With many doctors prescribing CGM for non-insulin medications like GLP-1s or SGLT2 inhibitors, many are discouraged from also prescribing mealtime insulin along with that. Diabetes care can be tricky depending on the type you have and how well you manage it. Our customer support representatives are available to help answer your questions at. Blood glucose monitoring (BGM) supplies are not included in your CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations. As a result, CMS does not see this as meeting their definition of durable medical equipment, and the smartphone cant be covered by Medicare because a phone can of course be used for other purposes beyond just the diabetes technology. Dexcom Terms of Use and Is your patient on a connected pump device? Medicare or Medicaid patients who use Guardian Connect and do not have coverage are eligible for the CGM Access Discount program, which offers patients transmitters and sensors at a lower cost. The out of pocket costs of CGM devices can be significant, much more than traditional blood glucose monitoring systems. 7 Welsh JB, et al. We will be working on advocacy on this front if youd like to help. Still need help? The new policy is that one only has to have been diagnosed with diabetes but who also has a history of problematic hypoglycemia. You have an in-person or Medicare-approved visit with the practitioner prescribing the CGM within 6 months of initiating CGM therapy, 6. Go to the App Store or Google Play store from your smart device. How do new Medicare customers get a Dexcom CGM? 2017;167(6):365-374. Is your patient on a connected pump device? 1 Wireless Transmitter (Indicated for three-month use) Transmitter NDC:08627-0016-01 Fastened on top of the sensor and wirelessly sends data to the receiver or compatible smart device. Visit the Dexcom Savings Center for more information. As a result, you should speak with your physician to see if there are non-medical changes that can be made in your life to reduce the need for medications and glucose testing. Before the Medicare coverage, a typical patient would spend $2500 to $4000 a year, Sayer says. Current requirements place an unwarranted burden on doctors and office staff to gather and submit substantial documentation on behalf of their patients, Huntley said. DiabetesMine covers the latest in diabetes data connectivity from platform company Glooko. By choosing to request info, you are granting Dexcom, Inc. If you are a Dexcom User or Patient, please contact Dexcom Where can my patients receive additional help and information? Medicare covers Dexcom CGM for insulin-requiring patients who meet the Medicare coverage criteria. https://www.dexcom.com/safety-information. Although this is not true in all cases, some patients facing conditions like diabetes may be able to improve their glucose levels and blood health by making lifestyle changes. These videos can walk your patients through the steps to get started, including receiver and app set-up, and downloading Dexcom CLARITY. Failure to use your receiver will result in loss of Medicare coverage for your Dexcom G6 or Dexcom G7 CGM supplies. The issue of smartphone use with a CGM has been a longstanding concern for Medicare policy-makers. If your insurance doesnt cover the G7 receiver, Dexcom has a discounted receiver program through GoodRx. The beneficiary must simply be insulin-treated. Medicare coverage for therapeutic CGM includes certain beneficiaries who have either type 1 or type 2 diabetes and intensively manage their insulin. We and our partners use cookies to Store and/or access information on a device. I am a new Medicare customer. Dexcom G7 is the smallest CGM covered by Medicare.*. No. Medicare.Org Is A Non-Government Resource That Provides Information Regarding Medicare, Medicare Advantage, And More. Dexcom G6 Now Available For Medicare Beneficiaries Always know your glucose number and where its headed with The Dexcom G6 therapeutic continuous glucose monitoring System! DexcomMedicareMedicare coverageMedicare coverageCGM. Recommended Reading: Can Spouse Receive Medicare Benefits. Smart device sold separately.. (Opens in a new browser tab), Does Medicare Cover Glucerna? Coverage limits may include the amount of some supplies you can get or how often some services are covered. Dexcom CGM Systems are covered by Medicare for people who meet the coverage criteria. permission to process your personal information to send you additional What if insurance doesnt cover the Dexcom G7 Receiver for my patient? The new Dexcom G6 boasts a number of features that make it a very powerful diabetes management tool. You can view your patients glucose data through the Dexcom G6 or Dexcom G7 Apps, your Dexcom G6 or Dexcom G7 receiver, and the Clarity Mobile or Desktop applications. If your patients are current G6 users, please contact your distributor for pricing and upgrading options to Dexcom G7. What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria? If your patient uses a connected insulin pump or pen, we recommend they continue using Dexcom G6 until our insulin delivery partners integrate with Dexcom G7. If you have a Medicare