Dexcom G7 is now
covered for all Medicare
patients on insulin*
Now more of your patients can experience the
life-changing benefits of Dexcom at no extra
cost compared to other CGM brands.†
New! Expanded
Medicare coverage
As of April 2023, Medicare now covers continuous glucose monitoring (CGM) for people who are on any type of insulin.* Even those who are not on insulin, but experience hypoglycemia events, can qualify for Dexcom CGM coverage.
Medicare eligibility criteria
Your Medicare patients may be eligible for Dexcom CGM if they meet the following criteria:
They have been diagnosed with diabetes
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
The patient has been diagnosed with diabetes and meets one of the following criteria:
• Is treated with any insulin, or
• 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
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
Patient has an in-person or Medicare-approved visit with the practitioner prescribing the CGM within 6 months of initiating CGM therapy
Patient has an in-person or Medicare-approved visit with the practitioner who prescribed the CGM every 6 months after initiating CGM therapy.
How to prescribe the Dexcom G7
CGM System for Medicare patients
Follow these two simple steps to get your eligible Medicare patients started quickly on the Dexcom G7 Continuous Glucose Monitoring System.
ENSURE THE CHART NOTES VERIFY THAT THE MEDICARE PATIENT MEETS THE CRITERIA ABOVE
SEND THE PRESCRIPTION TO ONE OF THE DISTRIBUTORS LISTED.
• Send the patient’s certificate of medical necessity (CMN) and chart notes to the distributor
• Let your patient know that they will be contacted by the distributor regarding their Dexcom G7 order
| DISTRIBUTOR | PHONE NUMBER |
|
Byram Healthcare CCS Medical US Med Solara Medical Supplies Edgepark USHL Edwards Healthcare Advanced Diabetes Supply Diabetes Management Supply BLN Mini Pharmacy |
800-775-4372 800-949-6481 866-934-5715 800-423-0896 opt 2 866-400-5183 opt 2 866-421-2732 888-344-3434 877-838-3026 888-738-7929 800-854-5729 888-545-6464 |
Dexcom CGM is an easier way to
manage diabetes without fingersticks.‡
91% of surveyed Medicare patients on
Dexcom CGM say it’s easy to use.1
4 out of 5 Medicare patients stay on Dexcom after 12 months.2
Patti Labelle, Dexcom user Paid spokesperson of Dexcom, Inc.
‡Fingersticks required for diabetes treatment decisions
if symptoms or expectations do not match readings.
Smart device sold separately.§
The American Association of Clinical Endocrinology (AACE) recommends real-time continuous glucose monitoring like Dexcom G7 for insulin-using adults ages 65 and older to achieve3:
- Improved glycemic control
- Reduced episodes of severe hypoglycemia
- Improved quality of life
Studies show that Dexcom CGM is
proven to increase time in range4-8
Studies show that Dexcom CGM use is clinically proven to increase time in range.4-8 Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Since A1C is a three-month average, it doesn’t give insight into potentially dangerous high and low glucose variations.
Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions.
*Medicare covers Dexcom CGM for patients who meet the Medicare coverage criteria. For a list of Medicare coverage criteria, please visit the Center for Medicare and Medicaid services website. †Under Medicare’s DME fee schedule, reimbursement, and coinsurance for CGMs using CPT codes A4239 and E2103 are the same, regardless of CGM brand. §For Medicare coverage of Continuous Glucose Monitoring (CGM), CMS requires use of a receiver. A patient may use a compatible smart device in conjunction with a receiver: dexcom.com/compatibility. ||To learn more about insulin pump integrations and compatibility with Dexcom CGM Systems, visit dexcom.com/integrate.
1 Qualtrax Data - Q1 2023.
2 Grunberger G, et al. Endocrine Practice. 2021;27(6):505-537.
3 Beck RW, et al. JAMA. 2017;317(4):371-378.
4 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374.
5 Martens T, et al. JAMA. 2021;325(22):2262-2272.
6 Laffel LM, et al. JAMA. 2020;323(23):2388-2396.
7 Welsh JB, et al. J Diabetes Sci Technol. 2022:19322968221099879.
*Medicare covers Dexcom CGM for insulin-requiring patients who meet the Medicare coverage criteria. For a list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website. †Must meet eligibility requirements. Under Medicare’s DME fee schedule, reimbursement for CGMs, using CPT codes K0554 and K0553, is the same, regardless of CGM brand. Regulation at 42 CFR 410.152(b), stipulates that coinsurance for items of durable medical equipment is 20% of the allowed amount. §For Medicare coverage of Continuous Glucose Monitoring (CGM), CMS requires use of a receiver. A patient may use a compatible smart device in conjunction with a receiver: dexcom.com/compatibility. ||To learn more about insulin pump integrations and compatibility with Dexcom CGM Systems, visit dexcom.com/integrate.
