Dexcom Tech support - 1-844-607-8398 If rejected, Dexcom will notify the patient of their unsuccessful application and discuss their options moving forward. commitment to long-term diabetes follow-up through regular assessments by diabetes educators, and prescribers at intervals deemed appropriate by the Diabetes Education Program; agrees to share the data components of the Ambulatory Glucose Profile (AGP) with the diabetes health care providers/team such as: precent time in target range, percent time above or below target range, precent time in hypoglycemia, visual representation of average 24-hour glucose profile for a 2-week period. When will existing Medicare patients have access to Dexcom G6? 2019;6. Everyones health insurance plan is different. Most people with type 1 diabetes on commercial health insurance are covered. 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. window.__mirage2 = {petok:"1HofDHLtMxUU5p5OUOWGr1uLsA_KL6zgddtQxlS.9Sg-1800-0"}; Patients can also self-refer to a DEP registered with the ADP of their choice. 1 0 obj the privacy and confidentiality of your personal information. 7E^DPN)0>fe E+gM2^6xX3,o):,`5-ihS,3Ei6^.h,.#=DaSv/ee)w(($2HG\Oz~:P+S~XysQ b~\ vT(PAQ{ 4\' @e^NN(eU. independently perform fingerstick glucose testing. All rights reserved. Medicare G6 HCP site -provider.dexcom.com/medicare Likewise, medical policy, which addresses the issue(s) in any specific case, should be considered before utilizing medical opinion in adjudication. A Diabetic's Guide: How to Count Carbs Like a Pro. Have private insurance coverage for Dexcom supplies? EN Canada Language English franais Change Country. 3 yr. ago. People with diabetes and other serious underlying medical conditions may be at higher risk for more severe complications from COVID-19. You will be going to a new website, operated on behalf of the Blue Cross and Blue Shield Service Benefit Plan by a third party. % Where can I get more information or support for my office or my patients? Phone Patients can expect their ADP assessment to take approximately 2-3 weeks after the submission of their application form. Where can patients fill their Dexcom G6 scripts? 7 Beck RW, et al. 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. Dexcom will also provide one (1) Dexcom G6 Receiver at no cost to each approved patient who does not have a compatible smart device. 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. information and promotional communications related to Dexcom products. All patients in Ontario with type 1 diabetes who meet the medical eligibility criteria, or would have met the medical eligibility criteria before they started on the Dexcom G6, should be referred for an assessment at an ADP registered clinic regardless of their current insurance status. Please submit your pharmacy receipt to Pacific Blue Cross for processing and payment. Are you a current customer facing financial constraints? You should first contact your primary care provider or diabetes specialist to initiate the BC PharmaCare Special Authority approval process and receive a written prescription. Retrospective review of glucose data from Dexcom G6 can identify patterns of hyper- and hypoglycemia, as well as glycemic excursions to help guide treatment decisions. Programs and resources to help you better understand, manage and prevent diabetes. * Dexcom data on file (commercial insurance plans for T1 and T2 patients taking insulin). Type 1 diabetes is when your body doesnt make insulin, or makes very little insulin, and cannot move sugar into your cells for energy. 1310 G Street, N.W. Dexcom Dexcom G6 Continuous Glucose Monitoring System A9277 and K0553 Prior authorization is . #qHeoQ (!V"S6:bM&uTO>3}+Td9e=},)|7hTOq)s)H(b:J&vG_H C=V2YndWg F 9Y|wr~;$PTAGC>:2CH!F&Qq& Hi guys! As a Blue Cross Community Health Plans SM member, you have coverage for selected generic prescriptions, brand name prescriptions, over-the-counter (OTC) drugs, and selected medical supplies. Sorry, you need to enable JavaScript to visit this website. Contact Dexcom to get the specific information you will need with your insurance plan as plan requirements vary. I'm with Anthem Blue Cross in California. The Freestyle Libre 2 is not a BC PharmaCare benefit. We comply with applicable . Your prescriber can complete the Special Authority Request. The Dexcom G6 device transmits blood glucose results in real time to an app; the Libre 2 requires the user to scan the sensor to get their results. Since A1C is a three-month average, it doesnt give insight into potentially dangerous high and low glucose variations. Effective January 1, 2022, continuous glucose monitors (CGMs) will no longer be covered under the medical benefit as durable medical equipment for certain Anthem Blue Cross (Anthem) fully insured groups. A small, reusable transmitter connects to the sensor and sends real-time readings wirelessly to a receiver, so users can view the information. ( OVtN 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]. %PDF-1.7 suspension of the applicants driving license, hospitalization or emergency room or EMS visit, glucagon administration, unconsciousness, or seizure. Medicare G6 Patient site -www.dexcom.com/medicare. If you are a healthcare provider and want to learn more about Dexcom, This is the most common type of diabetes. Dexcom respects The Diabetes Management Program by Livongo, Centers for Disease Control and Prevention (CDC), Work with a registered dietician to develop a healthy meal plan, Exercise at least 30 minutes a day, 5 days a week, Follow USDA ChooseMyPlate guidelinesfill half your plate with healthy fruits & vegetables, a quarter with protein & a quarter with whole grains, Take prescribed oral medication, insulin or a combination as directed by your doctor. Copyright 2023 PBC Health Benefits Society. Glucose results are used by the individual to closely monitor their glucose levels to help them to better self-manage their diabetes. Pacific Blue Cross will align coverage duration with PharmaCare. and Dexcom CLARITY are registered trademarks of Dexcom, Inc. in the U.S. and may be in other countries. Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributor regarding their Dexcom G6 order, 92% of Dexcom Medicare patients report that they are somewhat to extremely satisfied with product ease of use.4, The Medicare copay for Dexcom G6 is the same price as other CGM brands.5, Studies show that Dexcom CGM use is clinically proven to increase time in range.7-9. <> Medical technology is constantly evolving, and the Company reserves the right to review and update medical policy periodically. You can call your prescriber or pharmacist to confirm your approval, or call PharmaCare at 1-800-663-7100 (toll-free) or 604-683-7151 (from the Lower Mainland). I have been using G6 for almost a year and insurance has provided coverage up until now and I assume the policy changed because now they no longer do. 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. Internal Medical Policy Committee 3-16-2020 removed invalid diagnosis codes, Internal Medical Policy Committee 7-22-2020 removed Eversense CGM experimental/investigational statement, updated description, added additional diagnosis codes: E11.10, E11.11, E11.8 and E11.9 and added "Billed with Z79.4" to covered diagnosis codes section, Internal Medical Policy Committee 7-22-2021 Added diagnosis code Z96.41, Internal Medical Policy Committee 3-23-2022 Added new codes A4238 and E2102 to the policy effective 4-1-2022, Internal Medical Policy Committee 7-21-2022 Added new codes, G0308 and G0309, to the policy effective 7-1-2022, Fargo (Headquarters) Health insurance is offered by Florida Blue. https://www.dexcom.com/safety-information, Use an insulin pump or take 3 daily administrations of insulin, Have an insulin treatment regimen that requires frequent adjustments based on BGM or CGM testing results, Visited your clinic in person to evaluate their diabetes control and you determine that the above criteria have been met within six months prior to ordering the CGM, Have visited your clinic in person to assess adherence to their CGM regimen and diabetes treatment plan every six months. CGM users insert a tiny sensor wire just underneath the skin with an applicator. 2 0 obj Florida Blue HMO, an afliate of Florida Blue. Medicare covers therapeutic CGM devices under the DME benefit. Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information. As such, we will be matching coverage criteria for the Dexcom G6 CGM for our Members. For more information, please see our If your glucose alerts and readings from the Dexcom CGM do not match symptoms, use a blood glucose meter to make diabetes treatment decisions. If you could not find answers to your questions, contact us directly for help. The Dexcom G6 also provides predictive alerts that notify a user when blood sugar is going low up to 20 minutes before it occurs helping those who experience rapidly changing blood glucose levels. Description 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. The Dexcom G6 Continuous Glucose Monitoring (CGM) System is now covered through BC PharmaCare under Fair PharmaCare. 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. If you are a Dexcom User or Patient, please contact Dexcom Dexcom G4 Platinum A9277 Prior authorization is required. ?;E%}p}o]>H7 {"/:|Y }=l~Tx~dEW%[A+ |)Z9D%SE WW@Y\j7+nH! Reddit and its partners use cookies and similar technologies to provide you with a better experience. Some people have diabetes without showing any signs or symptoms in the early stages. 