2025 HCPCS code S1035
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Medical Supplies - Temporary National Codes (Non-Medicare) Miscellaneous Provider Services and Supplies Feed
Disposable invasive sensor for use with an artificial pancreas device system; measures subcutaneous blood glucose levels.
Modifiers may apply depending on the specific circumstances. For example, modifier 59 (distinct procedural service) could be used if the sensor insertion is performed separately from other procedures.Consult the payer's modifier guidelines.
Medical necessity for S1035 is typically established by the patient's diagnosis of diabetes requiring intensive glucose management.The physician must document the clinical indication for APDS therapy and the expected benefits, particularly the need for continuous glucose monitoring to mitigate complications of diabetes management.
The clinical responsibility lies with the physician or qualified healthcare professional who inserts the sensor, monitors the patient's response, and manages the overall APDS therapy.
- Miscellaneous Provider Services and Supplies
- S0012-S9999 > Miscellaneous Provider Services and Supplies
In simple words: This code is for a small sensor placed under the skin to check blood sugar levels.It's part of an artificial pancreas system that helps manage diabetes by automatically adjusting insulin doses.
HCPCS code S1035 represents a disposable, invasive sensor designed for subcutaneous placement to monitor blood glucose levels in patients using an artificial pancreas device system (APDS).The sensor is typically inserted into the abdomen using a needle or insertion device and secured with an adhesive patch for several days. A small transmitter attached to the sensor wirelessly transmits glucose level data to the APDS's glucose monitoring unit, enabling automated insulin regulation.
Example 1: A patient with type 1 diabetes is initiated on an APDS. The physician inserts the S1035 sensor, and the device begins automatically adjusting insulin delivery based on the sensor's glucose readings., A patient experiencing frequent hypoglycemic events while using an APDS needs a sensor replacement. The healthcare professional replaces the existing sensor with a new S1035 sensor., During a routine follow-up appointment, the physician discovers that the patient's S1035 sensor is malfunctioning and is providing inaccurate readings.The sensor is immediately removed, and a replacement is ordered.
Documentation should include the date of insertion, the type of sensor used (S1035), the patient's blood glucose levels before and after insertion, and any complications encountered during insertion or use.A record of the patient's APDS settings and any adjustments should also be included.
** S1035 is a temporary HCPCS code, meaning it is not a permanent code within the HCPCS system.Payment may vary widely depending on the payer's specific policies.This code is not reimbursable under Medicare.
- Revenue Code: Revenue codes will vary depending on the payer and the specific service provided.Consult the payer's specific coding guidelines.
- RVU: RVUs are not assigned to HCPCS codes. Reimbursement is determined by the payer's fee schedule.
- Global Days : The global period is typically one day per sensor, as the code reflects a single day supply.
- Payment Status: Active (Non-Medicare)
- Modifier TC rule: A technical component (TC) modifier does not apply to this code.
- Fee Schedule : Fee schedules vary by payer and are subject to change.Consult the payer's fee schedule for the most up-to-date information.Historically, reimbursement for S1035 has been determined by the payer’s policies regarding temporary HCPCS codes.
- Specialties:Endocrinology, Diabetology
- Place of Service:Office, Hospital (Inpatient or Outpatient), Ambulatory Surgical Center