Prescribing Info

CMN – Commercially Insured Patients

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Use this Certificate of Medical Necessity (CMN) to document medical necessity of Dexcom CGM for your commercially insured patients. This fillable form can also serve as the prescription.

More Prescribing Info

Prescribe Dexcom G6 for your intensive insulin therapy patients. See the sample prescription below.

The first prescription should include three items: 1 receiver, 1 wireless transmitter, and 1 three-pack of sensors.

1 Receiver

(Indicated for one-year use)

Required documentation for prescribing CGM to Medicare patients

When prescribing a Dexcom CGM System to a Medicare patient, the Certificate of Medical Necessity is a required part of the document package for Medicare reimbursement. This form...