Medicare

What if the patient’s claim is denied at the distributor?

If a Medicare patient is denied coverage for Dexcom G6, it will be the distributor’s role to advise the patient or provider on the next steps for obtaining coverage.  

Why is Dexcom referring patients to distributors?

Dexcom has decided to refer all Medicare patients to trusted distributors with experience serving Medicare patients. We chose to shift all Medicare distribution so we can more fully focus on developing innovative continuous glucose monitoring (CGM) systems that simplify and improve diabetes management for people around the world.

Does Medicare cover Dexcom G6?

Yes. The Dexcom G6 is available for patients who meet the Medicare coverage criteria. Dexcom G6 became available to new patients in October 2019. Existing patients will be eligible for an upgrade when their Dexcom G5 transmitter is out of warranty. The Dexcom G5 transmitter has a three-month warranty.

What patient information is required within chart notes to ensure eligibility along with CMS Medicare coverage criteria?

  • Has been seen in your clinic within the last 6 months
  • Has type 1 or type 2 diabetes
  • Performs frequent blood glucose monitoring (BGM) testing (≥4x/day)
  • Uses an insulin pump or takes ≥3 daily injections of insulin
  • Requires frequent adjustments to their treatment regimen based on BGM or CGM testing results

For a complete description of Medicare coverage criteria and additional information related to what shold be included in the chart notes, please visit the Centers for Medicare and Medicaid services website.

How can HCPs prescribe Dexcom G6 to their Medicare patients?

HCPs can prescribe Dexcom G6 to one of the distributors below via the following steps:

  • 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 distributors below regarding their Dexcom G6 order
Distributor Phone Number
Byram Healthcare 800-775-4372
CCS Medical 800-949-6481
US Med 877-659-9875
Solara Medical Supplies 800-423-0896 option 2
Edgepark 866-400-5183
USHL 866-421-2732
Edwards Healthcare 877-367-2444
Advanced Diabetes Supply  877-838-302
Diabetes Management Supply 888-738-7929
BLN 877-261-2179
Mini Pharmacy 888-545-6464

A patient must call their plan to confirm that the distributor is in their network.

For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare?

If a current Dexcom G6 patient “ages into” Medicare eligibility (i.e., turns 65), they will be treated as a new patient. Prescribers should follow the new patient prescription process.

When will existing Medicare patients have access to Dexcom G6?

Medicare patients currently using Dexcom G5 will be automatically updated to Dexcom G6 when their G5 transmitter is out of warranty. This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. If they do not have a compatible receiver, they will get a new Dexcom G6 receiver.

Where can I get more information or support for my office or my patients?

Dexcom Tech support - 1-844-607-8398
Dexcom CARE team - 1-877-339-2664
Medicare G6 HCP site - provider.dexcom.com/medicare
Medicare G6 Patient site - www.dexcom.com/medicare
List of DME distributors - www.dexcom.com/medicare-coverage
Full list of Medicare coverage criteria - Centers for Medicare and Medicaid services website

Contact Dexcom

If you are a clinician and want to learn more about Dexcom’s Continuous Glucose Monitoring Systems, please fill out the form and a Dexcom representative will contact you.

If you are a Dexcom User or Patient, please contact Dexcom here.

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