I recently learned that Dexcom has lined up new suppliers to sell the G5, and deal with Medicare. However, they will not be onboard until July 1, 2017. Three suppliers that I know of are: Diabetes Management & Supplies, Edwards, and Byram have all signed the Medicare deal, and are getting the new G5 receiver shipped to them.
If you don’t want to wait until July 1st, then you can call these suppliers, and pay out-of-pocket cash, then file a CMS form 1490S to proceed in dealing with Medicare directly on your own.
Someone shared this video on Facebook today. It is very clear about CMS criteria for CGM coverage and even more clear that smartphone use will not be allowed. The video is a little repetitive and longer than it needs to be, but a good resource for accurate info. It was released mid-April and unfortunately does not include the final info for coverage.
It makes sense–the receiver is basically what makes it covered as durable medical equipment. But I still think as long as one has a receiver, there is no way they can possible know what one uses day to day.
The problem has been that the final coverage guidelines had not been released by Medicare. Liberty Medical was the only Medicare authorized-supplier and began shipping supplies. Unfortunately I have heard that Medicare has not approved any of those shipments. Technically once the final guidelines are in place and there is a new supplier(s), you can file claims back to the January 12 date. Liberty announced late last month that it will no longer continue to be a supplier after May 28, so currently there is no authorized supplier.
This is an email that Dexcom sent out earlier this week on May 23. Someone shared it on Facebook. The text is as follows:
“Subject:Medicare Coverage Update: Dexcom G5 Mobile
Tuesday, May 23 at 2:14 PM
Dear XXXXXX:
We have a quick update regarding Medicare coverage of the Dexcom G5® Mobile Continuous Glucose Monitoring (CGM) System. On May 18th , a Local Coverage Decision (LCD) was issued, further defining the requirements for therapeutic CGM. This is positive news and allows us to take the next step in trying to establish a supplier of the product.
We will be back in touch in the coming weeks with another update and next steps. Thank you for your patience.
If you have an immediate, critical need for G5 supplies, please contact Dexcom at 888-738-3646.
Sincerely,
Dexcom”
Thanks Laddie. I did get that email from Dexcom a few days ago. Dexcom has been very helpful with me, even gave me a box of sensors since they can’t sell them to me anymore. I just wish this would get settled.
I also don’t understand the CMS position on using a phone as a receiver. I understand why the phone isn’t covered by insurance, but it sounds like if you use a phone you will lose coverage of the CGM.
Dexcom sent out an update message on 07/14/17 about getting G5 supplies to those of use on Medicare. There are some items in process and in fact some users are having orders placed by Dexcom. This is also a test to see if CMS will actually pay for the product as Dexcom and the users have done “exactly” what CMS has mandated … at least for now.
I had another talk via phone today with a Dexcom staffer and if I use my Smartphone to monitor my G5 and thus allow my wife to also monitor with the Dexcom APP on her phone … CMS will NOT pay for ANY of the G5 system. Even IF I also carried a G5 receiver in conjunction with my Smartphone … that is a deal breaker and CMS will NOT cover the G5.
In fact the new kits being sent out for us on Medicare will not have Bluetooth enabled so there will NOT be any signal transmitted that can be used by our Smartphones. Only the G5 receiver can get the signal.
No … you can’t use “Share” either.
To get your data to Clarity you have to connect via cable to your PC and upload the data to Clarity. Once the data is located there it can be shared with your medical support team with the mechanism that Dexcom Clarity has in place.
It is just that ones medical team cannot see the “ad hoc” data as it won’t be transmitted to the Smartphone to then pop it into the Clarity Cloud.
Sort of like one step forward, but two steps backward.
Good news to some degree, but we’re also going backwards when technology is seriously moving forward.
Although I do believe this is what you were told, I also do not believe this is technically accurate.
The G5 transmitter communicates with the Dexcom receiver via the Bluetooth communication protocol.
I also spoke with Dexcom Customer Service today on this topic and was told that Dexcom is still internally discussing whether they will be technically enforcing the CMS mandate to not allow the G5 transmitter to be used with SmartDevice or whether Dexcom will not be technically enforcing it.
I think that there may be “two” Bluetooth channels … one for the receiver and the other for a Smartphone. Ergo they could possibly shut one off to meet CMS’ mandate.
