Those who want the reimbursement must use the receiver that comes with the CGM system—and cannot use a smartphone app or tablet to display their glucose data. If they use their smartphone at all, even alongside the receiver, Medicare won’t pay.
Full Answer
Why is Dexcom no longer a Medicare supplier?
As part of Dexcom’s mission to focus more on innovation and product improvement, Dexcom will be discontinuing its role as a Medicare-enrolled supplier of medical equipment. This means that effective September 1, 2020, Dexcom will no longer be able to submit claims to Medicare on your behalf.
Does Medicare cover Dexcom G6?
Even if you aren’t able to receive coverage for the Dexcom G6, you may qualify for Medicare benefits that cover similar systems that provide continuous glucose monitoring technology.
What happens if I don't use my Dexcom G6 receiver?
Failure to use your receiver will result in loss of Medicare coverage for your Dexcom G6 CGM supplies. 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.
What is Dexcom share and how do I use it?
Dexcom Share is a feature of the Dexcom G6 app. To set up Dexcom Share, press the Share icon (the triangle in the upper right hand corner of the screen) and follow the instructions. The app will walk you through sending invitations to up to 10 Followers.
Smartphones Make the Dexcom G5 Better, and No Worse
The Dexcom G5 Mobile system always ships with a receiver, even before Medicare got involved. The system is a fully functional medical device without a smartphone.
Elderly People Use Smartphones Too
I’ve written about digital health and iPhone health apps since the launch of the App Store with the iPhone 3G, and I’ve noticed two things: 1) People frequently incorrectly assume that older people don’t use smartphones, and 2) Older folks are fantastic at using their smartphone, especially for health monitoring.
Allowing Smartphones Does Not Require Medicare to Pay for the iPhone
I’ve heard it argued that perhaps this restriction prevents Medicare patients from trying to require Medicare to reimburse the cost of the iPhone. I call BS.
Conclusion: Medicare Does Not Understand Digital Health
Look, I get that we should be immensely grateful that Medicare has gone so far as to finally approve their first Continuous Glucose Monitor. That’s a huge victory, and I applaud the folks at CMS for doing so. I even get why Dexcom isn’t fighting back very hard against Medicare. (Beggars can’t be choosers).
How often do you need to be rescreened for Dexcom?
Patients who receive coverage will need to receive an initial screening at the time of prescription, and going forward, they will need to be re-screened for changes every six months.
What is a Dexcom G5?
The Dexcom G5 is a system utilizes a sensor, transmitter and a receiver to monitor blood glucose levels and send and receive vital information in real-time regarding these levels. When first installing the Dexcom G5, a small sensor is injected under the skin that keeps track of blood glucose. This data is then transmitted via a wireless connection ...
Is a test strip still a viable method for monitoring blood glucose?
Although test strips are still a viable method for monitoring blood glucose, medical technology brought forth by companies like Dexcom has come a long way in providing diabetics with options for continuous blood glucose monitoring.
Does Medicare cover Dexcom G5?
Medicare benefits do cover the Dexcom G5 and other Dexcom G-series monitoring systems, but there are some guidelines that must be met in order for expenses to be included when billing Medicare. A qualifying Medicare member must be diagnosed with Type 1 or Type 2 diabetes and must be on intensive insulin therapy in order for coverage to apply.
Is Dexcom G5 covered by Part A?
If the Dexcom G5 is supplied during a temporary stay in a skilled nursing facility or while admitted to a hospital, it is possible that the system would be covered under Part A.
Can you use a Dexcom G5 with a smartphone?
Although the Dexcom G5 can interface with a smartphone, the qualifying patient must also use the supplied receiver in order for the coverage to remain continuous. This means that if you intend to use a smartphone with a Dexcom G5, you will also need to record your results using the receiver and be ready to supply those results when requested.
Does Dexcom respect privacy?
You may opt-out of these communications at any time. Dexcom respects the privacy and confidentiality of your personal information. The information you provide will be sent securely and subject to the Dexcom Terms of Use and Privacy Policy.
Does Medicare cover Dexcom G6?
Medicare does not cover Dexcom G6 supplies that are only used with a smartphone or other mobile device. Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website.
How does Dexcom G6 work?
How Does the Dexcom G6 Work? Unlike traditional glucose testing, the Dexcom G6 and similar systems involve the insertion of a sensor into an area around the body’s midsection. The sensor regularly tests blood glucose levels and sends the results back to a receiver that the user keeps on-hand.
Does Medicare cover Dexcom G6?
Medicare Coverage for Dexcom G6 Equipment. In most cases, Medicare benefits will cover Dexcom G6 equipment under a fee-for-service agreement. 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.
Does Dexcom G6 monitor glucose?
Today, however, advanced glucose monitoring using technology like the Dexcom G6 can provide real-time data 24 hours a day for people who need continuous monitoring. Modern monitoring provides important information regarding overall health as it relates to glucose levels, allowing for faster treatment in the event of an emergency.
What happens if a Medicare patient is denied coverage for Dexcom G6?
If a Medicare patient is denied coverage for Dexcom G6, it will be the distributor’s role to advise the patient or provider on the next steps for obtaining coverage.
What happens if a Dexcom G6 patient turns 65?
If a current Dexcom G6 patient “ages into” Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Prescribers should follow the new patient prescription process.
When will Dexcom G6 be available?
The Dexcom G6 is available for patients who meet the Medicare coverage criteria. Dexcom G6 became available to new patients in October 2019. Existing patients will be eligible for an upgrade when their Dexcom G5 transmitter is out of warranty. The Dexcom G5 transmitter has a three-month warranty.
What does it mean when a patient must call their plan?
A patient must call their plan to confirm that the distributor is in their network.
Does Medicare use Dexcom G5?
Medicare patients currently using Dexcom G5 will be automatically updated to De xcom G6 when their G 5 transmitter is out of warranty. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver. The existing Detailed Written Order (DWO) will be honored.
How to set up Dexcom share?
To set up Dexcom Share, press the Share icon (the triangle in the upper right hand corner of the 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 to see your data.* †
When will Medicare prescriptions be transferred?
For those Medicare beneficiaries who do not select a new Medicare-enrolled supplier by August 15, 2020, we will have your prescription files automatically transferred to one of the suppliers listed to minimize service disruptions.
How to view Dexcom training videos?
Visit www.dexcom.com/medicare to view online training videos. These videos can walk you through the steps to get started, including receiver and app set-up, and downloading Dexcom CLARITY
How to get a Walgreens prescription?
If you prefer to get your product through Walgreens, follow these steps: 1. Ask your doctor to prescribe to your chosen Walgreens. 2. Take your red, white, and blue Medicare card as well as any supplemental coverage cards to Walgreens to ensure you only owe your copay. 3.
Where to find serial number on Dexcom G6?
This can be found on the transmitter box, back of the transmitter or in your Receiver Settings. Pick up your Dexcom G6 System Continue visiting Walgreens to pick up your Dexcom G6 ongoing supplies.
Does Walgreens ship Dexcom G6?
If there is not a Walgreens in your area, Walgreens will ship your Dexcom G6 and supplies directly to you at no additional cost. If you cannot or choose not to fill your Dexcom G6 at Walgreens, you can choose to go through one of the participating distributors listed below.
Does Medicare cover CGM supplies?
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.