Is Dexcom covered by Medicare?
Does Medicare cover Dexcom G6 and Dexcom G7?
Yes. The Dexcom G6 and Dexcom G7 are covered by Medicare if you meet their criteria. Dexcom now ships Dexcom G6 and Dexcom G7 to Medicare patients with traditional fee-for-service coverage.
You can get Medicare coverage for therapeutic CGM if you:
- Have type 1 or type 2 diabetes,
- Use insulin (any kind)
- Don’t use insulin but have had certain low blood sugar events
Medicare updated its coverage requirements for CGM. For a full description of coverage criteria, Click HERE.
Reach out to your Distributor with any questions about the specifics of the Medicare coverage requirements for Dexcom CGM.
I am a current G6 user, how do I upgrade to Dexcom G7?
If you are a current G6 patient, contact your distributor. Your distributor will request a prescription for Dexcom G7 from your doctor and provide you with pricing and upgrade options. If you currently use Dexcom G6 with a connected insulin pump, we recommend continuing it until Dexcom G7 adds compatibility with your pump or pen. We're working with our insulin delivery partners to integrate with Dexcom G7 as soon as possible.
What if my insurance doesn’t cover the Dexcom G7 Receiver?
If your insurance doesn’t cover the G7 receiver, Dexcom has a discounted receiver program through GoodRx. Visit the Dexcom Savings Center for more information. Terms and conditions apply.
What is the Medicare Coverage Criteria for CGM?
To be eligible for coverage of a CGM and related supplies, the beneficiary must meet all of the following initial coverage criteria (1)-(5):
- The beneficiary has diabetes mellitus; and,
- The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and,
- The CGM is prescribed in accordance with its FDA indications for use; and,
- The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the criteria below:
- The beneficiary is insulin-treated; or,
- The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following:
- Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or,
- A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia
- Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with the beneficiary to evaluate their diabetes control and has determined that criteria (1)-(4) above are met.
For a full description of coverage criteria, CLICK HERE.
*To view a list of compatible smart devices, visit dexcom.com/compatibility
Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.
Medicare Coverage Criteria Details
Effective April 16, 2023, Medicare has expanded coverage[1] of CGM to more people with diabetes.
Who will be covered under the policy?
Medicare eligible patients with diabetes who use insulin or have a documented history of problematic hypoglycemia (low glucose).
Are there any frequency or dosage requirements for insulin?
No, if you have Medicare coverage, diabetes, and use insulin (any kind), you’re eligible for CGM.
What type of problematic hypoglycemia will meet the coverage criteria for people with diabetes who are not on insulin?
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
or
- 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
What documentation is required to meet coverage criteria for a history of problematic hypoglycemia?
For documenting one or more Level 2 hypoglycemic events that persist after more than one attempt to adjust medication and/or to change the treatment plan, your doctor should document the following:
- the actual glucose value
or
- classification of the hypoglycemic episode as a Level 2 event
or
- include a copy of your BGM testing log into the medical record. Additionally, the medical record must contain at least two previous medication adjustments or changes to the treatment plan (such as raising A1C targets) prior to the most recent Level 2 event.
For documenting one Level 3 hypoglycemic event that included altered mental and/or physical state requiring third-party assistance, the treating practitioner should document the following:
- the actual glucose value; or
- classification of the hypoglycemic episode as a Level 3 event; or
- including of a copy of your BGM testing log into the medical record.
- include a note in your medical record that you required third party assistance for treatment. Third-party assistance may be provided by anyone (for example: caregiver, family member, or any other person).
Are there any changes to the requirement for you to visit with your doctor every six months?
You must visit, in-person or via telehealth, with the treating practitioner every six months to assess how well you are following your CGM treatment plan.
Are there any changes to payment rates with the coverage policy?
No. There aren’t any changes to CGM payment rates or billing requirements under Medicare.
[1] Glucose Monitors Local Coverage Determination (L33822). Future Effective. https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdId=33822&ver=55
For a full description of coverage criteria, CLICK HERE.
*To view a list of compatible smart devices, visit dexcom.com/compatibility
Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.
I am a Medicare customer. How do I get my Dexcom G6 or Dexcom G7?
If you have Medicare, you can get Dexcom G6 and Dexcom G7 through a medical distributor (see distributor list below).
Your distributor will request a prescription for Dexcom G7 from your doctor and provide you with pricing and upgrade options and place your Dexcom G7 order. If you are not working with a distributor, call a distributor from the list below to start the ordering process.
If you use a connected insulin pump or pen, we recommend using Dexcom G6 until our insulin delivery partners integrate with Dexcom G7.
