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Medicare CGM

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CGM for Your Medicare Patients

Seniors with diabetes are susceptible to a greater frequency of hypoglycemia unawareness and higher rates of hypoglycemia than younger adults.1 The Dexcom G5® Continuous Glucose Monitoring System can be prescribed for your Medicare-eligible patients, providing this vulnerable population an additional layer of support.

Dexcom G5® Continuous Glucose Monitoring (CGM) System is the First Therapeutic CGM Covered by Medicare.

For your Medicare-eligible patients, the Dexcom product offering includes a blood glucose meter and related supplies needed for calibration. The complete Medicare bundle for the Dexcom G5 CGM System contains the following:

  • Dexcom G5 Touchscreen Receiver (3-year warranty)
  • Dexcom G5 Transmitter — 2 transmitters (6-month supply)
  • Dexcom G5 Sensors — 5 sensors 7-day wear (1-month supply)​
  • CONTOUR®NEXT ONE Blood Glucose Meter System (BGMS) from Ascensia
  • CONTOUR®NEXT Test Strips (2 boxes/50 strips per box) from Ascensia
  • MICROLET® Lancets (1 box) from Ascensia

Please note: For questions or technical issues with the CONTOUR®NEXT ONE Blood Glucose Monitoring System (BGMS) or test strips, patients should call the Ascensia Diabetes Care Customer Service number.

Medicare Workflow

1

Documentation

1. Prescription (CMN)

2. Images of insurance card(s)

3. Chart notes to document Medicare criteria

4. Prescriber info

2

Document Review

Dexcom Medicare specialists will reach out to the patient and your office with questions.

3

Product Shipment

After documentation has been received and approved, a Dexcom specialist will call the patient for authorization to ship the product.*

*Medicare FFS beneficiaries will be set up on a monthly subscription basis for sensor and blood glucose meter supplies.

4

Patient Training

A Dexcom Care Specialist will contact your patient to help them get started with their Dexcom G5 CGM System.

Prescribing CGM

For your Medicare-eligible patients, preparing the required documentation thoroughly and accurately is vital to receiving approval for CGM benefit coverage.

The Medicare documentation package will generally include the following:

  • Completed Medicare Assignment of Benefits (AOB).
  • Certificate of Medical Necessity (CMN) – the CMN serves as the prescription.
  • Documentation that the patient meets all coverage criteria must be included in the chart notes.
  • Images of insurance card (front and back), including secondary insurance.
  • Office information (name of practice, complete address, phone, fax).

See Coding and Reimbursement

Important Reminders:

  • Chart notes should clearly document the patient’s actual behavior and not be prescriptive in nature (”Tests glucose 4+ times a day” vs “’Test glucose 4+ times per day”).
  • Advise your patients to make sure they have their most recent address on file with Medicare.
  • Please advise your Medicare patient of the following: Medicare reimbursement requirements stipulate that beneficiaries must use the Dexcom G5 receiver exclusively with the Dexcom G5 CGM System. Using the Dexcom G5 Mobile app to view their glucose data on a smart device may disqualify their CGM coverage. 
  • In-person visits at specific intervals are required to evaluate diabetes control, adherence, and that qualifying criteria continue to be met. 

Multiple Benefits of Therapeutic CGM Use in Seniors

A1C Reduction

Some clinicians may assume that CGM may be too complicated for use in an older population. However, in a study of Dexcom CGM use in adults ≥ 60 years old (mean 67 years) with type 1 and type 2 diabetes, study participants showed a 0.9% average A1C reduction.1

A1C Reduction graph.

Reduction of Severe Hypo

Seniors, who are more prone to hypoglycemia unawareness, may also be at greater risk for severe hypoglycemic incidents.1 Dexcom CGM users ages 65 and older with type 1 and type 2 diabetes report significantly fewer episodes of severe hypoglycemia than non-CGM users in this same age category.2

Improved Quality of Life

Patients ages 65 and older with type 1 and type 2 diabetes also report significantly poorer well-being, increased hypoglycemic distress and heightened feelings of powerlessness than current RT-CGM users.2

Other Products

Personal CGM

The Dexcom G5® Mobile Continuous Glucose Monitoring (CGM) System is approved for patients two years and older.

Professional CGM

The Dexcom G4® PLATINUM Professional CGM System is a clinic-owned system that can be blinded when clinically necessary.

Data Analysis

With Dexcom CLARITY® software, evaluate patients’ glucose patterns, analyze data and diabetes management plans – all from your clinic computer.

1

Ruedy KJ, Parkin CG, Riddlesworth TD, Graham C, Group DS. Continuous Glucose Monitoring in Older Adults With Type 1 and Type 2 Diabetes Using Multiple Daily Injections of Insulin: Results From the DIAMOND Trial. J Diabetes Sci Technol. 2017;11(6):1138-1146.

2

Polonsky WH, Peters AL, Hessler D. The Impact of Real-Time Continuous Glucose Monitoring in Patients 65 Years and Older. J Diabetes Sci Technol. 2016;10(4):892-897.

Request Dexcom Information for Your Practice

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 have diabetes and are interested in getting started with Dexcom CGM, please contact us here.

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