My name is Joe, I am 67 and was diagnosed as a type 1 in 1984. I have managed my diabetes fairly well with the exception of Macular Edema with was treated with Eylea injections and is now stable.
I treat with MDI and started using the Medicare Dexcom G5 about 6 weeks ago.
That really opened my eyes to trending and what my blood sugar was doing, what a surprise! I have steadied my graph through better eating and dosing. It’s tough!
I am presently looking into the Tandem t:slimx2 pump and will be taking a saline “test drive” Feb 1st to see if I can live with the tubing and infusion set.
The fact that Medicare will not let me integrate my Dexcom G5 to the t:slimx2 as it was designed for really makes me mad! And because of that, I may hold off on the pump and wait for future developments.
Part of the reason I chose the Tandem t:slimx2 was that the Dexcom G5 is approved for Medicare coverage and Medicare will cover the pump also!
I am glad to be part of this community and I would like to hear your thoughts or comments!
Welcome, Joe! We are glad you join and please let us know if there is something we can help you.
Hi @Jalopiejoe, and welcome! I ask only because I don’t actually know the answer, but how would Medicare actually know if you used the G5 on the Tandem pump? I get that if you use the smartphone G5 app, that when the app “phones home” to Dexcom’s servers they are required to tell Medicare. The Tandem uploads to Tandems servers. Assuming they have a similar Medicare policy, what stops you from using something like Tidepool to see/analyze and export your data to your D-team? Tidepool is free forever and works with Tandem and many , many BG meters. I have to believe that since Tidepool is not tied to the procurement/supply protocols with Medicare, they have absolutely no reason to inform Medicare of anything. Just my 2 cents
I agree.
Personally, I still do not see where CMS has stated that the cgm data is not allowed to go to the pump. Certainly I see where it mentions in regards to a Smartphone and I understand that Tandem and/or Dexcom may say not to send the cgm data to a pump, but regardless, I still do not see direct from CMS where it says not to send the cgm data to a pump.
Nor (as @El_Ver states) do I think that CMS would know if the cgm data was going to the Tandem pump.
I have tested and verified that the Tandem t:slim X2 data (including all cgm data) will upload to Diasend.
https://diasend.com/
The Tandem Pump is very specifically classified as DME so as I read the CMS policy, this is entirely legitimate and within the rules to use the Tandem pump as your DME cgm receiver. I think Dexcom and Tandem are misinterpreting the CMS policy. I am always open to correction and continue to look to CMS for any clarification.
El_Ver and Tim35, What creeps me out about this whole situation as you state, no one seems to have a clear understanding of the CMS statement! I will take a look at Diasend and Tidepool.
I don’t think t:connect reports to Medicare and will try to confirm that with my Tadem Educator when I meet with her next Thursday.
The thought of losing the Medicare coverage on my G5 is disturbing!
I just read the CMS statement and it says the Dexcom Receiver is considered the Durable Medical Equipment and Must be used for Medicare reimbursement!
I read it differently. Can you cut-n-paste the particular section that you are referring to?
HCPCS Coding
For purposes of Medicare billing, the Ruling outlines therapeutic CGM as comprising two elements: (1) a DME component and, (2) an all-inclusive supply allowance. The DME component for the Dexcom G5® Mobile CGM system is the receiver. The receiver must be billed using the following code:
E1399 - DURABLE MEDICAL EQUIPMENT, MISCELLANEOUS
When billing this code, suppliers must enter “Dexcom G5® Receiver” in the narrative field of the claim.
That is correct. This is how to get the Dexcom Receiver reimbursement from Medicare. However that says nothing about the restriction on having the cgm data go elsewhere. The following cut-n-paste statements refer to restrictions on where the cgm data may go but none of them would exclude having the cgm go to the Tandem Pump which clearly is DME and can operate as the Receiver for the Dexcom cgm data.
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.
Medicare does not cover a beneficiary-owned smart device.
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.
BTW - Please don’t misunderstand me.
At this point, I think this is an interesting academic discussion.
However the reality (now) is that there is little practical purpose to having the cgm data on the Tandem pump. That simply means you would not need to carry the receiver but would provide little to no additional benefits.
The bigger reason for having the cgm data on the Tandem pump will not come until this Summer when Tandem releases the Predictive Low Glucose Suspend (PLGS) update. Assuming the update is FDA approved and launches on target. THEN it really will make a functional difference to have the cgm data on the Tandem pump.
I think we are on the same page Tim35!
Welcome, Jalopiejoe !
@Jalopiejoe something else to consider. as @Tim35 mentioned, the Tandem pump acts as the only Dexcom receiver (not including the G5 smartphone app), so it is definitely DME for Dexcom. You are not able to run a Tandem pump and your Dexcom receiver concurrently. You could however run the Tandem pump and XDrip+, which Medicare in no way would have access to the information that XDrip creates . The Tandem pump website doesn’t IMO have as many of the CGM reporting features as the Dexcom site has. With Tidepool I get the best of both worlds for free, and my CDE & Endo can pull their own reports of my info (with permission) whenever they want.
EL_Ver, Tim35, I have downloaded several recording apps including Tidepool, Glooko, t:connect and Diasend on my laptop and smartphone. I can’t use as yet t:connect because I don’t have the pump yet.
I think I like Diasend the best because it has great graphics and looks great on my phone also and I think it contains everything my Dr. and I want to see and I can upload the t:slim to it when I get it!
@Jalopiejoe whatever works best for you and your care team is perfect! I have yet to figute out how to get Diasend/Glooko for free, so that is why I use Tidepool. T:Connect is easy to set up, but most of the reports need Adobe Flash, which I will not run. My care team has access to both (with permission) so I never print anything out for Endo/CDE visits.
@El_Ver
Try sending the diasend support team an email request. They might be able to assist you. That worked for me when we switched from Animas over to Tandem.
support@diasend.com
@Tim35 Really??? Thank you! I will send an email this weekend.
Tim35, I just went into Diasend.com and set up an account and installed the uploader then went to the play store on my android phone and downloaded the app and they are linked. Plug your receiver in to download. It cost me nothing! I love the graphs and it looks great on my phone. I will be getting the clinic code Monday so they can take a look! 
Joe - I switched to the Dexcom G5 and the Tandem t-Slim about nine months ago. I cannot even come close to adequately explaining how incredibly pleased I have been with both the Dexcom and Tandem devices. After years of frustration and futility with Medtronics, I took a chance on Tandem and the Dexcom and my results are incredible. The integration of the products has been exceptionally good. And, the customer service of both of these companies has been stellar. Medtronics was a nightmare, especially when I tried to upgrade to the 670G with integrated CGM. There are work-arounds for the integration of the devices. I finally just paid cash for the devices. You are absolutely on the right path. The full integration of my two devices is helpful, but I would go this path even if the devices did not communicate.
DBBama, Thanks so much for the information! I love my Dexcom G5 and I am going to try the t:slim x2 Thursday with saline. I have been a Type 1 for nearly 34 years and I still not so sure about being connected to a pump! And I think I know the workaround for integration! We will see how it goes!