If something isn’t covered by Medicare, you don’t get to opt to get that item and simply pay an up charge.
Update: Dexcom now will send out the G6 if you are on Medicare. You just have to answer the same few questions each month to get a one-month supply (3 sensors) sent to you. If you need a transmitter, you have to ask for that since Dexcom does not seem to track when you need a new one. However, if you ask, they also will send a transmitter.
The Sensors will come in a box boldly marked, “Medicare/Medicaid DME Beneficiary Only.” That makes me feel like they are somehow not a good as the regular sensors. When I asked a Dexcom rep about that, he assured me that they were exactly the same. OK, if that is true, then why go through the effort and the ink to specially mark those boxes being shipped to Medicare recipients? I worked damn hard for almost 40 years, paying in to Medicare with each paycheck. Why should Medicare recipients be any different than anyone else?
All right. Thanks for letting me vent. Just know that you now can get the G6 from Dexcom if you are on Medicare.
The specially marked Medicare boxes have existed for years with test strips and meters.
It’s an attempt to prevent a grey market for supplies and DME and might be required by their contract.
That said, if I go to E-bay or Amazon to buy a spare meter, it is almost invariably marked Medicare-only. So it doesn’t seem to be doing much to limit grey market.
A few years ago, when I researched this very topic, I was told that the billing codes are different for Medicare patients for the identical product and more and more items would be specifically marked for “Medicare/Medicaid DME Beneficiary Only.” to avoid errors in processing claims. Dexcom, has always, for example, had a separate sku# for Medicare patients sensors even though they were identical. This is what led me to ask questions because a few years ago, Dexcom would sometimes send me the sensors with the Medicare SKU while at other times send me the sensors for non-medicare patients. It sounds like they were maybe not paid for certain orders based on submission of the wrong codes to medicare on their end for certain medicare orders.
The codes for CGMS supplies for non-Medicare patients are A9276; A9277; A9278. These codes are universal regardless of company. Medicare finally allowed CGMS when DexCom G6 became available because it does not “need” fingersticks. Medicare, decided to call this “therapeutic CGMS” (which the courts have already said in some cases that by their definition of “therapeutic”, Medtronic sensors also apply but, because you still have to do fingersticks to calibrate the Medtronic sensors, Medicare ignores this).
The result is now you have sensors that Medicare allows and ones that Medicare doesn’t. You need to differentiate them and the previous codes were applicable to all sensors. So Medicare created the codes K0553 and K0554 (there are only two codes because Medicare bundles the transmitter and the sensors). These are the “therapeutic” CGMS codes. That is the only reason why there are two different codes.
As to why boxes are labeled different. I’m not a 100% sure but Medicare’s has had a history of being really tight in policing diabetic supplies. Their auditors seem to get worse every year. I’m sure it somehow relates to that.
OK. That makes sense. I get the same designation on the boxes of my OmniPod DASH system pods. Ah, the glories of paperwork!
It’s because dexcom had to come out with a lower cost SKU for medicare patients. the commercial product is the exact same it just costs the commercial health insurance market 2x the cost. i’m on the freestyle libre which has the same cost for medicare and commercial insurance so there are no big labels indicating medicare only.