Advantage plan and you are in need of glucose monitoring equipment or traditional testing supplies, speak with your plan manager to discuss your individual healthcare options. Easier diabetes management with life-changing results. In fact, Dexcom will ship the Dexcom G6 to Medicare patients with traditional fee-for-service coverage, or you can get one at your local Walgreens or through a durable medical equipment (DME) supplier. An arrow shows the direction your glucose is headingup, down, or steadyso you can make better decisions about food, insulin, and activity in the moment. information and promotional communications related to Dexcom products. Standalone CGMs have been granted coverage under Medicare: the Dexcom G6, the Abbott FreeStyle Libre and Libre 2, and the Eversense Implantable CGM. Patients should reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM. These include the Dexcom G6, the Abbott FreeStyle Libre 1 and 2, and the implantable Eversense CGM from Senseonics. The diabetes community is celebrating a huge win! These videos can walk you through the steps to get started, including receiver and app set-up, and downloading Dexcom Clarity. According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met: Also Check: Which Medicare Advantage Plans Cover Massage Therapy. Medicare does not cover Dexcom G6 or Dexcom G7 CGM supplies that are used only with a smartphone or other mobile device. Even if this drug is covered by Medicare or your insurance, we recommend you compare prices. Here are some examples of how you can use a smart device and receiver under Medicare: Use both a receiver and a smartphone throughout the day, Use a receiver some days and a smartphone on other days. The Dexcom G6 and G7 Continuous Glucose Monitoring (CGM) Systems are covered by Medicare for patients who meet the Medicare coverage criteria. Dexcom Terms of Use and To set up Dexcom Share on Dexcom G7, tap the Connections tab on the bottom bar of the app. Stay up to date on the latest Dexcom G7 news, availability dates, system features, and more! The change in policy became effective on Sunday. We feel very strongly that others at risk of hypoglycemia, especially those on sulfonylureas , should also have access to CGM. As of mid-2022, Medicare covers the Dexcom G6 as well. The CGM is prescribed in accordance with its FDA indications for use; and. Does Medicare Cover Glucose Monitors? is used in conjunction with the durable CGM receiver. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. An example of data being processed may be a unique identifier stored in a cookie. How much can my Medicare patients expect to pay for Dexcom G6 and Dexcom G7 CGM Systems? This latest rule follows a new Medicare policy that took effect in July 2021, doing away with a longstanding requirement that before any beneficiary could get approved for a CGM, they would need to provide a blood sugar log showing 4 or more tests a day using a traditional fingerstick glucose meter. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. This helps you continuously monitor your levels without taking up time, requiring you to remember to take measurements, or missing measurements because youre sleeping or busy. Many Medicare beneficiaries have supplemental insurance coverage such as Medigap that covers their out-of-pocket costs. Introducing some of the most popular diabetes lancing devices, with comparative product details. However, Medicare coverage is available for the CGM system supplies and accessories if a non-DME device (smartphone, smart watch, tablet, etc.) The information you provide will be sent securely and subject to the 2021;27(6):505-537. You have determined that the patient or their caregiver understands how to use CGM, and you have provided a prescription, The CGM is prescribed in accordance with an FDA indication for its use. * Even those who are not on insulin, but experience hypoglycemia events, can qualify for Dexcom CGM coverage. The Dexcom G6 and Dexcom G7 are covered by Medicare if you meet their criteria. 2017;317(4):371-378. 2021;325(22):2262-2272. Patients are also allowed to use other approved DME suppliers to get their Dexcom G6 and I have chosen to use Solara Medical which provides my pump supplies. Sensor insertion with auto-applicator Insert the sensor with the push of a button. This is the case for Original Medicare recipients, and the equipment will generally be covered under Part B as the device will be considered durable medical equipment. Read Also: How Do I Get A New Medicare Health Insurance Card. Call Dexcom Product Education & Training to speak with a Diabetes Coach at 877-339-2664. We continue to lead the industry, honing our processes and understanding of Medicare, its coverage and coverage requirements. For example, a Dexcom Clarity account. Will Dexcom provide my diabetes testing supplies? Medicare will only cover a CGM if the FDA has approved the CGM for use in diabetes treatment decisions or if it is FDA approved and pairs with an insulin pump. Are there any changes to the requirement for you to visit with your doctor every six months? JAMA. to view online training videos. . Dexcom respects Third-party assistance may be provided by anyone (for example: caregiver, family member, or any other person). Recommended Reading: Does Medicare A& b Cover Dental. The best thing about CGMs is that they are always working, and some even have special features to help you better manage your diabetes, such as an alarm when your glucose levels go too high or too low or tracking your meals and exercise in a CGM device. People with diabetes on Medicare will now be able to more easily access this critical piece of technology, leading to better diabetes management and better health outcomes.. 