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Is Dexcom covered by Medicare?

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 be able to obtain reimbursement:

  • The patient 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.
  • In order to qualify for Medicare coverage, Medicare requires that you have a receiver that is compatible and that you use that receiver with your CGM supplies, even if you also use a compatible smart device. Medicare does not cover CGM supplies that are only used with a smartphone or other mobile device.

For a description of the Medicare Coverage criteria, please visit the Centers for Medicare and Medicaid services website.

 

When will the G6 System be available to Medicare customers?

Dexcom will start shipping Dexcom G6 to Medicare customers towards the end of this year.

 

I’m a current Dexcom Medicare customer, using the Dexcom G5 Mobile. How do I upgrade to the Dexcom G6?

You do not need to take any action at this time. Dexcom or your distributor will eventually upgrade your Dexcom G5 CGM System to Dexcom G6.

You will receive more details in your monthly check-in email or phone call.

 

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 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 10 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.

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