2025 HCPCS code S1037
(Active) Effective Date: N/A Revision Date: N/A Medical Supplies - Artificial Pancreas Device System Components Miscellaneous Provider Services and Supplies Feed
External receiver or monitor for an artificial pancreas device system (APDS).
Modifiers may apply depending on the circumstances of service, such as the use of the modifier -51 for multiple procedures, or other relevant modifiers as dictated by the payer. Consult specific payer guidelines for the appropriate use of modifiers.
Medical necessity for S1037 is established by the patient's documented need for an APDS to manage their diabetes.This typically involves frequent glucose monitoring and insulin adjustments, which are facilitated by the APDS system.Documentation must support the clinical need for this device in managing the patient's condition and preventing complications.
The clinical responsibility for this code involves the selection, fitting, and instruction on the use of the external monitor as part of an APDS.Regular monitoring and follow-up care are also needed to ensure proper device function and patient safety.Physician oversight is necessary for the comprehensive management of the patient's diabetes.
- Miscellaneous Provider Services and Supplies
- S1034-S1037 (Artificial Pancreas Device System Components)
In simple words: This code is for the external part of an artificial pancreas system.It's like a small computer that shows the blood sugar levels from a sensor placed under the skin.It helps people with diabetes manage their condition.
HCPCS code S1037 represents an external receiver, or monitor, that is part of an artificial pancreas device system (APDS).An APDS is a collection of devices that aids diabetic patients by continuously monitoring blood glucose levels and administering or withholding insulin as needed. This monitor receives blood glucose level data from an implanted sensor and displays the readings.The patient can wear it on a belt or keep it in a pocket.
Example 1: A patient with type 1 diabetes is fitted with a new APDS. Code S1037 is used to bill for the external monitor component of the system., A patient experiences a malfunction with their APDS external monitor.The monitor needs replacement.Code S1037 is used to bill for the replacement monitor., A patient requires adjustment of their APDS settings.A healthcare professional uses the external monitor (S1037) to review data and make adjustments to optimize insulin delivery.
Documentation should include details of the patient's diabetes diagnosis,the need for an APDS, specifications of the APDS system, including the model of the external monitor (S1037), and patient education regarding device use.
** This HCPCS code is not reimbursable by Medicare.Reimbursement is dependent on the payer's policies and specific contract agreements.Always verify coverage with the patient's insurance provider before providing services.
- Payment Status: Active (Non-Medicare)
- Modifier TC rule: A Technical Component (TC) modifier is not applicable to this code because it represents a supply, not a procedure.
- Fee Schedule : Fee schedule data for this code is not consistently available across payers and varies over time. Consult individual payer fee schedules for current reimbursement information.
- Specialties:Endocrinology, Diabetes Management
- Place of Service:Office, Hospital Outpatient, Home Healthcare