Prescribing Info

Medicare Assignment of Benefits Form

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Required documentation for prescribing CGM to Medicare patients

When prescribing a Dexcom CGM System to a Medicare patient, the Assignment of Benefits form is a necessary part of the document package for Medicare reimbursement. This form is to be signed by the patient or other authorized person.

Medicare Assignment of Benefits From (PDF)

Other documentation required for prescribing CGM to Medicare patients:

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...