But … as we often find out … talking to different folks we hear different comments and all just have to wait for the dust to settle.
However this does not (necessarily) mean that each channel is dedicated to a single device. Actually, that would be contrary to typical BlueTooth operations as multiple channels are generally used to reduce problems with interference.
I question the degree to which Dexcom would be able to modify their devices without requiring re-approval.
Dexcom has to be the absolute worst medical device company that we have
ever dealt with period! Another month has passed by since they contacted
my wife for her G5 CGM, and we are STILL waiting to receive a device that
was ordered on 3/27/17 by her doctor. I have nothing good to say about
Dexcom, and only wish their device wasn’t the only CGM device to be
approved by Medicare.
As I am sure you are aware the FDA approved (yesterday) the Tandem t:slim X2 integration with the Dexcom G5. The way I read the Medicare ruling for the coverage of the Dexcom G5, it restricts the usage of smartdevices but would have no issues at all with using the Tandem t:slim X2 pump which is covered durable medical equipment (DME). Although the Dexcom website says only the Dexcom receiver can be used, I believe the Dexcom wording is slightly incorrect. Prior to the FDA approval of the X2/G5 that was not relevant but with this approval, it would seem to be no issue at all in terms of Medicare coverage to choose whether you want to view your Dexcom G5 CGM data on either the Dexcom receiver or the Tandem t:slim X2 being used in place of the Dexcom receiver.
Would you concur or would you see this differently?
I concur that under Medicare regulations I will be able to use my X2 as my receiver because it is DME and it is not a smart phone.
My only concern is that i have heard several times that Dexcom will be making hardware/software changes to the Medicare transmitters to prevent smart phone usage. If so, I hope whatever changes that are made do not prevent the transmitter from linking with the X2 by Bluetooth.
I would be very happy having my CGM info on my pump. Although I would miss the data on my Apple Watch, I will not miss using the app on my phone except for automatic syncing of the data with Clarity.
I have enough supplies to make it until late January before buying Dexcom supplies through Medicare. Until then I will experiment with using the pump versus using my phone. I probably wouldn’t use both because I can’t stand dismissing alerts on two devices. Except for the 55BG alarm I can turn all alerts off and I guess that is a possibility for the phone.
@Laddie - The X2 will have the ability to completely replace the receiver (in general - not speaking from a Medicare specific point of view). So, it is possible the G5 transmitter can not really tell the difference between the Dexcom Receiver and the Tandem X2.
I do not believe the rumors that Dexcom will be making hardware changes to the transmitters specifically for Medicare recipients.
In order to use a Smart Device with the G5 Transmitter, you have to have a Dexcom app linked to a Dexcom account in their cloud - correct? (I forget how we set it up but I think this was how it works.) So if I was in charge of putting a “block” in place, the easiest way would be to block at the point of the Dexcom servers where your Dexcom app comes in to connect. Very easy to put in place and very easy to remove. No hardware changes required.
BTW - You can of course set the alerts at different levels so you could have your primary device with your “real” alerts and the secondary device with the alerts either turned off, muted or set to such extreme values that you would not likely be hitting them?
What you’re saying about the G5 transmitter matches my thoughts, but until we’re a couple months into this Medicare coverage, I’m not willing to bet money on exactly how things will be working. I know that a I can adapt to using my pump as my receiver a lot faster that I will be able to get back to using a receiver. The one downside of using the pump is as far as I know is I would then lose access to Clarity unless I was using the receiver. I haven’t seen how the CGM info would display on the Tandem site. And Insuppose that the CGM info contained in the pump would download to Diasend.
Jim (?) I am so sorry to hear this from you, and you aren’t the first complaint I have heard about Medicare Coverage and Dexcom. Believe me, I promise, it isn’t Dexcom; it’s the difficulties, and there are many, that Medicare has place on them. My friend who just got hers from Medicare Coverage, is so disillusioned she doesn’t even want to go forward with implementation. We are in caveman times. So sorry to you have had so much trouble. I have Medicare as Primary, but I am still denied coverage, even though I have had one for years, and have to go through my secondary insurance. Please keep on keeping on. It has to get better. All the best, Kim
