Healthcare providers can go to provider.dexcom.com/veterans to learn more about Dexcom G6 for veterans.
Yes. If a patient has VA pharmacy coverage, a healthcare provider can specify that this order should be filled via mail order when e-prescribing.
Yes, a healthcare provider can prescribe Dexcom G6 for a Veterans Affairs patient if the patient meets the qualifying criteria.*
*For a complete description of Veterans Affairs coverage criteria and additional information, please see the Department of Veterans Affairs Criteria for Use Memorandum, January 31, 2019. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to be eligible to receive coverage.
Disclaimer: CGM coverage and reimbursement information is being provided on an “as is” basis at the time of publication, with no express or implied warranty of any kind, and should be used solely for informational purposes. All coding, coverage policies, and reimbursement information are subject to change without notice. Coverage for CGM depends on a variety of factors, and coverage conditions will apply. Not all patients will be covered for Dexcom G6 or any other CGM device. Dexcom, Inc. does not represent or guarantee coverage under any applicable payor, program, or plan. The information provided herein does not constitute professional or legal advice on coverage or reimbursement and should be used at your sole liability and discretion. Dexcom, Inc. does not represent or warrant that any of the information being provided is true or correct and you agree to hold Dexcom, Inc. harmless in the event of any loss, damage, liability, expense, or claim arising from your use or reliance on this coverage or reimbursement information for billing purposes. Before submitting any claims for reimbursement to any payor, it is the provider’s sole responsibility to verify compliance with the payor’s current coverage conditions.
Last updated November 20,2020.
No, Dexcom G6 Pro can only be purchased by healthcare providers. For more information on how to order the Dexcom G6 Pro for your clinic, please visit provider.dexcom.com/products/dexcom-g6-pro.
Patients may be able to fill their Dexcom G6 supplies at the Veterans Affairs pharmacies.
To be eligible for Dexcom G6 coverage under Veterans Affairs, a healthcare provider must document that the patient meets the following qualifying criteria:*
*For a complete description of Veterans Affairs coverage criteria and additional information, please see the Department of Veterans Affairs Criteria for Use Memorandum, January 31, 2019. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to be eligible to receive coverage.
Disclaimer: CGM coverage and reimbursement information is being provided on an “as is” basis at the time of publication, with no express or implied warranty of any kind, and should be used solely for informational purposes. All coding, coverage policies, and reimbursement information are subject to change without notice. Coverage for CGM depends on a variety of factors, and coverage conditions will apply. Not all patients will be covered for Dexcom G6 or any other CGM device. Dexcom, Inc. does not represent or guarantee coverage under any applicable payor, program, or plan. The information provided herein does not constitute professional or legal advice on coverage or reimbursement and should be used at your sole liability and discretion. Dexcom, Inc. does not represent or warrant that any of the information being provided is true or correct and you agree to hold Dexcom, Inc. harmless in the event of any loss, damage, liability, expense, or claim arising from your use or reliance on this coverage or reimbursement information for billing purposes. Before submitting any claims for reimbursement to any payor, it is the provider’s sole responsibility to verify compliance with the payor’s current coverage conditions.
Last updated November 20,2020.
Yes, patients with type 1 or type 2 diabetes who meet the qualifying criteria* may be eligible for coverage of the Dexcom G6 Continuous Glucose Monitoring (CGM) System.
*For a complete description of Veterans Affairs coverage criteria and additional information, please see the Department of Veterans Affairs Criteria for Use Memorandum, January 31, 2019. A patient must be seen at a VA healthcare facility or a VA Community Care Network clinic to be eligible to receive coverage.
Disclaimer: CGM coverage and reimbursement information is being provided on an “as is” basis at the time of publication, with no express or implied warranty of any kind, and should be used solely for informational purposes. All coding, coverage policies, and reimbursement information are subject to change without notice. Coverage for CGM depends on a variety of factors, and coverage conditions will apply. Not all patients will be covered for Dexcom G6 or any other CGM device. Dexcom, Inc. does not represent or guarantee coverage under any applicable payor, program, or plan. The information provided herein does not constitute professional or legal advice on coverage or reimbursement and should be used at your sole liability and discretion. Dexcom, Inc. does not represent or warrant that any of the information being provided is true or correct and you agree to hold Dexcom, Inc. harmless in the event of any loss, damage, liability, expense, or claim arising from your use or reliance on this coverage or reimbursement information for billing purposes. Before submitting any claims for reimbursement to any payor, it is the provider’s sole responsibility to verify compliance with the payor’s current coverage conditions.
Last updated November 20,2020.
Claim denials can occur for a wide variety of reasons. It is important to understand why the claim was denied and as appropriate, know what options are available to resubmit or appeal the claim. Confirm that the ICD-10 diagnosis code(s) are specific and valid for services provided and that the specific codes and services of CPT codes 95249, 95250 and 95251 are covered services within each health plan.
Ensure that frequency of submissions is within the specific insurance policy limits. Modifier -25 should be added to Evaluation and Management code (E/M) if billed on the same day as CPT codes 95249, 95250 and 95251. Modifier -25 verifies that the E/M service was separate and identifiable from the CGM service. For insurance plans requiring prior authorization, ensure that the authorization has been obtained prior to the service being performed.
The Center for Medicare and Medicaid (CMS) has a website where you can find state and local fee schedules for all CPT codes: https://www.cms.gov/medicare/physician-fee-schedule/search/overview
Medicare physician payments are fee schedules based on relative value units (RVUs). Hospital outpatient services are paid under the outpatient prospective payment system (OPPS).
