Diabetes can serve an inconvenience when planning meals and maintaining a healthy weight, but it can also become a life-threatening condition when not properly controlled. In most cases, insulin plays a large role in the day-to-day life of someone living with diabetes, and whether you have Type 1 or Type 2 diabetes, you likely know the struggle of routine finger sticks and blood glucose monitoring using traditional test strips.

Although test strips are still a viable method for monitoring blood glucose, medical technology brought forth by companies like Dexcom has come a long way in providing diabetics with options for continuous blood glucose monitoring. Systems like the Dexcom G5 allow diabetics the ability to accurately keep track of glucose levels and be alerted if levels fall outside of a safe threshold, providing an early warning to take action before the change in blood glucose becomes dangerous.

How Does the Dexcom G5 Work?

The Dexcom G5 is a system utilizes a sensor, transmitter and a receiver to monitor blood glucose levels and send and receive vital information in real-time regarding these levels. When first installing the Dexcom G5, a small sensor is injected under the skin that keeps track of blood glucose. This data is then transmitted via a wireless connection to a receiver that the patient carries on his or her person. This receiver can display updated information about current levels, and it can also track a history of level changes along with pertinent date and time information for medical personnel to review.

Using the Dexcom G5, diabetics no longer need to repeatedly perform finger sticks to draw blood, and the system performs testing 24 hours a day. Some Dexcom G-series systems can also interface with smartphones through an app that allows for additional functionality and data review.

Does Medicare Cover the Dexcom G5?

Medicare benefits do cover the Dexcom G5 and other Dexcom G-series monitoring systems, but there are some guidelines that must be met in order for expenses to be included when billing Medicare. A qualifying Medicare member must be diagnosed with Type 1 or Type 2 diabetes and must be on intensive insulin therapy in order for coverage to apply. Additionally, a qualifying patient must have been on home blood glucose monitoring and has required four or more tests per day prior to the prescription of the Dexcom system.

The patient will also need to be using an insulin pump that requires the injection of three doses of insulin or more per day. Finally, it must be demonstrated that the patient requires frequent changes to insulin dosing in order for the Dexcom system to qualify for coverage. Patients who receive coverage will need to receive an initial screening at the time of prescription, and going forward, they will need to be re-screened for changes every six months.

Although the Dexcom G5 can interface with a smartphone, the qualifying patient must also use the supplied receiver in order for the coverage to remain continuous. This means that if you intend to use a smartphone with a Dexcom G5, you will also need to record your results using the receiver and be ready to supply those results when requested.

What Parts of Medicare Covers the Dexcom G5?

Most continuous blood glucose monitoring systems are considered durable medical equipment, and therefore, they are covered under Medicare Part B. This part of Medicare also provides coverage for outpatient treatment. If the Dexcom G5 is supplied during a temporary stay in a skilled nursing facility or while admitted to a hospital, it is possible that the system would be covered under Part A. If, however, the system is supplied under these conditions and is taken home upon release, then it is likely that Medicare Part B would once again apply. Medicare benefits under Part D cover prescription drugs, so it would not apply to any type of coverage for the Dexcom G5.

Related articles:

Does Medicare Cover Test Strips?(Opens in a new browser tab)

Does Medicare Cover Glucose Monitors?(Opens in a new browser tab)