Medicare

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.  

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.

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.

No. For a complete description of Medicare coverage criteria visit the Centers for Medicare and Medicaid services website.

• 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.

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

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

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.

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.

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