To add insurance information to your Dexcom online account, take the following steps: The Dexcom G6 Continuous Glucose Monitoring (CGM) System is covered by Medicare for type 1 or type 2 diabetic patients who meet the Medicare coverage criteria. Frequent and unpredictable hypoglycemic episodes. Are you a current customer facing financial constraints? are under the supervision or care of an ADP-registered DEP; and. Fargo, N.D., 58121. People living with diabetes can gain valuable insight about their glucose levels, rate, and direction of change, allowing them to proactively manage their diabetes. ]Odx+q]3hzq- r !sDFFHpe~uF6\h6617ML'i/ii>p@F[0AGqn,LMu{aEJMf? You should confirm that the request has been approved before bringing the prescription to their local pharmacy. [CDATA[ Dexcom Terms of Use and By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Medicare covers therapeutic CGM devices under the DME benefit. Diabetes Overview - Blue Cross and Blue Shield's Federal Employee Program Diabetes Programs and resources to help you better understand, manage and prevent diabetes. By choosing to request info, you are granting Dexcom, Inc. 9 Martens T, et al. 2017;167(6):365-374. If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. Over the next several months the Dexcom G6 online store will be phased out. HCPs can prescribe Dexcom G6 to one of the distributors below via the following steps: A patient must call their plan to confirm that the distributor is in their network. First Name* Last Name* Phone* Email Address* How would you prefer to be contacted? Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. If you are on 3 or more injections a day and you are testing your blood sugars at least 3-to 4 times a day you will qualify by Medicare criteria. WTF!!!! Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. <> ( OVtN Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy; Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy; Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider; Updated policy to mirror pharmacy CGM policy, Individual has type 1 diabetes and is receiving short- or rapid-acting insulin therapy, Individual has type 2 diabetes and is receiving short- or rapid- acting insulin therapy, Individual has gestational diabetes or is pregnant and a CGM is recommended by the provider. Have private insurance coverage for Dexcom supplies? Dexcom, Dexcom Clarity, Dexcom Follow, Dexcom One, Dexcom Share, and any related logos and design marks are either registered trademarks or trademarks of Dexcom, Inc. in the United States and/or other countries. 4 0 obj Dexcom CARE team - 1-877-339-2664 What can I do? Initially users will be covered for one year. 2 0 obj Take note of any annual dollar maximums, copays, or deductibles. x\moFna?JpRZ; h@?$-QZIT(%K IvvUO~ |s~x3{`w|Y(X6dM~xwP I'&"k$$?c[@K$C RX 8jdA$("m|]^|jRkX"A&A+T8 6m3 W D}hYFu9HXhsc%Xx~GVcmLId*p(Za4P}y/O[=AAH`3>B!\$j\3H1 -$uZETTA\{v7G5SHV2.&DA Current medical policy is to be used in determining a Member's contract benefits on the date that services are rendered. 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. stream 7 Beck RW, et al. Have private insurance coverage for Dexcom supplies? They simply complete a. % The patient/family/caregiver agrees to comprehensive and age-appropriate diabetes education by an interdisciplinary diabetes healthcare team and commits to regular follow-up. A remote interstitial CGM (e.g., mySentry) is considered investigational/experimental and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. ' iAGn u)ci` pi{QIZ`e[8q]smU9*2=C%8CJpx The Dexcom G6 CGM is now covered through BC PharmaCare under Fair PharmaCare, Plan C (Income Assistance), Plan F (At Home Program), or Plan W (First Nations Health Benefit). Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. To ensure a successful transaction, please confirm your submitted First Name and Last Name match that associated wtih your NPI number. This plan uses a Preferred Drug List (PDL). A customer representative will follow up with you to process a full insurance benefits check after reviewing your information. Most people with type 1 diabetes on commercial health insurance are covered. What documents must be provided to my insurance company? The Freestyle Libre 2 is not a BC PharmaCare benefit. Florida Blue HMO, an afliate of Florida Blue. For more patient-focused information, please visit: Sign up to stay up to date with the latest CGM news, product updates and educational events. Parents or guardians of a child under 18 years of age, living at home and who have a severe disability, may meet the program Eligibility criteria to receive ACSD funding. Discover how Dexcom G6 can empower your patients to make more informed Coverage is subject to the specific terms of the members benefit plan. Cookie Notice The Dexcom G6 is indicated for users aged 2 and older while the Libre 2 is indicated for ages 4 and older. A Diabetic's Guide: How to Count Carbs Like a Pro. E~"*`xne@? Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. To be eligible for coverage, individuals must meet the following Medical Eligibility Criteria: For your patients living with type 1 diabetes that meet the medical eligibility criteria stated above, they will need to be assessed and followed by healthcare professionals associated with a Diabetes Education Program (DEP) registered with the ADP. a Dexcom G6 receiver: $417.92 each (or $203.29 membership discount price) estimated total: $4,173 per year for lowest Costco membership, or $347 per month (not counting the optional Dexcom. I live outside of BC. At the assessment appointment, a member of the DEP will confirm the patients eligibility and help them complete the rtCGM application form which will need to be sent to Dexcom. The initial approval duration is two years. Medicare G6 Patient site -www.dexcom.com/medicare. More than 30 million Americans have diabetes. Follow these two simple steps to get your eligible* Medicare patients quickly started on Dexcom G6. Dexcom G6 Continuous Glucose Monitoring System (Dexcom) in 2018 and is indicated for the . Prescribers should follow the new patient prescription process. Covered Diagnosis Codes Billed with Z79.4 for Procedure Codes: 0446T, 0447T, 0448T, 95249, 95250, 95251, A4238, A4239, A9276, A9277, A9278, E2102, E2103, S1034, S1035, S1036, S1037, Internal Medical Policy Committee 11-14-2019 Revision -Effective January 01, 2020, Internal Medical Policy Committee 3-16-2020 coding update, Internal Medical Policy Committee 7-22-2020 Revision, Internal Medical Policy Committee 7-22-2021 Coding update, Internal Medical Policy Committee 11-23-2021 Updated description, non-invasive CGM and remote CGM language, Internal Medical Policy Committee 3-23-2022 Coding update-Effective April 01, 2022, Internal Medical Policy Committee 7-21-2022 Coding update -Effective July 01, 2022, Internal Medical Policy Committee 11-29-2022 Coding update -Effective January 01, 2023. I was just denied coverage for dexcom. How is this posssible. endobj Your pharmacist will be able to provide your Dexcom G6 CGM supplies and submit your claim to BC PharmaCare as well as issue you a receipt to submit to Pacific Blue Cross for reimbursement. I know plans are different, but BCBS only covers Dexcom under DME and your endo has to include why you need it over regular glucose monitor (high A1C, hypo unaware, etc). This means they will automatically get a new Dexcom G6 transmitter and sensors with instructions on how to update the receiver and app. The ACSD website also contains information on How to apply. Dexcom G6 is available at the distributors listed below. Individual private insurance plans may differ and are subject to change. Qualified individuals for the ADP funding will receive 100% coverage for their Dexcom G6. If a member receives coverage through BC PharmaCare, Pacific Blue Cross will coordinate that coverage. 2022 Dexcom Canada, Co. All rights reserved. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. Members residing outside of BC should have their Prescriber or Diabetes Specialist complete the Dexcom G6 CGM request form and return to us for review. Over time, diabetes can increase your risk for serious health conditions, including heart disease, blindness, kidney failure and even amputations. Blue Cross Blue Shield of North Dakota is an independent licensee of the Blue Cross Blue Shield Association, serving residents and business in North Dakota. This change applies only to the Dexcom G6 CGM. *Medicare covers Dexcom G6 for insulin-requiring patients who meet the Medicare coverage criteria. Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . After that, it may be renewed for five years. At this time, it is anticipated that private insurers already covering Dexcom G6 will expect plan members with type 1 diabetes to be assessed for ADP funding. Click here to download a printable PDF copy of the ADP Application for Funding Real-Time Continuous Glucose Monitoring System (rtCGM). This process typically takes 2-3 business days. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. This is also called blood glucose. ADP coverage for Dexcom G6 rtCGM is available for adults and children (2 years and older) living with type 1 diabetes, who are residents of Ontario and have a valid Ontario health card. 3 yr. ago. Non-invasive CGM and related supplies are considered experimental/investigational, and therefore, non-covered because the safety and/or effectiveness of this service cannot be established by the available published peer-reviewed literature. Medicare G6 HCP site -provider.dexcom.com/medicare The Dexcom G6 devices offers a similar member experience to the FreeStyle Libre 2 system. Yes. This process . The ODSP website also contains information on How to apply. 2 Seagrove Partners Q1 2021 HCP Perspectives Survey. #1 preferred CGM system For your patients with private insurance, a prescription for Dexcom G6 should be provided with the notation "ADP Pending" written on it, to enable uninterrupted coverage on their private health plan pending ADP determination. No, the Dexcom G6 Medicare copayment is the same price as other popular CGM brands. CareCentrix is an independent company contracted with Florida Blue to manage durable medical equipment. You can use these rewards to pay for qualified medical . If you are a healthcare provider and want to learn more about Dexcom, These companies are Independent Licensees of the Blue Cross and Blue Shield Association. &y/Brb4L xDAs?3t%Nufg|{CRt-Jm6lN(+/.