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PAYER POLICY CHANGES

S1037 Insurance Policy Changes

HCPCS S1037 is officially defined as "Receiver (monitor); external, for use with artificial pancreas device system." HCPCS S1037 is referenced in 4 tracked payer policy changes from UnitedHealthcare, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS S1037 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules5
Payers requiring prior auth5
  • Blue Shield of California · Effective October 1, 2026

    Prior authorization required

    Prior Authorization List for Blue Shield of California

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Centene · Effective December 31, 2025

    Prior authorization required

    Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for S1037?

Ambetter lists S1037 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for S1037?

AmeriHealth Caritas lists S1037 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans, with conditions. Verify with the payer before scheduling.

Does Blue Shield of California require prior authorization for S1037?

Blue Shield of California lists S1037 on Prior Authorization List for Blue Shield of California for commercial plans (list dated October 1, 2026). Verify with the payer before scheduling.

Does Capital Blue Cross require prior authorization for S1037?

Capital Blue Cross lists S1037 on Capital Blue Cross single source preauthorization code list for commercial plans. Verify with the payer before scheduling.

Does Centene require prior authorization for S1037?

Centene lists S1037 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS S1037?

There are 4 tracked policy changes affecting HCPCS S1037, including updates from UnitedHealthcare, Excellus BlueCross BlueShield, Sentara Health Plans. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS S1037?

Payers that have issued tracked updates for HCPCS S1037 include: UnitedHealthcare, Excellus BlueCross BlueShield, Sentara Health Plans, Blue Cross & Blue Shield of Mississippi.

How do I get notified when HCPCS S1037 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS S1037. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS S1037?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for S1037

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for S1037 in one place.

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