Distributor | Phone Number |
Advanced Diabetes Supplies | 877-838-3026 |
Byram Healthcare | 800-775-4372 |
CCS Medical | 800-949-6481 |
Diabetes Management & Supplies | 888-738-7929 |
Edgepark | 866-400-5183 |
Edwards Healthcare | 888-344-3434 |
Solara Medical Supplies | 800-423-0896 option 2 |
US Medical | 877-659-9875 |
Will Dexcom provide my diabetes testing supplies?
No. Blood glucose monitoring (BGM) supplies are not included in your CGM product shipments because Dexcom G6 and Dexcom G7 do not require fingerstick calibrations.* You must purchase any BGM testing supplies that you need for the future.
*If your glucose alerts and readings from the Dexcom G6 or Dexcom G7 do not match symptoms or expectations, use a blood glucose meter to make diabetes treatment decisions.
How can I view my glucose data?
You can view your glucose data through the Dexcom G6 or Dexcom G7 apps, your Dexcom G6 or Dexcom G7 receiver, and the Clarity Mobile or desktop applications.
Medicare does not cover Dexcom G6 or Dexcom G7 CGM supplies that are used only with a smartphone or other mobile device. If you don’t use your receiver, you’ll lose Medicare coverage for your Dexcom G6 or Dexcom G7 CGM supplies.
CMS Policy
If you use the receiver (classified as DME) to display glucose data, Medicare covers CGM system supplies and accessories. There is no Medicare coverage if the receiver isn’t classified as DME. However, you can use the app (on your smartphone, smartwatch, tablet, etc) as well as the receiver.
Here are some examples of how you can use a smart device and receiver under Medicare:
- Use both a receiver and a smartphone throughout the day
- Use a receiver some days and a smartphone on other days
Reach out to 1-800-MEDICARE with any questions about the Medicare coverage requirements for Dexcom CGM.
Is my smart device compatible with Dexcom G6 or Dexcom G7?
For a list of compatible devices, visit www.dexcom.com/compatibility.
I have a compatible smart device. How do I use my smart device to see my readings?
Dexcom G6
- Go to the App Store or Google Play store from your smart device. Search for “Dexcom G6”. Download and open the app.
- Create an account or log in using your Dexcom account. For example, a Dexcom Clarity account.
- Follow the instructions in the app. When asked, enter the SN (serial number) of the transmitter you're wearing. Find it on the transmitter box or in your Receiver Settings.
- Your app joins your current sensor session.
- To qualify for Medicare coverage of your Dexcom G6 supplies, you must use a G6 receiver, even if you also use a smart device. Medicare doesn’t cover Dexcom G6 supplies that are only used with a smartphone or other mobile device.
Dexcom G7
- Go to the App Store or Google Play store from your smart device. Search for “Dexcom G7”. Download and open the app.
- Create an account or log in using your Dexcom account. For example, a Dexcom Clarity account.
- Follow the instructions in the app. When asked, enter the pairing code of the sensor you're wearing. This can be found on the sensor box, sensor applicator, or in your Receiver Settings.
- Your app joins your current sensor session.
- To qualify for Medicare coverage of your Dexcom G7 supplies, you must use a G7 receiver, even if you also use a compatible smart device. Medicare doesn’t cover Dexcom G7 supplies that are only used with a smartphone or other mobile device.
How do I set up Dexcom Share, so that other people can see my glucose numbers?
Dexcom G6
To set up Dexcom Share on Dexcom G6, press the Share icon (the triangle in the upper right-hand corner of the screen) and follow the instructions. The app will walk you through sending invitations to up to 10 Followers. Your Followers will need to download the Dexcom Follow app to see your data.* †
Dexcom G7
To set up Dexcom Share on Dexcom G7, tap the “Connections” tab on the bottom bar of the app. Under “Available Connections” tap the Share icon (the triangle icon) and follow the instructions. The app will walk you through sending invitations to up to 10 Followers. Your Followers will need to download the Dexcom Follow app to see your data.* †
*For a list of compatible devices, visit www.dexcom.com/compatibility
† Separate Follow App required.
How much can I expect to pay for my Dexcom G6 and Dexcom G7 CGM System if I’m a Medicare customer?
Generally, Medicare patients pay 20% out of pocket. If you have secondary coverage such as Medigap, it will typically cover your out-of-pocket costs.
I need help getting started. What can I do?
Visit www.dexcom.com/medicare to view online training videos. These videos can walk you through the steps to get started, including receiver and app set-up, and downloading Dexcom Clarity.
Still need help?
- General customer inquiries, CGM training and education: 1-888-738-3646
- Troubleshooting and software support: 1-844-607-8398
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Is Dexcom G7 CGM available at my pharmacy?
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Is Dexcom G7 CGM available at my pharmacy?
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