}NX[oP4i*V }"WI"+i\mQb}d*W.i}H * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). We are working to enhance our system functionality to improve our Member experience by allowing pharmacies to bill us directly. CGM systems consist of a sensor, transmitter and receiver. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? This applies for both new prescriptions and refills. Learn more here. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. Applicant had severe hypoglycemia in the past 2 years without an obvious precipitant, despite optimized use of insulin therapy and glucose monitoring (at least 4 times/day) which result in one of the following. Time in range is a powerful supplement to A1C because it shows a more complete picture of changes in glucose levels. 6 Grunberger G, et al. Contract language, including definitions and specific inclusions/exclusions, as well as state and federal law, must be considered in determining eligibility for coverage. Continuous Glucose Monitoring (CGM) Systems (also known as Real-Time or interstitial) monitor, measure, and record glucose levels in interstitial fluid and produce data that show trends in glucose measurements. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> *28zVe +2a$ V Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4 PLATINUM, Dexcom Follow, Dexcom Share, If a current Dexcom G6 patient ages into Medicare eligibility (i.e., turns 65), they will be treated as a new patient. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. % riaG1SO[Y!AA~ Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. The Dexcom G6 is covered by BC PharmaCare. Our Diabetes Management Incentive Program is designed to help educate and support members who take an active role in managing their diabetes. Dexcom respects Call the National Information Center at 1-800-411-BLUE (2583) weekdays from 8 a.m. to 8 p.m. Eastern time. While there is no cure for diabetes, it can be managed. View the Preferred Drug List (PDL) · 2021;27(6):505-537. Dexcom will submit the completed form to ADP on your patients behalf. I have used dexcom for over 10 years, dozens of different policies and never denied! 1 0 obj LBL017680 Rev004. These products are covered by U.S. patent. 5 Centers for Medicare & Medicaid Services, Medicare Coverage of Diabetes Supplies, Services, & Prevention Programs. Easy to use Dexcom CGM is easy to apply, easy to wear, and easy to use.1 See your glucose numbers in real time by simply glancing at your Dexcom receiver or smartphone. Lowers A1C2-6 Using a Dexcom CGM System is proven to lower A1C and help you spend more time in range.2-6 New Patients: Get Started with Dexcom CGM To view a list of compatible smart devices, visit dexcom.com/compatibility. Coverage Information | Blue Cross and Blue Shield of Texas Find Care Shop Plans Prescription Drugs Insurance Basics Member Services Ask Question Request Brochure Request Agent Call Us Please send us your question so a licensed agent can contact you. Prescribe Dexcom G6 CGM Prescribe Medicare Powerful glucose insights for better diabetes management Proven clinical outcomes Easy to use1 Covered by Medicare With expanded coverage for CGM, the Dexcom G6 Continuous Glucose Monitoring (CGM) System is accessible for more of your Medicare patients* than ever before. Thats about one in every 10 adults. For patients currently using Dexcom G6 who turn 65 (becoming Medicare-eligible), how will they be transitioned to Dexcom G6 for Medicare? #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg %PDF-1.5 Replacement is not covered due to loss, negligence or improper use. Following the ADP assessment, the completed application form should be submitted to Dexcom as soon as possible by secure fax at 1-844-348-0784 or by encrypted email at [emailprotected]. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. The PharmaCare Special Authority form will be the only one required to obtain coverage from Pacific Blue Cross. please fill out the form and a representative will contact you. 4 0 obj Click here for important updates on coverage and purchase options. 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Such, we will be phased out Inc. 9 Martens T, et al information Center at 1-800-411-BLUE ( ). 2018 and is indicated for users aged 2 and older because it shows a more picture. 65 ( becoming Medicare-eligible ), How will they be transitioned to Dexcom G6 CGM for members... It can be managed more complete picture of changes in Glucose levels for qualified.. And may be renewed for five years used Dexcom for over 10 years dozens... Adp-Registered DEP ; and disability, patients must meet the Medicare coverage criteria Program Eligibility criteria started. To get the specific terms of the ADP funding will receive 100 % coverage for Dexcom. For diabetes, it can be managed from 8 a.m. to 8 p.m. time. Dexcom ) in 2018 and is indicated for ages 4 and older the... And commits to regular follow-up devices under the supervision or care of an ADP-registered DEP ;.. Dexcom Glucose Monitoring System based on certain criteria ODSP website also contains information on How to apply rewards taking...