Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. Speak with a Licensed Medicare Sales Agent 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST | Sunday Closed), 877-388-0596 - TTY 711 (M-F 8am-9pm, Sat 8am-8pm EST | Sunday Closed). At Abbott, we are continuously challenging ourselves to ensure our innovative technology is accessible to the majority of people who need it, said Jared Watkin, Sr. VP at Diabetes Care. The fee schedule amounts for the newly covered adjunctive CGMs and related supplies and accessories will be established in accordance with existing regulations for establishing fee schedule amounts for new durable medical equipment items and services without a fee schedule pricing history at 42 CFR 414.238. The more you know about your glucose levels, the better decisions you can make. If you use a connected insulin pump or pen, we recommend using Dexcom G6 until our insulin delivery partners integrate with Dexcom G7. Where can my patients receive additional help and information? Third-party assistance may be provided by anyone (for example: caregiver, family member, or any other person). Be insulin-treated with three or more daily administrations of insulin, or a continuous subcutaneous insulin infusion (CSII) pump, Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results, Have had an in-person visit with their provider within six months prior to ordering the CGM in order to evaluate their diabetes control and determine coverage criteria is met. Some patients prefer to be notified about impending hypo- or hyperglycemia, whereas others do not want to hear the alarms. CGMs . Medicare Coverage for Dexcom G6 Equipment What if my insurance doesnt cover the Dexcom G7 Receiver? For a full description of coverage criteria, Click. Medtronic). This is because Medtronics stand-alone Guardian Connect only uses a smartphone app, and does not have a handheld receiver or a separate display device, which can be provided by the insulin pump. Features of the Dexcom G6 System include: No calibration required No need to calibrate with a blood glucose meter, eliminating the need for fingersticks.if(typeof ez_ad_units!='undefined'){ez_ad_units.push([[250,250],'medicaretalk_net-large-mobile-banner-2','ezslot_1',172,'0','0'])};__ez_fad_position('div-gpt-ad-medicaretalk_net-large-mobile-banner-2-0'); Long-life sensor Approved for up to 10 days of use. Even with these latest changes, many see a need for more Medicare reform across the board. Medicare does not cover Dexcom G6 or Dexcom G7 CGM supplies that are used only with a smartphone or other mobile device. The removal of this criterion has been an effort long-led by the ADA, on which we have been actively engaged with CMS, the organization tweeted. As of July 18, 2021, Medicare is no longer enforcing the 4-fingerstick requirement for those with type 1 (T1D) and type 2 diabetes (T2D) who use insulin and want to use a CGM. If you have Medicare Part B, you must meet strict criteria and have a prescription to have your CGM covered. Yes. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Here are some examples of how a Medicare patient may use a smart device with their receiver: A patient uses both a receiver and a smartphone throughout the day, A patient uses a receiver some days and their smartphone other days. The needle retracts and the sensor sits on top of the skin and is held in place by adhesive tape. If you would like to change your settings or withdraw consent at any time, the link to do so is in our privacy policy accessible from our home page.. Your provider has determined that you or their caregiver understands how to use CGM, and you have provided a prescription, 3. The Freestyle Libre is a little simpler for the older patient or others who arent as comfortable with the technology. Diabetes care can be tricky depending on the type you have and how well you manage it. Medicare Part B covers several other types ofdiabetic equipment and suppliesincluding: To receive coverage, you must have a prescription by your doctor. We and our partners use cookies to Store and/or access information on a device. In 2020, almost two-thirds of T1D Afrezza patients were utilizing a CGM concomitantly. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. In order for patients to qualify for Medicare. Send the patients 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 G7 order, Dexcom CGM is an easier way to Follow these two simple steps to get your eligible Medicare patients started quickly on the Dexcom G7 Continuous Glucose Monitoring System. