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Is Dexcom covered by Medicare?

January 13, 2017

Important information regarding the recent Medicare announcement

 

What does this announcement mean for Dexcom?
Medicare has recognized that the Dexcom G5 Mobile Continuous Glucose Monitoring (CGM) System qualifies as durable medical equipment under the Medicare statute. Dexcom G5 Mobile will be covered under Medicare for patients who meet the medical necessity requirements. Coverage specifics are under development and we expect more information about those coverage policies in the very near future.

 

Are other CGM products covered as well?
The ruling specifically states that only CGM products labeled as a replacement of fingerstick blood glucose testing for diabetes treatment decisions by the FDA and referred to in the ruling as “therapeutic CGM” will be covered. Thus, Dexcom G5 Mobile is the only therapeutic CGM on the market set to be covered by Medicare.

 

When will Medicare begin covering this product?
The ruling that was issued made the benefit category effective immediately, however it will take some time to be able to process claims. Medicare will be issuing guidance shortly and we will be working to understand the process.

 

I am using a Dexcom G4 PLATINUM CGM, how will this affect me?
The ruling specifically states that only CGM products labeled as a replacement of fingerstick blood glucose testing for diabetes treatment decisions by the FDA would be covered, so the Dexcom G4 PLATINUM will not apply. Currently, only the Dexcom G5 Mobile CGM System meets this criteria and would be eligible for Medicare coverage. Once Medicare establishes coverage criteria, patients using Dexcom G4 PLATINUM may want to talk to their physicians to see if they would be eligible for Dexcom G5 Mobile.

 

I am using an insulin pump integrated with Dexcom CGM, how will this affect me?
As Dexcom G5 Mobile (non-adjunctive) is the only product covered by this decision, only patients using Dexcom G5 Mobile (non-adjunctive) will be eligible for this coverage when criteria is determined.

 

We will be updating this page as new information become available regarding this decision.

LBL014723 Rev002

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