Ann Intern Med. Read Also: How Do I Get A New Medicare Health Insurance Card. Dexcom G7 is a real-time CGM system that sends glucose numbers to your Dexcom receiver and smartphone* without fingersticks. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is indicated for ages 2 years and older. I am a new Medicare customer. 2017;317(4):371-378. The needle retracts and the sensor sits on top of the skin and is held in place by adhesive tape. 2023;11(2):96-108. You have an in-person or Medicare-approved visit with the practitioner who prescribed the CGM every 6 months after initiating CGM therapy, General customer support MondayFriday 6:00 am5:00 pm PST, Product troubleshooting inquiries 24 hours a day, 7 days a week. Originally, Medicare would not pay for both Afrezza and CGM technology, meaning that someone wanting to use either of these for their diabetes management would have to choose. 8 Miller KM, et al. *Medicare covers Dexcom CGM for insulin-requiring patients who meet the Medicare coverage criteria. How Long Can Your Body Survive Without Insulin? Yes. See additional information. Beginning Feb. 28, 2022, those using a Medtronic CGM integrated with the companys MiniMed insulin pumps will be able to get Medicare coverage for their transmitters, sensors and supplies. If you continue to have this issue please contact . This could also mean missing regular testing during the night due to sleep. In addition, I certify that I (i) am the patient referenced above or (ii) am the parent or legal guardian of the patient referenced above, and that I am at least eighteen (18) years of age. For new patients, complete the Get Started form to get a free benefits . Dexcom respects Follow these two simple steps to get your eligible Medicare patients started quickly on the Dexcom G7 Continuous Glucose Monitoring System. All the details of putting that new policy into place were laid out for Medicare contract companies in a comprehensive Local Coverage Determination document. To set up Dexcom Share on Dexcom G7, tap the Connections tab on the bottom bar of the app. 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. 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. Be insulin-treated with three or more daily administrations of insulin, or a continuous subcutaneous insulin infusion (CSII) pump, Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results, Have had an in-person visit with their provider within six months prior to ordering the CGM in order to evaluate their diabetes control and determine coverage criteria is met. What if insurance doesnt cover the Dexcom G7 Receiver for my patient? The restriction was in the fine print. The app will walk you through sending invitations to up to 10 Followers. Visitwww.dexcom.com/medicareto view online training videos. 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. Ahmann agrees that the Dexcom might be preferred by patients who have hypoglycemic episodes: If you want the most data, you would certainly want the Dexcom platform because it provides more information and has the alarms. Features of the Dexcom G6 System include: No calibration required No need to calibrate with a blood glucose meter, eliminating the need for fingersticks.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'medicaretalk_net-large-mobile-banner-2','ezslot_1',172,'0','0'])};__ez_fad_position('div-gpt-ad-medicaretalk_net-large-mobile-banner-2-0'); Long-life sensor Approved for up to 10 days of use. Aleppo says that the real-time data from the Dexcom and its alerts of impending problems make it particularly suited to patients whose hypoglycemia unawareness might lead them to manage their fear of hypoglycemia by overeating, taking less insulin, being afraid of exercise, being afraid of driving, and eating unnecessary bedtime snacks to avoid overnight events. However, you can use the app (on your smartphone, smartwatch, tablet, etc) as well as the receiver. In order for patients to qualify for Medicare. Medtronic). https://www.dexcom.com/safety-information. Glookos Role in Revolutionizing Diabetes Data Usability, Advocates Take a Stand Against Diabetes Stigma. The consent submitted will only be used for data processing originating from this website. 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.. The sensor regularly tests blood glucose levels and sends the results back to a receiver that the user keeps on-hand. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. It also viewed the FreeStyle Libre flash glucose monitoring a bit differently than other tech, like Dexcom and Eversense. Recommended Reading: Does Medicare Require A Referral For A Colonoscopy. 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. But some seniors are definitely ordering G6 systems and that is great news. My patient is a current G6 user. Terms and conditions apply. Coverage limits may include the amount of some supplies you can get or how often some services are covered. Description. 