LBL014723 Rev002
January 13, 2017
Is Dexcom covered by Medicare?
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, theDexcom 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, sothe 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 DexcomG4 PLATINUM may want to talk to their physicians to see if they would be eligible for DexcomG5 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 becomes available regarding this decision.
GETTING STARTED:
While we do anticipate a short amount of time to finalize details, now is the time to get started! Please click here ( or call our customer service team at 1 (888) 738-3646 to speak to an agent. We look forward to talking with you!
CLINICIAN SITE
What does this Medicare announcement mean?
Medicare has recognized that Dexcom’s G5 Mobile CGM System qualifies as durable medical equipment under the Medicare statute. The Dexcom G5 Mobile will be covered under Medicare for patients who meet the medical necessity requirements. The local MAC’s (Medicare Administrative Contractor) must still establish the specifics of coverage and we expect more information about those coverage policies in the very near future.
When will Medicare begin covering this product?
The ruling that was issued made the benefit category effective immediately, however it will take the MACs some time to be able to process claims. We are hopeful that within the next couple of months claims will begin to be processed. We will gain more clarity on this during the coming weeks.
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. The Dexcom G5 Mobile is the only therapeutic CGM on the market.
What should I do if I have Medicare patients that can benefit from using a CGM?
For patients who could benefit from CGM, you will be able to write orders for “therapeutic CGM” for your patients very soon. In the interim, you can send them to Dexcom and we will notify them as soon as Medicare begins processing. Patients can be directed to or they can also contact our customer service team at 1 (888) 738-3646 to speak to a customer service agent.