 PLATINUM will not apply. Currently, only the Dexcom G5 Mobile 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 Mobile.

 

I still have questions. Who can I contact?
Please call Dexcom Customer Service at 888-738-3646 for additional information.

Insurance FAQ Topics:

LBL015124 Rev004

Interested in getting a Dexcom CGM?

If you are ready to take the next step, the process is simple. Provide us with a few details and we will contact you to begin your order.