Billing Tips for Dexcom G6®
Dexcom G6® sensors, transmitters, and receivers continue to be audit targets. Pharmacies have faced recoupment on their Dexcom G6® claims for billing an incorrect days’ supply, refilling the item too soon, and for having vague directions. The proper quantity and days’ supply can be found in the table below, along with suggested instructions. Following these billing guidelines will help decrease the risk of recoupment on the Dexcom G6® continuous glucose monitor and supplies.
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| Dexcom G6® Item | NDC | NCPDP Billing Quantity (unit of measure) |
Suggested Day Supply | Suggested Instructions |
| Receiver | 08627-0091-11 | 1 each | 365 days | Use receiver to check blood sugar; replace yearly |
| Transmitter | 08627-0016-01 | 1 each | 90 days | Use transmitter to check blood sugar; replace every 90 days |
| Sensors (3 sensors/box) |
08627-0053-04 | 3 each | 30 days | Use sensors to check blood sugar; replace every 10 days |
PAAS Tips:
- Always double check the directions on each Dexcom G6® item to ensure they are specific enough for an auditor to determine the correct days’ supply
- If there is an insurance plan limit which prevents the pharmacy from billing the true days’ supply for the transmitter or receiver (i.e., 30-day plan limit), PAAS analysts suggest adding the true days’ supply to the patient instructions to help patients and pharmacy staff recognize how long the item should last which can help prevent future claims from being billed too soon
Analyst at PAAS National®
After graduating from UW-Madison's School of Pharmacy with my PharmD, I spent my first eight years at an independent pharmacy dividing my time between both retail and long-term care. I fell in love with the independent pharmacy world and joined the PAAS team to help independents not only survive, but thrive.
I enjoy assisting pharmacy staff both pre- and post-audit and enjoy providing them with knowledge and tools to decrease audit risk going forward. I write articles for Third-Party Newsline each month and answer member questions daily. I look forward to building professional relationships with each of our members and assisting you with your next audit.
I enjoy assisting pharmacy staff both pre- and post-audit and enjoy providing them with knowledge and tools to decrease audit risk going forward. I write articles for Third-Party Newsline each month and answer member questions daily. I look forward to building professional relationships with each of our members and assisting you with your next audit.
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