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. What can I do? Thats why its important to know your risk factors for type 2 diabetes and see your doctor regularly for blood glucose tests. Dexcom, Dexcom G6, Dexcom G5 Mobile, Dexcom G4 PLATINUM, Dexcom Follow, Dexcom Share, 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. *28zVe +2a$ V Diabetes occurs when your body is unable to use sugar in the blood. We chose to shift all Medicare distribution to our trusted distributors, so we can more fully focus on developing innovative continuous glucose monitoring (CGM) systems that simplify and improve diabetes management for people around the world. Dexcom G6 is available at the distributors listed below. a physician or nurse practitioner, registered with the ADP-registered DEP as a prescriber, confirms that prior to starting real time continuous glucose monitoring, they met the device-specific Medical Eligibility Criteria. A patient must call their plan to confirm that the distributor is in their network. Does Blue Cross Blue Shield cover Tandem and Dexcom supplies? My endo thankfully jumped through the hoops and now mine is 100% covered. LBL017680 Rev004. To help ensure uninterrupted coverage for these patients on their private health plan pending ADP determination, provide them with a prescription for Dexcom G6 with the notation "ADP Pending" written on it, in conjunction with their referral to ADP. If you are interested in obtaining a Dexcom Continuous Glucose Monitoring System and have financial concerns, we offer a free insurance benefits check to see if you are covered. Some insurances will cover Dexcom glucose monitoring system based on certain criteria. Dexcom G6 supplies will be delivered at no cost to your patient. We use cookies on this website to give you the best experience and measure website usage. What you need to know about the disease and our commitment to ensuring you have access to the right care at the right time. For more information, view our privacy policy. and our stream Get timely provider information including policy, benefits, coding or billing updates, education, and moredelivered directly to your email. Discover all the ways members can earn wellness incentives and rewards for taking an active role in their health. These products are covered by U.S. patent. When presenting your prescription at the pharmacy, your pharmacist will submit the coverage claim to BC PharmaCare and, when needed, coordinate coverage between BC Pharmacare and private insurance. Learn more here. please fill out the form and a representative will contact you. Has been seen in your clinic within the last 6 months, Uses an insulin pump or takes 3 daily administrations of insulin, Requires frequent adjustments to their insulin treatment regimen based on BGM or CGM testing results, For a complete description of Medicare coverage criteriaand additional information related to what should be included in the chart notes, please visit the, Centers for Medicare and Medicaid services website, Send the patients certificate of medical necessity (CMN) and chart notes to the distributor, Let your patient know that they will be contacted by the distributors below regarding their Dexcom G6 order. Specific information you will need with your insurance plan as plan requirements.. Their ADP assessment to take approximately 2-3 weeks after the submission of their unsuccessful application discuss... The U.S. and may be at higher risk for more severe complications from COVID-19 and sends readings. Blue Shield cover Tandem and Dexcom CLARITY are registered trademarks of Dexcom this! Or contact a Member Services representative for specific coverage information help you better understand, manage prevent. Your risk factors for type 2 diabetes and other serious underlying medical conditions may at. Commercial health insurance are covered plans for T1 and T2 patients taking insulin ) through PharmaCare! Now covered through BC PharmaCare benefit help you better understand, manage and prevent diabetes 2 is not a PharmaCare! For processing and payment best experience and measure website usage 2 diabetes and other serious medical. Javascript to visit this website for my office or my patients their plan to that! Discover all the ways members can earn wellness incentives and rewards for an. Is the most common type of diabetes and measure website usage can also self-refer a! Cross Blue Shield cover Tandem and Dexcom CLARITY are registered trademarks of Dexcom, this is the most type. 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