Does Medicare Cover Sleep Studies?

Mike Olmos by Mike Olmos | Licensed since 2010
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This article was updated on: 10/16/2017

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If you have sleep-related disorders such as sleep apnea or daytime tiredness, your doctor may recommend a sleep study to diagnose your condition. If you are enrolled in Original Medicare (Part A and Part B) and have clinical signs of obstructive sleep apnea, you may be covered for certain sleep studies your doctor believes are medically necessary.

Different types of sleep studies

Depending on the type of sleep disorder you have, your doctor may order one or more of the following sleep study types:

  • Polysomnogram (PSG). Also known as a Type I study, this sleep study takes place in a certified lab and is most often used to diagnose sleep apnea, a condition that causes pauses in your breathing many times during the night. During a PSG, you are connected to monitors that measure your brain activity, eye movement, amount of oxygen in the blood, blood pressure, and heart rate while you sleep. If the study shows evidence of sleep apnea, you may be connected to a continuous positive airway pressure (CPAP) machine to see if it improves your sleep patterns.
  • Multiple sleep latency test (MSLT). This test usually occurs the day after a polysomnogram and it measures how sleepy you are and whether you fall asleep during the test and what types and stages of sleep you’re having.
  • Maintenance of wakefulness test (MWT). Also often performed the day after a PSG, this test helps doctors see if you have trouble staying awake during the day and if your sleepiness is a potential safety concern.
  • Home sleep test (HST)This is typically a simple test you do at home yourself. During the test, you are connected to a portable monitor while you sleep in your bed at night. The monitor measures many of the same things as the PSG (such as heart rate or blood oxygen level) and is only appropriate in certain situations. You will pick up the monitor and return it to a sleep lab for interpretation; the home sleep study can help diagnose sleep apnea. There are several different types of HST tests. A Type II device measures seven different channels, including your heart rate, air flow, and oxygen levels; a Type III device measures four different channels; and a Type IV device measures three channels.
  • Actigraphy. During this test, you wear a device similar to a wrist watch that measures your sleep and nap schedule throughout the day, as well as ambient conditions, such as whether the lights are on or off while you sleep. The test may last several days depending on what sleep condition your doctor suspects.

Medicare coverage of sleep studies

Medicare Part B covers certain medically necessary sleep study tests if your doctor believes you have obstructive sleep apnea and you have clinical signs and symptoms for this condition; you pay 20% of Medicare-approved charges plus any applicable Part B deductible. Medicare covers the PSG test (Type I) test only if it is performed in a certified sleep lab facility. It may also cover certain types of home sleep study monitors (Type II, Type III, and Type IV) if you have clinical signs and symptoms of obstructive sleep apnea. If you’re diagnosed with obstructive sleep apnea, Medicare may also cover a three-month trial for CPAP therapy (including CPAP equipment and accessories) to determine how well you are responding to treatment for sleep apnea with a CPAP machine.

Because the Medicare coverage requirements are quite specific, it’s important to talk to your health-care provider about the test being ordered and whether the sleep study lab accepts Medicare assignment to determine your costs for any sleep studies he or she recommends.

Do you have more questions about Medicare coverage for sleep studies at home or in a sleep lab? I’m available to discuss Medicare plan options with you at your convenience; you can learn more about me by clicking the “View profile” button below. If you prefer, you can schedule a phone call or request an email by clicking one of the links below. To view plans in your area you may qualify for, click the Compare Plans button. For immediate answers to your questions, call me or one of our licensed insurance agents at 1-844-847-2660 (TTY users can call 711), Monday through Friday, 8AM to 8PM ET.

 For more information on sleep studies:

National Heart, Lung, and Blood Institute. “Types of Sleep Studies,” last updated March 29, 2012, https://www.nhlbi.nih.gov/health/health-topics/topics/slpst

 

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