After writing three email complaints to our Dexcom Sales Rep today as to why this process is taking so long to get the Dexcom G5 I just received a phone call from a Dexcom sales manager executive in San Diego. The gentleman informed me before Medicare will reimburse for the Dexcom G5 the patient will have to furnish a manual 60 day log of BG testings to Liberty Medical as mremmers previously pointed out in her list of the seven requirements above. So it appears this process is going to take A LOT longer than originally expected. The Dexcom sales manager apologized for this misunderstanding, but said this is a growing pains learning experience for them as well. It seems CMS (Medicare) is publishing these new guideline rules after the CMS approval process from last month, and requiring Liberty Medical to ensure that these seven items are on file before Liberty Medical will receive any reimbursement from CMS. Liberty was going to send out the devices prior to receiving reimbursement, but now has taken a different stance, and requiring this information prior to shipping the Dexcom G5 CGM. So Medicare folks who have applied for the G5 thatās where our order information is as of today! As any new information comes in I will try to keep everyone who is interested posted.
I just went through a similar process with Medicare and Medtronic for pump infusion sets. I was told that I needed a 30-day blood glucose (fingerstick) log that showed an average of 4 tests/day. I think the word āaverageā makes compliance with this type of rule easier. My electronic log showed an average of 6 test/day, did not miss any days, and no day showed less than four tests.
If the Medicare rule is enforced exactly as you wrote, āa minimum of four times a day over the last 60 days,ā one skipped day or a day with only three checks will negate full compliance with the letter of the rule.
The acceptance of a manual (Iām assuming this means hand written) log means that a person wishing to meet this fastidious rule will be sorely tempted to āpencil whipā compliance. Iām not advocating this but I think administering this rule as an āaverage of 4 checks per dayā will make truthfully living with it an easier task.
I wonder what documentation Medicare wants to see to show that we āmade treatment decisions based on the results.ā Will that mean that we must annotate the log with one remark per blood glucose entry? Every time I monitor my CGM display, I make a decision to either act or not. Actions could include: eat fast acting carbs, take more insulin, or go for a walk. I wonder how they would respond to a list dominated by, āI decided to take no action at this time?ā A decision to not act is an action.
Iāll be curious to see what the actual requirements will be. As you can see, even this list of 7 rules is not completely clear.
Terry4, that wording was mine. It should not be taken as policy. I bet your interpretation more closely captures how this will be implemented. This just feels messy. And I sure donāt want to get any boxes from Liberty until reimbursement is certain.
Here is a Liberty document that may answer some questions. Iām hoping the info and forms are up to date. There is even a link to the prescription doctors are being ask to submit. https://libertymedical.com/cgm/
Drilling further you find this: https://libertymedical.com/wp-content/uploads/2017/04/MedicareDexcomG5CoverageCriteriaCheckListforpatients.pdf
My wife has decided that she is NOT going to complete this requirement of recording a 60 day log of BGās just to prove to Liberty Medical/Medicare that she deserves one of these CGM devices in order to receive reimbursement. She said if Medicare can not accept what her doctor wrote then sheās done trying. After all, who knows whatās best for the patient - the doctor or Medicare? Also as Terry so well pointed out, whatās to prevent someone from fudging the BG log? So this requirement is a joke! After living for 61 years with diabetes she has grown very tired of all these idiotic requests from Medicare to prove she is a Type 1 diabetic. My wife a Retired RN who did her best to control her diabetes is only being made to jump through additional hoops to receive a device that may or may not help her in her remaining years as she said to me. So weāre suspending trying to get a Dexcom G5 for now unless CMS relaxes their ridiculous requirements.
I really hope your wife just gives this a needed break. The rules will become clearer in time. The technology is worth jumping through hoops. I was recently reminded of how comforting it can be to have a Dex on the bedside table when I was alone in a foreign country and I couldnāt speak the language and the local food had me guessing at insulin coverage. A safety net would have been nice. I want my Dexcom back! 