1 Qualtrax Data - Q1 2023. 2 Dexcom, data on file, 2022. 3 GLawrence Blonde, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan—2022 Update. Endocrine Practice. Volume 28, Issue 10. 2022. 4 Beck RW, et al. JAMA. 2017;317(4):371-378. 5 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374. 6 Martens T, et al. JAMA. 2021;325(22):2262-2272. 7 Laffel LM, et al. JAMA. 2020;323(23):2388-2396. 8 Welsh JB, et al. J Diabetes Sci Technol. 2022:19322968221099879. 9 Section 1834(a)(1)(A) of the Social Security Act. https://www.ssa.gov/OP_Home/ssact/title18/1834.htm. 10 MedPAC Data Book. Section 3: Medicare beneficiary and other payer financial liability. July 2022. LBL021746 Rev004
The two receivers have different hardware.* Please refer to the user guides for information about the hardware.
|
|
| Current Dexcom G6 Touchscreen Receiver | New Dexcom G6/G7 Receiver |
* Please note that images are not to scale.
The Current Dexcom G6 Touchscreen Receiver can not be upgraded to G7.
The New Dexcom G6 Touchscreen Receiver can be upgraded from G6 to G7.
Please reference Current Dexcom G6 Touchscreen Receiver user-guide here.
Please reference New Dexcom G6 Receiver user guide here.
Please reference New Dexcom G7 Receiver user guide here.
Medicare requires the use of the receiver for all patients. For all other payers, patients have the choice of what device to view their numbers. Users can also view their numbers on both their phone* and receiver if they choose.
Yes, the new Dexcom G6 receiver can be upgraded from the G6 to the G7 CGM system once your patient has a G7 prescription and has received the product. To upgrade, please instruct your patient to first use a secure internet connection to upload his/her G6 data to clarity.dexcom.com by logging in with his/her Dexcom account information and clicking Upload. Then, Clarity will ask if he/she wants to upgrade the receiver from G6 to G7. Just click the boxes to confirm that all the requirements are met. Please note that by upgrading the receiver from G6 to G7 your patient will no longer be able to use Dexcom G6 sensors or transmitters with the new Dexcom G6 receiver and your patient will not be able to revert the receiver back to G6. Your patient may opt to update from G6 to G7 any time he/she chooses, just return to Clarity and upload to be asked again.
Dexcom G6 and Dexcom G7 are available to Medicare patients through a medical distributor (see distributor list below).
Your patients may call a distributor from the list below to start the ordering process.
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.
| Distributor | Phone | Fax |
| Advanced Diabetes Supply | 877-838-3026 | 760-444-8771 |
| Byram Healthcare | 800-775-4372 | 888-457-1277 |
| CCS Medical | 800-949-6481 | 866-823-4482 |
| Diabetes Management & Supplies | 888-738-7929 | 504-734-7165 |
| Edgepark | 866-400-5183 | 866-510-6583 |
| Edwards Healthcare | 888-344-3434 | 502-657-0237 |
| Solara Medical Supplies | 800-423-0896 option 2 | 800-999-7021 |
| US Medical | 877-659-9875 | 888-659-9112 |
Medicare beneficiaries with diabetes mellitus who are using any kind of insulin will be eligible for CGMs. Frequent adjustment of insulin on the basis of CGM results is no longer required. The beneficiary must simply be insulin-treated.
For a full description of coverage criteria, Click HERE
If your patients are current G6 users, please contact your distributor for pricing and upgrading options to Dexcom G7. If your patients currently use Dexcom G6 with a connected insulin pump, we recommend continuing it until Dexcom G7 adds compatibility with your pump or pen. We're working with our insulin delivery partners to integrate with Dexcom G7 as soon as possible. Medicare covers one CGM receiver every five years.
Dexcom has a discounted receiver program through GoodRx for getting a G7 receiver at an affordable price. Visit the Dexcom Savings Center for more information. Terms and conditions apply.
Dexcom G6 and Dexcom G7 are available to Medicare patients through a medical distributor (see distributor list below).
Your patients may call a distributor from the list below to start the ordering process.
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.
|
Distributor |
Phone Number |
|
Advanced Diabetes Supplies |
877-838-3026 |
|
Byram Healthcare |
800-775-4372 |
|
CCS Medical |
800-949-6481 |
|
Diabetes Management & Supplies |
888-738-7929 |
|
Edgepark |
866-400-5183 |
|
Edwards Healthcare |
888-344-3434 |
|
Solara Medical Supplies |
800-423-0896 option 2 |
|
US Medical |
877-659-9875 |
No. Blood glucose monitoring (BGM) supplies are not included in the CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations.* Any BGM testing supplies need to be purchased.
*If your patient’s 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.
How does my patient view glucose data?
You can view your patient’s glucose data through the Dexcom G6 or Dexcom G7 Apps, your Dexcom G6 or Dexcom G7 receiver, and the Clarity Mobile or Desktop applications.
Medicare does not cover Dexcom G6 or Dexcom G7 CGM supplies that are used only with a smartphone or other mobile device. Failure to use your receiver will result in loss of Medicare coverage for your Dexcom G6 or Dexcom G7 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. 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, smart watch, 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.
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
Patients should reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.
Generally, Medicare patients pay 20% out of pocket. Many Medicare beneficiaries have supplemental insurance coverage such as Medigap that covers their out-of-pocket costs.
Visit www.dexcom.com/medicare to view online training videos. These videos can walk your patients through the steps to get started, including receiver and app set-up, and downloading Dexcom CLARITY
Still need help? Call Dexcom Product Education & Training to speak with a Diabetes Coach at 877-339-2664.
For technical troubleshooting, our specialists are available 24/7 at 844-607-8398.