Veterans Affairs FAQs
Is Dexcom G6 covered by Veterans Affairs benefits?
Yes, patients with type 1 or type 2 diabetes who meet the qualifying criteria* are eligible for coverage of the Dexcom G6 Continuous Glucose Monitoring (CGM) System.
*For a complete description of Veterans Affairs coverage criteria and additional information, please see the Department of Veterans Affairs Criteria for Use Memorandum, January 31, 2019. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to be eligible to receive coverage.
Disclaimer: CGM coverage and reimbursement information is being provided on an “as is” basis at the time of publication, with no express or implied warranty of any kind, and should be used solely for informational purposes. All coding, coverage policies, and reimbursement information are subject to change without notice. Coverage for CGM depends on a variety of factors, and coverage conditions will apply. Not all patients will be covered for Dexcom G6 or any other CGM device. Dexcom, Inc. does not represent or guarantee coverage under any applicable payor, program, or plan. The information provided herein does not constitute professional or legal advice on coverage or reimbursement and should be used at your sole liability and discretion. Dexcom, Inc. does not represent or warrant that any of the information being provided is true or correct and you agree to hold Dexcom, Inc. harmless in the event of any loss, damage, liability, expense, or claim arising from your use or reliance on this coverage or reimbursement information for billing purposes. Before submitting any claims for reimbursement to any payor, it is the provider’s sole responsibility to verify compliance with the payor’s current coverage conditions.
What are the eligibility requirements for patients?
To be eligible for Dexcom G6 coverage under Veterans Affairs, a patient must meet the following qualifying criteria:*
- Has diabetes
- Performs frequent blood glucose monitoring (BGM) testing (≥4x/day)
- Uses an insulin pump or takes ≥3 daily injections of insulin
- Has the skillset and knowledge to use CGM successfully
- Has agreed to be followed-up in the clinic a minimum of every six months
- And is one or more of the following:
- At risk for hypoglycemia
- Unable to meet glycemic control despite adherence to the treatment regimen
- Performing job-related activities where a hypoglycemic event could put them at risk of harm
- Unable to perform self-monitoring of blood glucose due to disability or disease
*For the full coverage criteria, please talk to your VA healthcare provider. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to receive coverage.
Is Dexcom G6 covered by Veterans Affairs medical or pharmacy benefits?
The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered under pharmacy benefits for eligible patients.
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