`S1034` Art pancreas system

Artificial pancreas device system (e.g., low glucose suspend (lgs) feature) including continuous glucose monitor, blood glucose device, insulin pump and computer algorithm that communicates with all of the devices

Medicare coverage: Not payable by Medicare
Status: active (October 2026 file)

Medicare pricing for S1034

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for S1034

21 of 22 payer prior-auth lists that name S1034 require prior authorization or set conditions: Blue Shield of California, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, Molina Healthcare of New Mexico, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).

Payer	Plan	State	Prior auth	Since	Source
Blue Shield of California	Blue Shield commercial	CA	prior auth required	Sep 1, 2026	Prior Authorization List for Blue Shield
Humana	Humana Healthy Horizons	KY	prior auth required	Jan 1, 2027	please visit Humana Healthy Horizons in Kentucky Clinical coverage policies.
Humana	Humana Healthy Horizons	VA	prior auth required	Jan 1, 2027	Humana Healthy Horizons in Virginia Prior Authorization and Notification List (PAL)
Humana	Oak Street Health	All	prior auth required		Oak Street Health (Humana): Prior Authorization List (PAL) Codes Under Management
Molina Complete Care (Virginia)	Medicaid	VA	prior auth required	Apr 1, 2025	Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of California	Medicaid	CA	prior auth required	Apr 1, 2026	Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of Idaho	Medicaid	ID	prior auth required	Jan 1, 2025	Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of Illinois	Medicaid	IL	prior auth required	Jan 1, 2022	Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of Iowa	Medicaid	IA	prior auth required	Jul 1, 2023	IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of Michigan	Exchange	MI	prior auth required	Jul 1, 2021	Molina Healthcare of Michigan PA Matrix, effective 7/1/2021
Molina Healthcare of Michigan	Medicaid	MI	prior auth required	Jul 1, 2026	Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of Mississippi	Medicaid	MS	prior auth required	Jan 1, 2025	Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of Nevada	Medicaid	NV	prior auth required	Oct 1, 2022	Medicaid Prior Auth (PA) Code Matrix, effective Q4 2022
Molina Healthcare of New Mexico	Medicaid	NM	prior auth required	Jul 1, 2026	New Mexico Medicaid Prior Auth (PA) Code Matrix, effective July 1, 2026
Molina Healthcare of Ohio	Medicaid and MyCare Ohio (MMP) Medicaid	OH	prior auth required	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Ohio	Exchange	OH	prior auth required	Oct 1, 2023	Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of Texas	STAR	TX	prior auth required	Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR), reviewed 2025-02-19
Molina Healthcare of Texas	STAR+PLUS	TX	prior auth required	Feb 19, 2025	Molina Healthcare of Texas Prior Authorization Annual Review Report (STAR+PLUS), reviewed 2025-02-19
Molina Healthcare of Texas	STAR, STAR+PLUS, STAR Kids, CHIP (Medicaid PA code matrix)	TX	prior auth required	Jul 1, 2026	Medicaid Behavioral Health and Medical Prior Authorization (PA) Code Matrix (Texas), 2026-Q3
Molina Healthcare of Utah	Medicaid	UT	prior auth required	Jan 1, 2025	Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)	Medicaid	KY	prior auth required	Jul 1, 2026	Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026

Payer coverage policies that name S1034

S1034 appears in 17 coverage policies from Aetna, Anthem, Blue Cross & Blue Shield of Mississippi, Blue Shield of California, Capital Blue Cross, Premera Blue Cross, Regence, UnitedHealthcare.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Infusion Pumps (0161)	covered if criteria are met	Mar 31, 2026	payer document
Anthem	Automated Insulin Delivery Systems (CG-DME-50)	covered if criteria are met	Feb 19, 2026	payer document
Blue Cross & Blue Shield of Mississippi	Automated Insulin Delivery Systems	listed, no stance		payer document
Blue Shield of California	BSC1.03 \| External Insulin Infusion Pump	listed, no stance		payer document
Capital Blue Cross	External Infusion Pumps for Insulin Delivery and Automated Insulin Delivery Systems (MP 6.007) Procedure codes	covered if criteria are met	May 1, 2026	payer document
Premera Blue Cross	Automated Insulin Delivery Systems (1.01.30) LGS	listed, no stance	May 11, 2026	payer document
Regence	Insulin Infusion Pumps, Automated Insulin Delivery and Artificial Pancreas Device Systems (Durable Medical Equipment 77) LGS	listed, no stance	Dec 1, 2025	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (2026T0347XX) LGS	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (CS024SS.AH) LGS	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Idaho Only) (CS024ID.D) LGS	listed, no stance	May 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Kansas Only) (CS024KS.03) LGS	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Kentucky Only) (CS024KY.14) LGS	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Nebraska Only) (CS024NE.AE) LGS	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for New Mexico Only) (CS024NM.F) LGS	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Pennsylvania Only) (CS024PA.AI) LGS	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Continuous Glucose Monitoring and Insulin Delivery for Managing Diabetes (for Tennessee Only) (CS024TN.AF) LGS	listed, no stance	Sep 1, 2026	payer document
UnitedHealthcare	Insulin Delivery for Managing Diabetes (for Ohio Only) (CS0242OH.D) LGS	listed, no stance	Nov 1, 2025	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Oct 1, 2026: PA removed, Oxford Health Plans
Jan 1, 2026: PA added, Molina Healthcare of Michigan
Aug 9, 2024: PA removed, humana:pa:commercial
Jan 1, 2024: PA removed, humana:pa:commercial

Medicaid fee-for-service

Prior authorization required or conditional in IN.

ND: $0.00 (physician), effective Aug 1, 2026
VT: $0.00 (outpatient_hospital_opps), effective Jan 1, 2017

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

S1034 Art pancreas system