2025 HCPCS code S1036
(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
Continuous glucose monitoring transmitter for use with an artificial pancreas device system (APDS).
Modifiers may be applicable to adjust payment based on the service provided (e.g., 59 for distinct procedural service if performed in conjunction with other procedures).
Medical necessity for S1036 is established by documentation supporting uncontrolled diabetes despite optimized medical management with other therapies. This includes detailed glucose profiles demonstrating significant hyperglycemia or hypoglycemia despite intensive medical management.Payer-specific criteria may apply.
The clinical responsibility includes inserting the subcutaneous sensor, attaching the transmitter, educating the patient on the device's use, and monitoring the patient's response to therapy. Regular follow-up and adjustments to the APDS settings might also be part of the clinical responsibility.
In simple words: This code is for a small device that's part of an artificial pancreas system. It wirelessly sends information from a sensor placed under the skin to a device that helps manage blood sugar levels in people with diabetes.
HCPCS code S1036 represents a continuous glucose monitoring (CGM) transmitter that interfaces with an invasive, disposable sensor placed subcutaneously.The provider inserts this sensor, typically into the patient's abdomen, using a needle or insertion device. An adhesive patch secures the sensor in place for several days. The sensor measures glucose levels, and the transmitter wirelessly sends this data to the APDS's glucose monitoring unit. This system regulates insulin delivery based on the glucose readings, aiding in blood glucose and insulin level management for diabetic patients.
Example 1: A Type 1 diabetic patient is initiated on an artificial pancreas system. The endocrinologist inserts the subcutaneous sensor, attaches the transmitter (S1036), and programs the insulin pump and glucose monitor settings.Follow-up visits are scheduled to assess glucose control and adjust the system as needed., A patient with poorly controlled Type 2 diabetes undergoes APDS implantation.The surgeon places the sensor, the diabetes educator attaches the transmitter, and the patient receives education on device management.Regular clinic visits and remote monitoring track blood glucose data for algorithm adjustments., A patient experiencing frequent hypoglycemic episodes despite intensive insulin therapy is prescribed an APDS.The primary care physician inserts the sensor and transmitter.The patient is educated on the system and provided with remote monitoring support to promptly address any issues. Regular laboratory testing is ordered to monitor hemoglobin A1c and evaluate therapy effectiveness.
The medical record must include documentation of the patient's diagnosis, the need for APDS therapy (including evidence of uncontrolled diabetes), the insertion procedure, education provided on the device, and ongoing monitoring and adjustments to the system settings.Detailed glucose readings obtained from the APDS should be recorded and analyzed to assess treatment efficacy.
** This code is a temporary national code and is not payable by Medicare.It is subject to change or removal.Always verify payer-specific coverage and reimbursement policies.
- Payment Status: Non-Medicare Payable
- Specialties:Endocrinology, Diabetology, Surgery
- Place of Service:Office, Hospital, Outpatient Clinic