Does S1031 require prior authorization?

No, S1031 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for S1031?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

Verity

`S1031`, Continuous noninvasive glucose monitoring device, rental, including sensor,

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records documentation may be required to assess whether the member meets the clinical criteria for coverage.

Key Coverage Criteria

I.Non-ImplantedContinuous Interstitial Glucose Monitoring Devices for Personal Use
Use of anon-implantedcontinuous interstitial glucose monitoring device for personal use is consideredmedically necessaryfor individuals who meet the following criteria:
Individual has been diagnosed with diabetes mellitus (any type);and
Insulin injections are required multiple times daily or an insulin pump is used for maintenance of blood sugar control;and
Both of the following (1 and 2):The individual or caregiver(s) demonstrates the following:An understanding of the technology, including use of the device to recognize alerts and alarms;andMotivation to use the device correctly and consistently;andContinued participation in a comprehensive diabetes treatment plan;andAnyof the following are present, despite ongoing management using self-monitoring and insulin administration regimens to optimize care:Inadequate glycemic control, demonstrated by HbA [...]
The individual or caregiver(s) demonstrates the following:An understanding of the technology, including use of the device to recognize alerts and alarms;andMotivation to use the device correctly and consistently;andContinued participation in a comprehensive diabetes treatment plan;and

4 Active Policies

ANTHEM-CG-DME-42, CG-DME-42 Continuous Glucose Monitoring Devices

UHC-POL-continuous-glucose-monitoring-insulin-delivery-managing-diabetes, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes

UMR-POL-UMR-continuous-glucose-monitoring-insulin-delivery-managing-diabetes, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes

SUREST-POL-SUREST-continuous-glucose-monitoring-insulin-delivery-managing-diabetes, Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes

Have a follow-up question?

Ask Verity about documentation requirements, denial risks, or coverage in your state.

S1031, Continuous noninvasive glucose monitoring device, rental, including sensor,