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Medicare Coverage and Prescribing Information

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Prescribe Dexcom G6 for Your Medicare Patients

Use these simple steps to get your new Medicare patients quickly started on the Dexcom G6 Continuous Glucose Monitoring (CGM) System.

1. Ensure the chart notes* verify that the Medicare patient:

  • Has been seen in your clinic within the last 6 months
  • Has type 1 or type 2 diabetes
  • Performs frequent blood glucose meter (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 the full list of Medicare coverage criteria, visit the Centers for Medicare and Medicaid services website.

2. Prescribe to one of the Medicare distributors below

  • 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

Medicare Coverage Criteria

Medicare patients with type 1 and type 2 diabetes on intensive insulin therapy may be able to obtain reimbursement if the following Medicare coverage criteria are met:

  • The patient has diabetes;
  • The patient has been using a home blood glucose monitor (BGM) and performing frequent (four or more times a day) BGM testing;
  • The patient is insulin-treated with three or more daily injections (MDI) of insulin or a continuous subcutaneous insulin infusion (CSII) pump;
  • The patient's insulin treatment regimen requires frequent adjustments based on therapeutic CGM testing results;
  • Within six months prior to ordering the CGM, the patient had an in-person visit with the treating practitioner to evaluate their diabetes control and determine that the above criteria have been met; and
  • Every six months following the initial prescription of the CGM, the patient has an in-person visit with the treating practitioner to assess adherence to their CGM regimen and diabetes treatment plan.

In order to qualify for Medicare coverage of your Dexcom G6 supplies, Medicare requires that you have a receiver that is compatible with Dexcom G6 and that you use that receiver with your supplies, even if you also use a compatible smart device.  Medicare does not cover Dexcom G6 supplies that are only used with a smartphone or other mobile device.

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.

List of Medicare Distributors

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 877-659-9875
Solara Medical Supplies 800-423-0896 option 2
Edgepark 866-400-5183
USHL 866-421-2732
Edwards Healthcare 877-367-2444
Advanced Diabetes Supply  877-838-302
Diabetes Management Supply 888-738-7929
BLN 877-261-2179
Mini Pharmacy 888-545-6464

 

Prescribing Information

View and download resources for prescribing CGM.

Medicare Coding

Find the latest coding references and billing instructions for Medicare patients.

Medicare Frequently Asked Questions

Learn about Medicare coverage criteria, distribution options, 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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