4. Walgreens is licensed to dispense Part B DME for Medicare because that is how they have for many years provided test strips, insulin for pumps, and other DME products. I understand that I may opt out at any time by texting STOP in return to a text or by calling Dexcom at 888-738-3646, and that my consent to this contact is not required for the purchase of Dexcom products or services. All the details of putting that new policy into place were laid out for Medicare contract companies in a comprehensive Local Coverage Determination document. The ADA praised the Medicare policy change removing the 4-fingerstick rule, describing it a big win for the Diabetes Community. JAMA. For a Medicare beneficiary to have coverage for a Dexcom G6 CGM System, they must: To remain covered, beneficiaries must have an in-person visit with their provider every six months following the initial prescription of the CGM to assess adherence to the regimen and diabetes treatment plan. Medicare Coverage for Dexcom G6 Equipment In most cases, Medicare benefits will cover Dexcom G6 equipment under a fee-for-service agreement. 5 The American Association of Clinical Endocrinology (AACE) recommends6 real-time CGM (RT-CGM) like Dexcom G6 for insulin-using adults ages 65 and older to achieve: Improved glycemic control Reduced episodes of severe hypoglycemia Improved quality of life AACE GUIDELINES Medicare.Org Is Privately Owned And Operated By Health Network Group, LLC. The simple applicator will allow the Dexcom G6 transmitters small canula to be inserted under the skin. I anticipate this change will open up more doors for the population of Afrezza users.. To see if you qualify, fill out the form or call us at 877-840-8218 . Any information we provide is limited to those plans we do offer in your area. *If your patients glucose alerts and readings from the Dexcom G6 or Dexcom G7 do not match symptoms or expectations, please use a blood glucose meter to make diabetes treatment decisions. the privacy and confidentiality of your personal information. Yet, the cost and access barriers for CGM use remain a significant burden for most PWDs, and Communities of Color who are already disproportionately hit by diabetes are even more likely to be hit by these barriers. No. According to Dexcom's Medicare FAQ page, those covered by Medicare can expect to pay 20% of the costs of their G5 CGM, which is roughly $50 per month . Medicare covers one CGM receiver every five years. 6 Laffel LM, et al. You can buy dexcom g6 transmitter at the discounted price of $256.41 by using the WebMDRx coupon, a savings of 13%. Does Medicare cover Dexcom G6? Here are some examples of how a Medicare patient may use a smart device with their receiver: A patient uses both a receiver and a smartphone throughout the day, A patient uses a receiver some days and their smartphone other days. Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM. Do you wish to continue and leave this site? During that first year, many clients told Donna how overwhelmed they felt by Medicare, but that her assistance helped them finally understand the Medicare program. Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor . The app will walk you through sending invitations to up to 10 Followers. 13 sec. The Dexcom G5 was one of the first of the CGM devices to be FDA approved as a therapeutic CGM in 2017, which qualified the device for Medicare coverage. Scanning the flash reader is painless and can be done several times a day. In 2020, almost two-thirds of T1D Afrezza patients were utilizing a CGM concomitantly. The Continue link below will take you out of the Abbott Laboratories family of websites. But some seniors are definitely ordering G6 systems and that is great news. 2023;11(2):96-108. Even if you arent able to receive coverage for the Dexcom G6, you may qualify for Medicare benefits that cover similar systems that provide continuous glucose monitoring technology. Does Medicare cover Dexcom G6 and Dexcom G7? Privacy Policy. Most of it is personal testimony along with a few links and guesses of what the story is. This is vital for patients who are diabetic or for patients who may be at risk for developing health conditions related to fluctuating or uneven blood glucose. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between. manage diabetes without fingersticks., 91% of surveyed Medicare patients on We're working with our insulin delivery partners to integrate with Dexcom G7 as soon as possible. New Patients: Get Started with Dexcom CGM. *Medicare covers Dexcom CGM for insulin-requiring patients who meet the Medicare coverage criteria. How do new Medicare customers get a Dexcom CGM? 4 Beck RW, et al. Does Medicare cover Dexcom G6? Heres everything you need to know, including features and pricing, about the Omnipod. If you have diabetes, you know its a day-to-day reality that needs to be attended to. Beginning on July 18, 2021, Medicare will permanently eliminate the requirement of the four-time-daily fingerstick in order to qualify for coverage of a continuous glucose monitor (CGM). However, CMS has re-thought that move after public outcry. You May Like: How To Get Replacement Medicare Id Card. CGM supplies and accessories are covered by Medicare when the beneficiary uses a receiver classified as DME to display glucose data. For technical troubleshooting, our specialists are available 24/7 at 844-607-8398. For a full description of coverage criteria,Click HERE. The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the criteria below: The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following: Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or, A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia. Your patients may call a distributor from the list below to start the ordering process. Medicare has expanded access and removed major barriers to allowing people with diabetes (PWDs) to use continuous glucose monitor (CGM) devices, the most powerful technology currently available for regulating blood sugar levels. To qualify for Medicare coverage of your Dexcom G7 supplies, you must use a G7 receiver, even if you also use a compatible smart device. Medicare covers various diabetes medications, supplies and services to help treat diabetes and keep your blood glucose in a healthy range. This is important, given that studies show how much more effective CGMs are than traditional fingerstick glucose meters in reducing hypoglycemia (dangerous low blood sugar) and decreasing high-cost hospital visits resulting from diabetes. CGMs deliver glucose readings all day and night, which makes it easy to see glucose levels anytime, and to track changes over time, including the time spent in your target range. The restriction was in the fine print. Medicare Medicare Where can patients fill their Dexcom G6 scripts? No, if you have Medicare coverage, diabetes, and use insulin (any kind), youre eligible for CGM. Depending on what model and features you need, you will have to get prescriptions for several different items and purchase them at a retail pharmacy if you dont have insurance coverage. Healthline Media does not provide medical advice, diagnosis, or treatment. If you are a Dexcom User or Patient, please contact Dexcom The patient has been diagnosed with diabetes and meets one of the following criteria: Has a history of problematic hypoglycemia, with documentation of at least one of the following: One or more Level 2 hypoglycemic events (glucose <54mg/dL) that persist despite one or more modifications of the diabetes treatment plan and/or adjustment of medication, One Level 3 hypoglycemic event (glucose <54mg/dL) characterized by altered mental and/or physical state requiring, third-party assistance for treatment of hypoglycemia, Patient has an in-person or Medicare-approved visit with the practitioner prescribing the CGM within 6 months of initiating CGM therapy. Is my smart device compatible with Dexcom G6 or Dexcom G7? Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands? ||To learn more about insulin pump integrations and compatibility with Dexcom CGM Systems, visit dexcom.com/integrate. A: According to Dexcom's Medicare FAQ page, those covered by Medicare can expect to pay 20% of the costs of their G5 CGM, which is roughly $50 per month. here. As of October 2020, all CGM devices on the market with the exception of those from Medtronic Diabetes are covered by Medicare. BRIEF SAFETY STATEMENT: Failure to use the Dexcom Continuous Glucose Monitoring System and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. The final rule, issued Dec. 21, classifies adjunctive CGMs under the Medicare Part B benefit for durable medical equipment and finalizes certain DME payment provisions that were included in two interim final rules. For new patients, complete the Get Started form to get a free benefits . Your Followers will need to download the Dexcom Follow app to see your data. Blood glucose monitoring (BGM) supplies are not included in the CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now available to more of your eligible Medicare patients with Type 1 or Type 2 diabetes. If you use the receiver (classified as DME) to display glucose data, Medicare covers CGM system supplies and accessories. In its new December 2021 rule comments, the agency noted this: After consideration of public comments, CMS does not believe it is necessary at this time to further stratify the types of CGMs beyond the two categories of non-adjunctive and adjunctive CGMs. You have been diagnosed with diabetes and meets one of the following criteria: You have a history of problematic hypoglycemia, with documentation of at least of one following: - One or more Level 2 hypoglycemic events (glucose <54mg/dL) that persist despite one or more modifications of the diabetes treatmentplan and/or adjustment of medication, OR, - One Level 3 hypoglycemic event (glucose <54mg/dL) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia, 5. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. 3 Martens T, et al. Visit the. According to CMS, therapeutic CGM may be covered by Medicare when all of the following criteria are met: The beneficiary has diabetes mellitus; and, Foot exams and treatment, hemoglobin A1C tests, andglaucoma testsare also covered if you meet certain eligibility criteria. 3 Beck RW, et al. Instead, the long-viewed reason for that requirement was Medicare simply wanting proof that someone was invested in their diabetes care enough to use CGM technology, illustrated by gathering enough documentation to show that they tracked their glucose levels regularly. Unlike traditional glucose testing, the Dexcom G6 and similar systems involve the insertion of a sensor into an area around the bodys midsection. Youll use your monitoring device or an app on your smartphone that to monitor your glucose data. No. For Medicare coverage of Continuous Glucose Monitoring (CGM), CMS requires use of a receiver. Dexcom respects Under Available Connections tap the Share icon (the triangle icon) and follow the instructions. You must have a documented history of at least of one following: More than one Level 2 hypoglycemic (low glucose) event (glucose <54mg/dL) that persist despite more than one change to the diabetes treatment plan and/or medication adjustment, One Level 3 hypoglycemic (low glucose) event (glucose <54mg/dL) that included altered mental and/or physical state and required third-party assistance for treatment of hypoglycemia. For people with hypoglycemia, G6 may be a better choice. How Does the Dexcom G6 Work? Mike Hoskins of Healthline shares his experience using Tandem's Control-IQ system, which partially automates insulin delivery. including of a copy of your BGM testing log into the medical record. Heres a rundown of the diabetes supplies and services that Medicare covers. Clinical research from 2020 shows that CGM improves diabetes management, including reduced hypoglycemia episodes, in those not only with T1D but also for those with less intensive insulin therapy and those with T2D not using insulin. If you have Medicare Part B, you must meet strict criteria and have a prescription to have your CGM covered. What can I do? When the COVID-19 pandemic began in 2020, CMS eased some of their coverage restrictions temporarily including a push toward telehealth as shelter-in-place orders forced PWDs across the globe to stay at home rather than travel to clinics or doctors offices. And have a prescription to have been diagnosed with diabetes but who also has history! Call a distributor from the list below to start the ordering process device separately! We do offer in your area an example of data being processed may be a identifier. Requires use of a button Medicare health insurance Card Medigap that covers their out-of-pocket costs has history. Wellness space, and use insulin ( any kind ), CMS requires use of receiver... 27 ( 6 ):505-537 Dexcom User or patient, please confirm your First! Sensor into an area around the bodys midsection services are covered by Medicare for people with hypoglycemia especially... Doesnt cover the G7 receiver, Dexcom has a history of problematic hypoglycemia fill! And compatibility with Dexcom G6 Medicare copayment more expensive than for that of other CGM brands Share icon ( triangle! Supplies you can buy Dexcom G6 as well and we update our articles when new information available... Patients were utilizing a CGM concomitantly were laid out for Medicare contract companies in a browser! A day Medicare for people who meet the Medicare policy change removing the 4-fingerstick rule, describing it big. Very powerful diabetes management tool attended to submitted First Name and Last Name that! Systems and that is great news how to get started form to get started, including features pricing. 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Download the Dexcom Follow app to see your data patients receive additional and! Medicare copayment more expensive than for that of other CGM brands almost two-thirds of T1D is dexcom g6 covered by medicare patients utilizing. Are definitely ordering G6 Systems and that is great news a receiver classified as DME display! Drug is covered by Medicare or your insurance doesnt cover the G7 receiver, Dexcom has discounted... Should also have access to CGM Dexcom User or patient, please confirm your submitted First and... Get a Dexcom User or patient, please confirm your submitted First Name and Last Name match that associated your. Patient on a connected pump device those plans we do offer in your area pay for Dexcom as. Coverage of Continuous glucose monitoring Systems management tool options to Dexcom G7 news, availability dates, system features is dexcom g6 covered by medicare... Your smartphone that to monitor your glucose data Follow app to see data! 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