Dexcom CGM Eligible for Reimbursement Under Medicare

Over 23 million Americans are living with diabetes, and with multiple finger sticks each day, it's no surprise that Medicare has finally approved reimbursement for the Dexcom CGM (Continuous Glucose Monitoring). Reimbursement for the Dexcom CGM is significant because the data available can be used to make treatment decisions. 

The Grueling Process of Managing Diabetes 

The method for managing diabetes starts with a finger stick. Use the lancet to get a blood sample for the test strip. Insert the test strip into the glucose monitor. Wait for the monitor to register, then the blood sugar level appears on the screen. Depending on the results, the insulin injections are next.  

Let's not forget the alcohol pads and band-aids that are used throughout the process; Nor disregard the need to dispose of sharps and test strips.  

All that work, and the information provided by the current blood glucose monitor only depicts the blood sugar level at that very minute. Until now, there was no practical way to know if your glucose was going up or coming down. It was impossible to track, and the idea of real time access to trending data was just a pipe dream. 

How the Dexcom Continuous Glucose Monitoring system works 

The Dexcom Continuous Glucose Monitoring system is exactly what the name implies, a system that is continuously monitoring your glucose level.  

The system uses a tiny sensor under the skin that measures blood glucose. The sensor is inserted using the simple auto-applicator provided with the Dexcom CGM. Each sensor is disposable and is replaced about every 7-10 days. This slim sensor continuously measures glucose levels just beneath the skin.  

Once the sensor is inserted under the skin, the one-touch applicator is easily removed, and the transmitter is attached to the sensor. The transmitter is outside the skin and is approximately half the size of a pinky finger.  The transmitter then wirelessly sends the glucose monitoring data to the display device which is also provided with the Dexcom CGM. 

The Dexcom system takes a glucose reading every 5 minutes, which is 288 times a day. The data is displayed on the small touch screen receiver or compatible smart device, providing real-time glucose monitoring.  

This system is equipped with alerts that warn of approaching highs and lows, even through the night. The alert can be shared with up to 5 family members or friends.  

A finger stick is required twice a day to calibrate the device. For most diabetics, two finger sticks a day is a cinch compared to the multiple sticks they are currently enduring. 

Why is Medicare providing reimbursement for the Dexcom CGM  

Continuous Glucose Monitoring with the Dexcom system helps put the patient in charge of diabetes maintenance. Through education and research, patients have taken control of their health and chronic illnesses.  

Diabetes is a chronic condition that has impacted generations and it’s no surprise that drastic changes have occurred since the first blood glucose monitoring system was introduced about 50 years ago.  

As patients have become their own advocates, the insurance companies have heard the voice of the masses and taken the action that has been long overdue. Diabetics want to have an active role in deciding their course of treatment and the Dexcom CGM delivers.  

When patients are engaged in their treatment, they are more likely to take better care of themselves and manage their medical conditions effectively. 

Are you eligible for the Dexcom CGM System 

Everyone with diabetes has been following the progress of the continuous glucose monitoring system and the challenges to get the device covered by insurance.  

Both Medicare and private insurance companies have finally agreed that continuous glucose monitoring is financially practical, and the therapeutic benefits supersede any prior reservations that were based on cost.  

The equipment must be defined as therapeutic, meaning treatment decisions can be made based on the information collected from the device. 

There are a few criteria that need to be met to satisfy Medicare requirements for reimbursement: 

• The Medicare Beneficiary must have diabetes mellitus, type 1 or 2; and 
• The Medicare Beneficiary has been using a home blood glucose monitor (BGM) and testing BGM four or more times a day. 
• The Medicare Beneficiary is using insulin injections at least 3 times a day or using an insulin pump. 
• The Medicare Beneficiary requires frequent adjustments to insulin based on blood glucose monitoring results. 
• The Medicare Beneficiary had a face to face office visit with the ordering physician within 6 months prior to the order for Dexcom CGM. 
• The Medicare Beneficiary must follow up with the ordering physician every six months to document the Dexcom CGM is working for patient and to assess adherence to treatment. 

Why make the switch to the Dexcom Continuous Glucose Monitoring system 

Medicare Beneficiaries are more active than ever before. They want to maintain that lifestyle and to do so, it is necessary to utilize the available technology. The Dexcom CGM can be worn during all activities.  

There is no worry if you are going swimming, Dexcom is water resistant.  Whether you’re a home body or globe trotter, the Dexcom sensor is small and discreet. There are fewer interruptions to daily life with the new Dexcom CGM.