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Medicare Certificate of Medical Necessity

Required documentation for prescribing CGM to Medicare patients.
When prescribing a Dexcom CGM System to a Medicare patient, the Certificate of Medical Necessity is a required part of the document package for Medicare reimbursement. This form serves as the prescription and must be completed by the prescribing healthcare provider. 

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Forms_Medicare Certificate of Medical Necessity

Medicare Assignment of Benefits Form

Required documentation for prescribing CGM to Medicare patients. 
When prescribing a Dexcom CGM System to a Medicare patient, the Assignment of Benefits form is a necessary part of the document package for Medicare reimbursement. This form is to be signed by the patient or other authorized person.

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Forms_Medicare-Assignments-of-Benefits

Site Training Verification Form

Site training for Dexcom G6® CGM System and Dexcom CLARITY® is available nationwide at no cost to health care providers and their staff for those clinics wanting to offer training to their patients. Clinic site trainings are conducted by a Dexcom employee or trained designee. A training certificate is issued to clinics that complete the review of proper product training procedures. Clinics should use this form to either provide verification to Dexcom that site training has been completed or indicate that patients are referred to other trained and authorized diabetes centers for product training.

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Forms_Site-Training

CMN - Commercially Insured Patients

Use this certificate of Medical Necessity (CMN) to document medical neccessity of Dexcom CGM for your commercially insured patients. This fillable form can also serve as the prescription.

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Forms_Commercial-CMN

Refer a Patient

For the fastest way to get your patients started in their process to obtain a Dexcom CGM System, refer them through this easy online web form today.

Frequently Asked Questions

Get answers to frequently asked questions about Dexcom G6 CGM, CLARITY, Medicare, pharmacy, Dexcom Studio, non-adjunctive indication, and more.

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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