Does Medicare Cover a Sleep Study?

Key Takeaways

• Original Medicare (Part B) and Medicare Advantage (Part C) both cover sleep studies that a doctor or sleep specialist has deemed medically necessary.
• Medicare covers initial sleep studies used to diagnose a sleep disorder, like sleep apnea, and follow-up sleep studies to evaluate how well treatment is working.
• An in-lab sleep study can also help diagnose narcolepsy and other sleep disorders, but some people who suspect they have obstructive sleep apnea can opt for a less expensive home sleep test to receive their diagnosis.
• A sleep study or test confirming obstructive sleep apnea is required for a CPAP therapy prescription.

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Does Medicare Cover a Sleep Study?

Medicare Part B, which is Original Medicare's medical insurance, covers sleep studies for people who are suspected of having a sleep disorder like sleep apnea. Medicare Advantage, or Medicare Part C, also covers sleep studies, though coverage varies depending on plana and whether the sleep lab and specialist are in network. Some Medicare Advantage plans require prior authorization before a sleep study is approved. 

Medicare coverage for a sleep study begins after you've met your annual deductible. Once this deductible has been met, Medicare covers 80% of sleep study costs and the policy-holder is responsible for the remaining 20% of the cost.

Sleep studies fall into different categories, and Medicare covers Type I, II, III, and IV sleep tests. Types I tests are strictly in-lab sleep studies or polysomnographies, while types II, III, and IV are portable studies that may be conducted in a lab or at home. 

Considered the gold standard, Type I sleep studies track the most sleep metrics, including brain waves, eye movements, and airflow. A sleep technician monitors these tests. Home sleep studies measure fewer parameters and do not require technician supervision. Home sleep studies work best for people who are thought to have obstructive sleep apnea rather than another disorder. 

What Conditions Are Covered?

Medicare covers sleep studies when they are considered medically necessary to diagnose a specific condition. Medicare may cover a sleep study when a person is suspected of having one of the following disorders:

• Obstructive sleep apnea
• Narcolepsy
• Impotence
• Parasomnias, such as sleepwalking, night terrors, and REM sleep behavior disorder

Medicare may also approve sleep studies for evaluation of periodic limb movement disorder, circadian rhythm disorders, or unexplained excessive daytime sleepiness when other causes have been ruled out.

Does Medicare Cover a Sleep Study at Home?

Medicare covers a home sleep apnea test when a person is suspected of having sleep apnea and their doctor or sleep specialist deems the test medically necessary. Home sleep apnea testing is often much less expensive than an in-lab sleep study, with typical costs in the hundreds of dollars rather than thousands.

Sleep Doctor offers an at-home sleep study for less than $200. This test is mailed to you and disposable, so after you use it for one night, you don't need to mail anything back. After the test, your data automatically uploads and is reviewed by a board-certified physician. If the study reveals that you have sleep apnea, Sleep Doctor can get you set up with an appropriate treatment plan, including CPAP therapy and oral appliances. Sleep Doctor can provide documentation to help with reimbursement, but you'll need to check your Medicare plan details to see if you qualify.

How Often Will Medicare Pay for a Sleep Study?

Medicare does not set a strict limit on how often you may receive a covered sleep study. Medicare typically covers an initial sleep study for diagnosis and may also cover a follow-up sleep study ordered by a sleep specialist.

Follow-up sleep studies can determine how well sleep apnea treatment is working and help with making adjustments to CPAP machine settings. Some Medicare Advantage plans allow repeat testing only every one to two years unless medical necessity is documented.

Do Sleep Studies Expire for Medicare?

Sleep studies do not “expire.” However, if you want Medicare to cover your CPAP therapy, you may need to begin therapy within a certain timeframe, such as 12 months after the test results have been recorded. This timeframe may differ from health insurance provider policies, which sometimes allow longer gaps. 

Medicare Sleep Study Requirements

To receive coverage, you must meet the following Medicare sleep study requirements:

• Experience clinical symptoms that suggest you have an eligible disorder like sleep apnea or narcolepsy
• Have a doctor or sleep specialist refer you for a sleep study that they deem medically necessary for you to either receive a diagnosis or maintain treatment for a disorder
• Undergo a Type I, II, III, or IV sleep test, either in a lab or at home, based on what your doctor or sleep specialist recommends
• Stay up-to-date on your monthly premium payments, pay your yearly deductible, and pay the 20% of the sleep study cost that Medicare doesn't cover
• Obtain the sleep study from a doctor, hospital, or provider that takes the type of Medicare you have, whether that's Original Medicare (Part B) or Medicare Advantage (Part C)