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. But some seniors are definitely ordering G6 systems and that is great news. . Reach out to your Distributor with any questions about the specifics of the Medicare coverage requirements for Dexcom CGM. If you have diabetes, you know its a day-to-day reality that needs to be attended to. 2020;323(23):2388-2396. J Diabetes Sci Technol. The Dexcom G5 was the first to obtain that status and be known as a therapeutic CGM, followed by the Abbott FreeStyle Libre and then Eversense 90-day implantable CGM. For a full description of coverage criteria,Click HERE. Some of our partners may process your data as a part of their legitimate business interest without asking for consent. Does Medicare cover Dexcom G6? information and promotional communications related to Dexcom products. Does Medicare cover Dexcom G6 and Dexcom G7? Patients should reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM. These results can also be uploaded into software that is used by the users physician to decide on a treatment plan or make adjustments to a patients lifestyle. Refill every 3 months. Find it on the transmitter box or in your Receiver Settings. include a note in your medical record that you required third party assistance for treatment. Description. What does this mean for you? These changes may include altering a diet by eliminating certain foods, adding exercise into a daily routine, improving sleep and managing stress levels. Regulation at 42 CFR 410.152(b), stipulates that coinsurance for items of durable medical equipment is 20% of the allowed amount. Many Medicare beneficiaries have supplemental insurance coverage such as Medigap that covers their out-of-pocket costs. Under Medicares DME fee schedule, reimbursement for CGMs, using CPT codes K0554 and K0553, is the same, regardless of CGM brand. He points out that this new policy change only applies to people with T1D or T2D who use insulin. please fill out the form and a representative will contact you. Fingersticks required for diabetes treatment decisions if symptoms or expectations do not match readings. I can follow her numbers|| and help prevent the low 30s and 40s she was having. Redetermination for Medicaid | What to Know in 2023. Who Is Eligible for Medicare Part B Premium Reimbursement? Medicare eligible patients with diabetes who use insulin or have a documented history of problematic hypoglycemia (low glucose). How Long Can Your Body Survive Without Insulin? Recommended Reading: Does Medicare Coverage Work Overseas. No. Read Also: How Do I Get A New Medicare Health Insurance Card. No fingersticks The Dexcom G6 eliminates fingersticks for calibration and diabetes treatment decisions. In a fact sheet, noted it is not finalizing the proposed categories of supplies and accessories and fee schedule amounts for three types of CGM systems. For more information, visit Dexcom G6 Set Up Guide here. To view the purposes they believe they have legitimate interest for, or to object to this data processing use the vendor list link below. They are easy to wear and use. Your Followers will need to download the Dexcom Follow app to see your data. 8 Miller KM, et al. This revolutionary health technology is ultimately going to empower Medicare beneficiaries with diabetes to live better, healthier lives. Please note: Information provided with the sample request is validated against Provider's license information. BRIEF SAFETY STATEMENT: Failure to use the Dexcom Continuous Glucose Monitoring System and its components according to the instructions for use provided with your device and available at https://www.dexcom.com/safety-information and to properly consider all indications, contraindications, warnings, precautions, and cautions in those instructions for use may result in you missing a severe hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose) occurrence and/or making a treatment decision that may result in injury. Does Medicare cover Dexcom G6? For Medicare coverage of Continuous Glucose Monitoring (CGM), CMS requires use of a receiver. If you use the receiver (classified as DME) to display glucose data, Medicare covers CGM system supplies and accessories. That so-called dosing claim was a new category created by the Food and Drug Administration (FDA), its first attempt to distinguish the different levels of CGM technology that existed at that time in 2017. Visit the Dexcom Savings Center for more information. Dexcom CGM removes the mystery from diabetes. While these systems can be beneficial, its important to know if they are covered by insurance. As with most other technology, diabetes technology continues to evolve, and newer products have since followed suit, including those manufactured by Abbott, Medtronic, and others. Every six (6) months following the initial prescription of the CGM, the treating practitioner conducts an in-person or Medicare-approved telehealth visit with the beneficiary to document adherence to their CGM regimen and diabetes treatment plan. With access and affordability often the biggest hurdle to achieving better health outcomes, Medicare policy changes are key, as the federal insurance program typically leads the way on what coverage will be provided by private health insurers. You must have a documented history of at least of one following: More than one Level 2 hypoglycemic (low glucose) event (glucose <54mg/dL) that persist despite more than one change to the diabetes treatment plan and/or medication adjustment, One Level 3 hypoglycemic (low glucose) event (glucose <54mg/dL) that included altered mental and/or physical state and required third-party assistance for treatment of hypoglycemia. 