Powerful glucose insights for better diabetes management


checkmark    Proven clinical outcomes

checkmark    Easy to use1

checkmark    Covered by Medicare

With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before.

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Does Medicare Cover Dexcom G6 for Type 1-2 Diabetes Patti LaBelle

receiver

#1 preferred
CGM system

by healthcare providers2 and patients3

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Dexcom CGM Medicare Criteria for Patient

Who is covered?

 

Your patients may be eligible for CGM if they:

  • Have type 1 or type 2 diabetes (T1D/T2D)
  • Use an insulin pump or take ≥3 daily administrations of insulin
  • Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results
  • Visited your clinic in person to evaluate their diabetes control and you determine that the above criteria have been met within six months prior to ordering the CGM
  • Have visited your clinic in person to assess adherence to their CGM regimen and diabetes treatment plan every six months

For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website.

Prescribing information

Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6.

 

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Ensure the chart notes* verify that the Medicare patient meets the criteria above
 


 


 

 

MEDICARE BILLING & CODING 

 

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Send the prescription to one of the Medicare distributors listed on the Medicare tearpad
 

• 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 distributor regarding their Dexcom G6 order

 

DOWNLOAD MEDICARE TEARPAD & CODING 

 

 

Patti Labelle

 

92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4

 

 

Patti Labelle

 

The Medicare copay for Dexcom G6 is the same price as other CGM brands.5


AACE

 

The American Association of Clinical Endocrinology (AACE) recommends6 real-time CGM (RT-CGM) like Dexcom G6 for insulin-using adults ages 65 and older to achieve:

  • Improved glycemic control
  • Reduced episodes of severe hypoglycemia
  • Improved quality of life


AACE GUIDELINES 


 

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dr swamy

 

Greater time in range

Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9 

Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. Since A1C is a three-month average, it doesn’t give insight into potentially dangerous high and low glucose variations.

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40% in range
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100% in range

Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions.


See how it works

Discover how Dexcom G6 can empower your patients to make more informed
diabetes management decisions to help them stay in target glucose range.

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Where can patients fill their Dexcom G6 scripts?

Dexcom G6 is available at the distributors listed below. A patient must call their plan to confirm that the distributor is in their network.
 

 

Distributor

Phone Number

Byram Healthcare

800-775-4372

CCS Medical

800-949-6481

US Med

866-934-5715

Solara Medical Supplies

800-423-0896 opt 2

Edgepark

866-400-5183 opt 2

USHL

866-421-2732

Edwards Healthcare

888-344-3434

Advanced Diabetes Supply

877-838-3026

Diabetes Management Supply

888-738-7929

BLN

800-854-5729

Mini Pharmacy

888-545-6464

Is the Dexcom G6 Medicare copayment more expensive than for that of other CGM brands?

No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Also, many Medicare beneficiaries have secondary insurance that covers their copayment.

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
  • Uses an insulin pump or takes ≥3 daily administrations of insulin
  • Requires frequent adjustments to their insulin treatment regimen based on BGM or CGM testing results

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

Does Medicare cover Dexcom G6?

Yes. The Dexcom G6 is now available for patients who meet the Medicare coverage criteria.

What is the Medicare coverage criteria?

For a complete description of Medicare coverage criteria 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

866-934-5715

Solara Medical Supplies

800-423-0896 opt 2

Edgepark

866-400-5183 opt 2

USHL

866-421-2732

Edwards Healthcare

888-344-3434

Advanced Diabetes Supply

877-838-3026

Diabetes Management Supply

888-738-7929

BLN

800-854-5729

Mini Pharmacy

888-545-6464

 

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

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 to our trusted distributors, 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.

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.

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. The existing Detailed Written Order (DWO) will be honored.

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

Full list of Medicare coverage criteria see the applicable coverage policy.

*Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. For the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid Services website.

†Receiver is required to be used along with smart device in order to receive Medicare benefits for CGM. To view a list of compatible smart devices, visit dexcom.com/compatibility. 

 

1 Dexcom, data on file. 2020.

2 Seagrove Partners Q1 2021 HCP Perspectives Survey. 2021: 65.

3 dQ&A US Q1 2021 Diabetes Connections Patient Panel Report. 2021: 69-72.

4 Dexcom, data on file, Q3 2021.

5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. 2019;6.

6 Grunberger G, et al. Endocrine Practice. 2021;27(6):505-537.

7 Beck RW, et al. Ann Intern Med. 2017;167(6):365-374.

8 Welsh JB, et al. Diabetes Technol Ther. 2019;21(3):128-132

9 Martens T, et al. JAMA. 2021;325(22):2262-72. 

Contact Us

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