Mary, we wish you all the best in getting your Dexcom G5. I canāt make my wife record a log as she has grown very tired of fighting Medicare over the last three years. First on the OmniPod, and now the Dexcom. As we both said, if your doctor writes a scrip, and provides all the other necessary documentation to prove she is type 1 diabetic with hypo unawareness a BG log isnāt going to prove anything. I just might have to take a video of her during a hypo episode when I have to call paramedics to administer a glucose IV to prove to CMS just like another personās spouse did, and was used as evidence in a hearing before a CMS Administrative Law Judge to get them to believe it. Good Luck & Thanks!
So, I checked out your two Liberty websites. It seems to me that Liberty is trying to get this down to a clear set of rules. Iād feel better if Medicare itself published the actual details.
It looks like to me, reading this Liberty publication, that you will need a 30-day blood glucose log with at least four BG checks each day and it must be submitted by your doctor.
On the other Liberty link, a document entitled, āMedicare Dexcom G5 Coverage Criteria Patient Check List,ā it seems to say that a patientās first pump therapy request will need to submit 60-day BG logs while renewals will only need to submit a 30-day BG log. Iām thinking, at this point, all patients are considered āinitial/first therapyā requests.
Iām just trying to take the language at face value and I certainly could be wrong.
This will become clearer as people start to go through the process. This is a better set of problems to have than trying to organize and campaign to convince Medicare that it should cover CGMās for seniors. The hard work is done. Now all we have to do is feed the bureaucracy!
All this is great but is Liberty medical able to handle it. I have tried several times for hours but given up in frustration. What good is the Medicare approval if you can get the CGM set from Liberty? You need to have hours and patience to get anyone on Liberty to lift the phone. Believe me I have tried and given up.
Vijay
I donāt know about the 30-day versus 60-day requirement for BG logs. I was asked for 30 days, but that was several weeks ago and I have not followed up with Liberty because I am not yet desperate for supplies. Gary Scheiner of Integrated Diabetes and author of āThink like a Pancreasā recently came out with this post that says: āHowever, there is a catch. Medicare patients who want reimbursement have to use the receiver that comes with the system, rather than using a smartphone app to see their trend graph. If they use the smartphone app, even if itās in addition to the receiver, they will not be eligible for reimbursement. Dexcomās announcement of Medicare coverage did not include this information.ā
He goes on to give a link to a Noridian Medicare (MAC for certain states) document. When I read the relevant part of the document, I interpret it to mean that a receiver must be used and a smart phone will not be reimbursable. But I donāt read it to mean that you canāt use both. How will they know anyway?
From the Noridian document: āSmart Device Usage
The Medicare DME Benefit excludes coverage for non-medical items, even when the items may be used to serve a medical purpose. As a result, smart devices (smart phones, tablets, personal computers, etc.) are non-covered by Medicare under this exclusion. Likewise, medical supplies used with non-covered equipment are not eligible for Medicare reimbursement.
In addition to the DME receiver included in the Dexcom G5Ā® Mobile CGM System, an alternative option for displaying the received data is with a smart device using the Dexcom G5Ā® app and a beneficiary-owned smart device such as a smart phone or tablet. Medicare does not cover a beneficiary-owned smart device. Claims for beneficiary-owned smart devices submitted to Medicare must be coded:ā¦ā
Good info, @Laddie. I, for one, didnāt like using my iPhone in addition to the Dex G5 receiver. Perhaps I didnāt have it set up well, but I felt like I had to answer every alert and alarm twice.
The bigger picture here is that Medicare now cover CGMs. Their bureaucratic and legal hook for gaining coverage is the classification of at least one item in the CGM system as durable medical equipment. They awarded the Dex G5 receiver with this DME designation. Their prohibition of even using a smartphone as an additional receiver seems petty to me but if thatās what allows them to defend their original decision, then I readily accept this idiosyncrasy.
We need to keep our eyes on the prize. And be careful what we communicate to Medicare or its vendors about our CGM daily practice. There is no way, that I know of, that Medicare will be able to monitor or enforce use of smartphones instead of, or in addition to, the required G5 receiver. This is not a battle we need to fight.