6 Laffel LM, et al. If you are a healthcare provider and want to learn more about Dexcom, Separate Follow app and internet connection required. For a full description of coverage criteria,Click HERE. I am a new Medicare customer. No, if you have Medicare coverage, diabetes, and use insulin (any kind), youre eligible for CGM. DISCLAIMER: People using products sold by US MED should always refer to the directions provided by a products manufacturer for usage information. Under Available Connections tap the Share icon (the triangle icon) and follow the instructions. If you are a Dexcom User or Patient, please contact Dexcom Coverage of CGM system supplies and accessories are available for those therapeutic CGM systems where the beneficiary uses a receiver classified as DME to display glucose data. The new Dexcom G6 boasts a number of features that make it a very powerful diabetes management tool. The information provided by a CGM can help people with diabetes make informed decisions about food, activity, and medication. Patient has an in-person or Medicare-approved visit with the practitioner who prescribed the CGM every 6 months after initiating CGM therapy. The Dexcom G6 and Dexcom G7 are covered by Medicare if you meet their criteria. 9 Visser MM, et al. Read on to learn if Dexcom G6, a CGM system, is covered by Medicare, how it works, and what other diabetes supplies are also covered. With the Dexcom G6, a tiny sensor is placed Libre and Dexcom G6 CGMs are covered by Medicare and most private insurance. Heres everything you need to know, including features and pricing, about the Omnipod. Today, Donna takes pride in providing outstanding customer service and going the extra mile to make sure each client knows all of their options and has a sound understanding of their Medicare plan, from costs to coverage and all points in between. Visitwww.dexcom.com/medicareto view online training videos. In 2018, a policy change first allowed limited smartphone use with a CGM device for data-sharing and display. I am a current G6 user, how do I upgrade to Dexcom G7? An example of data being processed may be a unique identifier stored in a cookie. The sensor does this every few minutes, and the information is sent wirelessly to a monitor. cost compared to other CGM brands.. The Durable Medical Equipment, Prosthetics, Orthotics and Supplies final rule aligns with the key goals of the administration to create a health care system that results in better accessibility, quality, affordability, empowerment and innovation, CMS stated on its web site. Use the Dexcom Share feature available in the Dexcom G6 CGM app to provide your real-time glucose data with up to 10 followers. Its easy to use the Dexcom G6. Up until now, Medtronic has been the only CGM company without Medicare coverage. Dexcom, headquartered in San Diego, is dedicated to helping people better manage their diabetes by developing and marketing continuous glucose monitoring (CGM) products and tools for adult and pediatric patients. Now, this system is covered under Medicare for people with diabetes on intensive insulin therapy who meet the eligibility criteria. Continue with Recommended Cookies. Aleppo says that the real-time data from the Dexcom and its alerts of impending problems make it particularly suited to patients whose hypoglycemia unawareness might lead them to manage their fear of hypoglycemia by overeating, taking less insulin, being afraid of exercise, being afraid of driving, and eating unnecessary bedtime snacks to avoid overnight events. But it stopped short of opening the door to coverage for CGM technology that is controlled solely by a smartphone and isnt already deemed FDA-cleared for treatment decisions by itself. We recommend new users on automated insulin delivery (AID) systems to explore the benefits of Dexcom G6 and for existing users on AID to stay on Dexcom G6 until Dexcom G7 is compatible with your pump. Is your patient on a connected pump device? Search for Dexcom G6. For those who want a simpler or longer dress system, FreeStyle Libre 14day may be preferable. Dexcom G7 makes it easier to achieve lasting results. We do not offer every plan available in your area. What if insurance doesnt cover the Dexcom G7 Receiver for my patient? Medicare Medicare Where can patients fill their Dexcom G6 scripts? Visit the Dexcom Savings Center for more information. Yes. 5 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 Frequent adjustment of insulin on the basis of CGM results is no longer required. Talk with your doctor about the benefits of a Continuous Glucose Monitor and find out if this no-stick glucose monitoring method is a good choice for you! The company believes that more than 50 percent of healthcare professionals would increase the number of prescriptions they write for CGM if it were available across the board as a mainstream pharmacy benefit to all patients. 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