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. There is a lot of discussion on social media this week about Dexcom G6 finally being available for Medicare recipients. These videos can walk you through the steps to get started, including receiver and app set-up, and downloading Dexcom Clarity. The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS, the organization tweeted. Slim, water-resistant sensor The new, slim sensor is water-resistant and can be submerged under 8 feet of water for up to 24 hours when installed properly. I need help getting started. Will Dexcom provide my diabetes testing supplies? When asked, enter the SN (serial number) of the transmitter you're wearing. Up until now, Medtronic has been the only CGM company without Medicare coverage. Dexcom, Dexcom Follow, Dexcom Clarity, and Dexcom Share are registered trademarks of Dexcom, Inc. in the U.S., and may be registered in other countries. Even with these latest changes, many see a need for more Medicare reform across the board. Medicare has often been criticized for its CGM prerequisite rules, because they arent based on any scientific data or sound medical reasoning tied to A1C reduction or even better CGM use. Search for Dexcom G7. No. With this stated, an imbalance in glucose levels can lead to severe health consequences, so you should never make big changes to your diet or exercise routine without discussing your situation with a qualified health professional first. If your insurance doesnt cover the G7 receiver, Dexcom has a discounted receiver program through GoodRx. manage diabetes without fingersticks., 91% of surveyed Medicare patients on All rights reserved. Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. 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. Medicare Coverage for Dexcom G6 Equipment In most cases, Medicare benefits will cover Dexcom G6 equipment under a fee-for-service agreement. The CGM is prescribed in accordance with an FDA indication for its use. Dexcom CGM removes the mystery from diabetes. Insulet's Omnipod 5 becomes the first commercially available Automated Insulin Delivery (AID) system with no tubes and smartphone control. For Government Resources Regarding Medicare, Please Visit www.medicare.gov. 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. Scanning the flash reader is painless and can be done several times a day. 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 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. Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings. Still need help? The Dexcom G6 Continuous Glucose Monitoring System is covered by Medicare, as long as you meet coverage criteria. Medicare coverage for therapeutic CGM includes certain beneficiaries who have diabetes, are insulin-treated, and see their doctor for their diabetes every 6 months. CMS will expand Medicare coverage for all types of continuous glucose monitors, including adjunctive and non-adjunctive CGMs. Prescribing Info Dexcom G6 CGM Pharmacy Ordering and Filling Info Sheet The Dexcom G6 CGM is Available Through Pharmacy! . By choosing to request info, you are granting Dexcom, Inc. 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. Failure to use your receiver will result in loss of Medicare coverage for your Dexcom G6 or Dexcom G7 CGM supplies. Medicare.Org Is A Non-Government Resource That Provides Information Regarding Medicare, Medicare Advantage, And More. 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. Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM. Each has its own set of unique features, alarms, and recommended age range. We feel very strongly that others at risk of hypoglycemia, especially those on sulfonylureas , should also have access to CGM. Coverage for therapeutic CGM includes certain beneficiaries who have either Type 1 or Type 2 diabetes and intensively manage their insulin. Its easy to use the Dexcom G6. Does Medicare cover Dexcom G6 and Dexcom G7? We will be working on advocacy on this front if youd like to help. Speak with a Licensed Medicare Sales Agent 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST | Sunday Closed), 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST | Sunday Closed). Effective April 16, 2023, Medicare has expanded coverage[1] of CGM to more people with diabetes. You can view your 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 you are a current Dexcom G6 user not on a connected insulin pump, please speak to your doctor about getting a prescription for Dexcom G7. 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 . * Even those who are not on insulin, but experience hypoglycemia events, can qualify for Dexcom CGM coverage. Dexcom respects Dexcom G6 Medicare Patient Coverage Medicare will cover CGMs for people who: Have an established diagnosis of Type 1 or Type 2 diabetes Are currently using a traditional blood glucose monitor Must check their blood sugar a minimum of four times daily the privacy and confidentiality of your personal information. If you currently use Dexcom G6 with a connected insulin pump, we recommend continuing it until Dexcom G7 adds compatibility with your pump or pen. A person can see their glucose level anytime and review how it changes over a few hours or days to find trends, which allows them to make better decisions about balancing food, exercise, and medication. The average cost for 1 Miscellaneous, 1 box each, is $294.99. I have heard from two sources that Dexcom will be sending current Medicare G5 users A LETTER. What documentation is required to meet coverage criteria for a history of problematic hypoglycemia? As of mid-2022, Medicare covers the Dexcom G6 as well. Create an account or log in using your Dexcom account. Must meet eligibility requirements. The FreeStyle Libre is a line of continuous glucose monitors that are typically worn on the skin of the upper arm for up to 14 days. . 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. In a fact sheet, noted it is not finalizing the proposed categories of supplies and accessories and fee schedule amounts for three types of CGM systems. With time constraints, many clinicians are unwilling or unable to assist patients with this submission. Getting Dexcom CGM has truly been life-changing for my mom. 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. The sensor does this every few minutes, and the information is sent wirelessly to a monitor. 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