Does Medicare Cover Sleep Studies?

Sleep studies are a necessary tool for diagnosing sleep related breathing and neurologic disorders, including obstructive sleep apnea (OSA) Trusted Source National Heart, Lung, and Blood Institute (NHLBI) The NHLBI is the nation's leader in the prevention and treatment of heart, lung, blood and sleep disorders. View Source . There are four types of sleep tests that record enough sleep and health data to accurately diagnose sleep apnea. People who suspect that they may have sleep apnea or another sleep disorder may be able to get their sleep study partially covered with a qualifying Medicare plan. 

This guide explains which sleep studies Medicare covers, expected costs, and the steps required for approval.

Does Medicare Cover a Sleep Study?

Medicare covers sleep studies when symptoms suggest sleep disordered breathing, such as obstructive sleep apnea, narcolepsy, parasomnia, or impotence.

If you qualify for a Medicare-covered sleep study, you’ll pay 20% of the Medicare-approved amount after you reach your Part B deductible Trusted Source Medicare.gov Medicare.gov provides essential information about signing up for and using Medicare, which is health insurance for people 65 or older. View Source . Medicare will then pay the remaining 80%. Medicare recognizes four types of sleep studies for sleep apnea diagnosis.

• Type I: A Type I test, or polysomnography, is the most comprehensive kind of sleep test. This in-person sleep test measures the most amount of data, like brain waves, respiratory effort and airflow, and blood oxygen levels. Medicare only covers Type 1 tests if they’re done in a sleep lab. 

• Type II: This is an at-home test that measures seven or more variables. Because they require advanced monitoring equipment, Type II tests can be hard to set up and complete at home. 

• Type III: Type III tests are at-home tests that measure and record four or more data points that can help diagnose sleep apnea. Unlike Type I and Type II tests, they don’t measure brain activity.

• Type IV: A Type IV sleep test is the most basic test. It’s an at-home, wearable device that measures three or more variables and records enough data to diagnose sleep apnea.

What Conditions Are Covered?

Medicare covers sleep study costs when people show clinical symptoms of specific disorders Trusted Source Medicare Coverage Database View Source . 

• Obstructive sleep apnea
• Narcolepsy
• Parasomnia
• Impotence

Coverage can depend on symptom driven evaluation and physician documentation. Medicare does not cover sleep testing for insomnia, actigraphy, circadian rhythm disorders, chronic lung disease, or restless leg syndrome.

Does Medicare Cover a Sleep Study at Home?

Medicare can cover costs of at-home sleep studies: Type II, Type III, Type IV. Most at-home sleep studies are Types III and IV, which are portable devices that are easy to operate without the help of a technician or physician. 

You’ll be responsible for 20% of the Medicare-approved amount of the at-home study after meeting your Part B deductible. Many at-home sleep studies are affordable, especially compared to a traditional, in-person polysomnography.

While in-person sleep studies are still the highest standard for sleep apnea diagnostics, researchers think the simplicity and convenience of at-home tests may make it easier for people with sleep apnea to get diagnosed Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . 

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How Often Will Medicare Pay for a Sleep Study?

There isn’t a strict number of sleep studies that Medicare will pay for. Instead, Medicare will help cover sleep study costs as often as it is medically necessary documented by your provider. Initially, Medicare covers a diagnostic sleep study for suspected sleep apnea, narcolepsy, impotence, or parasomnia. Medicare may also cover follow-up sleep studies if you need to adjust continuous positive airway treatment (CPAP) therapy, see a specialist, or record more data.

Do Sleep Studies Expire for Medicare?

Sleep studies do not expire, but you may not be able to get CPAP therapy coverage with a sleep study that was done more than one year prior. To get Medicare coverage for sleep apnea, you should start treatment within 12 months of your last sleep study. 

If you’re diagnosed with OSA after taking your sleep test, you should familiarize yourself with Medicare’s specific guidelines for CPAP insurance coverage. You may be required to undergo further sleep studies to get your CPAP prescription fine tuned.

Medicare Sleep Study Requirements

In order to qualify for sleep study coverage, Medicare requires that you follow certain steps.

1. Schedule an appointment with a physician or provider after experiencing symptoms related to sleep apnea, narcolepsy, parasomnia, or impotence. 
2. Obtain an order for sleep testing
3. Successfully complete a Type I, Type II, Type III, or Type IV sleep study. Use a company or provider that’s covered by your Medicare Part B or Medicare Advantage (Part C) plan. 
4. Pay your Part B deductible as well as 20% of the study cost. Medicare Part B will cover the remaining 80% of the study cost once you’ve met your deductible.
5. Stay current with your premium and deductible payments.

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