Dexcom G5

What is required to use the G5 with a smart device? Medicare requires their members to use the Receiver that comes with the system, but how would Medicare enforce this requirement if I install the app on my phone and connect to the transmitter. What am I missing?

Hey Tim if I every get my requested G5 through my Medicare Advantage Plan I will be using the G5 Receiver just because I prefer it over the phone, but if I use my Receiver as required by Medicare and also connect to my phone if possible and never transmit information to Dexcom or give data to my Endo what rule have I broken or how would Medicare ever know. The whole thing is silly. Personally I don’t like Bluetooth for monitoring my transmitter information because of it shorter range. Now I can leave my G4 Receiver just about anywhere in my house and it stays connected to my Transmitter.

I wish the BT tech worked further than roughly 30’, also. I have the G5. It’s easy to get outside it’s range, in the house. Same room; no problem. Go elsewhere; no dice.

@Tim35 Dexcom has already called people who are violating the smartphone policy and warned them that if they violate it again, they will no longer receive Dexcom supplies with Medicare reimbursement. There are several people in the Seniors with Sensors group on Facebook who were called. For some it was an innocent mistake because they were using supplies purchased prior to Medicare. But the consensus seems to be that once Dexcom ships your first Medicare G5 bundle, you need to immediately delete the app off of your smartphone.

@Bob_Martin Dexcom can immediately see if Medicare-flagged accounts are linking up to the G5 app on their phones. If you look at a Dexcom Clarity report, it says exactly where the information is coming from. And although not every user knows this, if you use the G5 app, your data automatically goes to Dexcom and into Clarity even if you never set up a Clarity account.

Medicare Advantage plans don’t necessarily have to follow the Medicare ban on smartphones, so you should check with your plan to see whether you can use a phone. Anyone with Basic Medicare and a Supplemental plan is absolutely forbidden from using a smartphone.

If you delete the G5 app off of your smartphone, you could use xDrip and Dexcom/Medicare would have no way of knowing. xDrip is easy to set up on Android, less easy on an iPhone. You would absolutely be in violation of Medicare policy and if you choose to go this route, I would recommend not mentioning it on social media.

I am still in the process of getting my first Dexcom order through Medicare. Dexcom is totally overwhelmed and customer service is less than optimal for most Medicare users trying to get their first order. I am currently using out-of-warranty supplies and hope my order is completed before I run out.

My best source of information for other users’ experiences with Medicare and CGM is on Facebook in the Seniors with Sensors group: https://www.facebook.com/groups/989708904400922/

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Good luck with getting your G5 soon, Laddie! Must be very frustrating! I and my wife feel super lucky to have received our Medicare-approved G5’s in the middle of September. I hope that processing of Medicare patient orders proceeds with the utmost of speed. When I had heard how many they had to process (around 19,000, by some accounts), I figured it would be 2018 before we would get the Dexcom. Now that I have one, and know how freaking accurate it is, I shudder even more to think that we might have been one of those whose orders would be delayed for many months.

My ace in the hole if I get desperate to continue on Dexcom is that I have a brand new G4 transmitter that was sent to me by error by Tandem/Dexcom when I was supposed to get a replacement G5. They said that it couldn’t be sent back. I unfortunately don’t have a G4 Share receiver because both of mine were previously updated to G5. I do have an original G4 receiver so I could at least see some numbers. With G4 I think that the algorithm is in the receiver and I wonder if this receiver is the old or new algorithm. I could also use my Vibe pump as a receiver although I don’t know if I can use it without getting insulin from it. It is definitely the old algorithm. I assume that I could put in a cartridge with some insulin and then program basals of zero. I hope that I don’t get to this point…

Laddie, as I said before I have absolutely no plans to use my smartphone with my G5, since I prefer the Dexcom Receiver. I have used the G4 Receiver for a few years now like it. Thanks for your response

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I’m a Medicare-covered G5 user. I don’t use the smart phone app. Why? Because I (electronically) sign something saying that I don’t. Also, I don’t want to be the one that gets caught and triggers a “no more CGM coverage under Medicare”. The “no smart phone” rule will go away in time, I expect.

I will be happier, however, when Medicare allows me to use my t:slim X2 as the receiver instead of the Dexcom reciever … When will that happen? Soon, I hope.

Thanks,

John

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I too don’t want to be that guy who gets his Medicare coverage revoked for not following their rules. There’s no way I want to be without the Dexcom system and there’s no way I could afford to buy it out of pocket

I hear you Dave. I am currently paying out of pocket that’s the reason I am
begging for G4 leftovers Dexcom users my have to help me out until I can get
Dexcom to process my G5 request through my Medicare Advantage Plan.

Bob

I set mine up anonymously. Nobody knows it’s me. Not Dexcom, not my provider, not my doctor.

If you are on Medicare, Dexcom knows who they sent the transmitter to. You can play games with how you registered your account, but you are not invisible…

I think you have keyed in on the nature of the fly in the ointment. The serialized transmitter

I think using xDrip would remove that fly.

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Not every 65+ year old Medicare recipient is going to want to delve into xDrip! The audience for that sort of complexity is not going to include the bulk of older people who want to use Dexcom and bypass the Medicare rules to use a smart device instead of the included receiver.

