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Reimbursement

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Reimbursement for CGM

Significant progress has been made for coverage of continuous glucose monitoring (CGM) with both commercial health insurers and government-sponsored plans. Many of the reimbursement challenges experienced by the early-adopters of CGM no longer exist and today’s reimbursement environment has become more favorable. 

Commercial Health Coverage
Coverage of CGM for type 1 diabetes is offered for 98% of commercially insured members, and many plans also provide coverage for members with insulin-using type 2 diabetes.* Below you will find reimbursement information for commercial coverage, including the CGM coding reference sheet and sample plans of regional payers for personal CGM.

Medicare Coverage for CGM
Medicare now provides coverage for therapeutic CGM systems (those approved for use in making diabetes treatment decisions).The Dexcom G5® CGM System is the first therapeutic CGM system covered as a Medicare benefit.

Learn more about Medicare CGM coverage

 

*Internal data on file.

 

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...

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...

This resource can be provided to Medicare patients. The handout describes:

Eligibility requirements for Medicare Part B reimbursement for Medicare beneficiaries Next steps after a patient on Medicare is prescribed a Dexcom CGM including...

We're making it easier to get your patients started on continuous glucose monitoring (CGM). A majority of commercial insurance plans cover Dexcom CGM Systems for diabetes, and many provide coverage for type 2 patients on both national and select...

We're making it easier to get your patients started on continuous glucose monitoring (CGM). A majority of commercial insurance plans cover Dexcom CGM Systems for diabetes, and many provide coverage for type 2 patients on both national and select...

We're making it easier to get your patients started on continuous glucose monitoring (CGM). A majority of commercial insurance plans cover Dexcom CGM Systems for diabetes, and many provide coverage for type 2 patients on both national and select...

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