Regarding the finger sticks, I have been using the Dexcom 5 since last summer. It was covered by insurance. I am now running short and as of January 1st must use Medicare. So I only finger stick twice per day for the Dexcom, Now must I start testing two times more per day just for Medicare?
Iām thinking the Liberty publication posted above is likely right: āPatient must be testing at least 4 times per day and 30 day blood glucose logs (BGL) must be submitted by your prescriber as part of your medical record.ā
So, at a minimum, for whatever periods Medicare wants blood glucose logs, you will need to test at least four times per day. Unless or until they decide to add the word, āaverageā to that statement I would make sure not to miss a day or go below four fingersticks for any day.
I think itās well worth the effort to cross the ātāsā and dot the āiāsā to gain economic access to this technology.
I think that you are allowed to submit hand-written logs and can just fudge some readings. Or even go back into your Dexcom Clarity records and select actual numbers from your G5.
I use Diasend to download my pump and BG meters and can get a BG log that includes manually entered numbers. For me the manually entered numbers are from my G5, but the report doesnāt say that. That gives me an average of about 11 BG tests per day although I average only 5-6 fingersticks.
If any of you TuDiabetes seniors are involved with Facebook, there is a group called Seniors with sensors which is worth joining. Iāve read some firsthand reports of what othersā experiences are as they order G5 supplies from Liberty.
Like you, Terry, I am ready to play whatever the game is to achieve Medicare coverage of my G5. I wrote this post in January about the importance of the receiver and I am OK with carrying it if I have to.
But like you, I love my Apple Watch and would hate to lose the BG numbers on my wrist and that of course means I have to link to my phone. I am definitely worried about having 3 devices beeping at me. Two is bad enough. 
Thanks for all that info, Laddie. Iām sorry to see tucked into the fine print that excess test strips, above and beyond what will come with the CGM supplies, will not be covered by Medicare. I was afraid that would be part of the deal.
Vijay, Send them an email like I did, because like you, I was on hold two different times for long periods of time with no answer. Liberty will state this apology to you; that they are very sorry because they did not expect the volume of Medicare orders for the Dexcom G5 from all over the country that they are trying to process.
Email: LibertyCares@LibertyMedical.com
They answered my email last night, and a Liberty Medical rep also called my wife today. Dexcom may have pushed them along as I also called Dexcom and complained to them about no replies for three weeks after the Dexcom sales rep submitted my wifeās paperwork.
Although, thereās still a lot more to be done, after my wifeās phone call with the Liberty Rep today, they are requiring some more paperwork from her doctor, and Liberty will be doing the contacting of her doctor to obtain it. OBTW: At the end of her phone call, the rep asked her if she would like to purchase some supplies now? She politely said No, not until she receives the G5. These supply outfits are always trying to make a $.
Also, If you are a NEW Dexcom patient, Medicare/Liberty still wants the 60 day log of BGās. My wife is going to use her OmniPod PDM to try and extract at least 30 days worth of data.
I did have lots of time on hold at the very beginning but I bet it is worse
now. I think I was earlier than most in Libertyās queue. Even then they
were working Saturdayās. I emailed my 30 day BG data and my Endoās office
faxed a copy of my medical records the same day I found out about the new
requirements. That plus follow-up emails to and calls from their rep sped
things upā¦ once I finally got through the first time.
They seem to be the only Medicare approved distributor right now so I can
only suggest to be patient and be prepared with your BG data and perhaps
check with your Endo so they are aware of what Liberty will need from them.
Thanks. I sent all the stuff on April 7. I have no email address to contact Liberty. I have a lot of experience with them in handling my pump supplies and they are pretty bad. My point is that it was a very ill informed choice to give them the sole contract. I doubt if that opinion is going to change.
Thanks for your email. It is clear that I am not alone in my experience.
Hmmm. I had a good experience so I was considering switching to them for
my pump supplies (Medicare allowing). Maybe I will stick with my current
supplier.