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I had a techy friend help me install xDrip on my iphone prior to getting sensors through Medicare. It is harder to do on an iphone than an Android phone and is not nearly as feature rich as on an Android. I had not decided whether I would use it once I got Medicare sensors and I didn’t particularly like it. Last week my 6S phone did not survive the latest ios update and Apple help ended up resetting my phone and putting on a new operating system to restore my battery. Although the phone was backed up, xDrip did not survive the reset. So my decision was made for me. :grinning: Yesterday Mike Hoskins of Diabetes Mine shared with me the likely-to-be-true update that Medicare will probably change the smartphone policy in mid-late 2018. Hope it’s true because 3 days into using my receiver, I hate it.

I do not believe there is a reasonable way for Medicare/Dexcom to see if you are using the Tandem pump as the receiver for your Dexcom.

I also do not believe that the statement from Medicare specifically prohibits the use of the Tandem pump as a receiver. Regardless of how Dexcom and/or Tandem interpret the Medicare statement - I still do not see this restriction (as applying to the Tandem Pump) if only looking at the Medicare statement itself.

It seems to be reasonable to use the Tandem now as the Dexcom Receiver. When the Tandem PLGS comes out (hopefully in Summer 2018 according to Tandem projection) then I think it would definitely make sense to use the Tandem (as the Dexcom receiver device) so as to be able to take advantage of the PLGS functionality.

Tandem has informed us that Medicare users are forbidden from using the X2 as our receiver and you’re right that the likelihood of being caught is quite low. The technical issue with this is that you cannot use the Dexcom receiver and the X2 simultaneously. There is no absolute requirement to download the Dex receiver to Clarity but there is some risk of not being able to use Clarity. For example if I have a transmitter problem, they may want to see the Clarity tracings. I say I’m not using the receiver and can’t download to Clarity and I’m busted.

If PLGS comes out before the Medicare policy is changed, I wonder whether Tandem will allow Medicare users to install the update.

If Mike Hoskins is correct, this will be fixed in 6-12 months and I am going to stay on the honest side of things.

Ultimately it is up to each person’s comfort level which ends up being the most important thing.

Potentially, you could tell them you prefer the Diasend reporting capabilities.

The Tandem t:slim X2 will download integrated Dexcom G5 cgm data into Diasend. As will the actual Dexcom Receiver. So whether the cgm data is received in one device (Dexcom G5 Receiver) or the other (Tandem t:slim X2) - both will work with the diasend uploader to import (via USB) the cgm data into Diasend.

In any event, I flat out do not believe that Tandem is correct on this point. Actually, I do not believe they (Tandem) should even be involved with this. If it actually was a Medicare violation to use the X2/G5 integration for Medicare recipients then it still would not be Tandem at risk but Dexcom at risk (with the Dexcom/Medicare contract and reimbursements). Tandem (as a company) would continue to have nothing at risk here.

The CMS prohibition is on Smart Devices and non-DME devices. Of which, the Tandem pump falls into neither category. The Tandem pump is NOT a smart device and it IS dme and comes with a 4-year warranty. The Tandem pump fits all categories as required by CMS, is in non of the excluded categories and is quite specifically NOT called out as being an exclusion.

The likely reality here is the timing of events. The CMS ruling was from March of 2017. Tandem released the X2/G5 integration in August of 2017. The CMS ruling could not reasonably address future events which were not yet approved however it does appear they were aware of this possibility and worded their statement so as to NOT exclude this. In my opinion.

It will be interesting to see what happens when Tandem releases the PLGS update. It would certainly be nice for everybody if the entire issue goes away before that which can happen with a single public statement from CMS. At a minimum and as a start, it would be helpful for a CMS clarification to the point that the Tandem Pump is indeed DME and so does not fall under the CMS restriction

https://med.noridianmedicare.com/web/jddme/policies/dmd-articles/coding-and-coverage-therapeutic-continuous-glucose-monitors

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 G5® Mobile CGM System, an alternative option for displaying the received data is with a smart device using the Dexcom G5® 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:
A9270 - NONCOVERED ITEM OR SERVICE

Coverage of the CGM system supply allowance is limited to those therapeutic CGM systems where the beneficiary ONLY uses a receiver classified as DME to display glucose data. If a beneficiary uses a non-DME device (smart phone, tablet, etc.) as the display device, either separately or in combination with a receiver classified as DME, the supply allowance is non-covered by Medicare.

CONCLUSION
For CGM products that are used in the home and approved by the FDA for use in place of a blood glucose monitor for making diabetes treatment decisions, these therapeutic CGMs are primarily and customarily used to serve a medical purpose because they are used by Medicare beneficiaries with diabetes who must measure their glucose level frequently and check trends in their glucose measurements for the purpose of adjusting their diet and insulin in the treatment of their diabetes. … A receiver (or type of monitor) for a therapeutic CGM that has an expected life of at least 3 years and is the component performing the medically necessary function of accurately monitoring the trends of the patients’ blood glucose levels so that he or she can make necessary diabetes treatment decisions meets the 3-year MLR [minimum lifetime requirements]. [Emphasis added]

It’s awesome when a government agency controls your healthcare.
:roll_eyes: