Sleep studies
Medicare Coverage Information
Overview
Medicare provides coverage for medically necessary sleep studies to diagnose potential sleep disorders like sleep apnea. These diagnostic tests are typically covered when ordered by a physician to evaluate specific health concerns.
- Medicare covers diagnostic sleep studies prescribed by a doctor
- Studies must be deemed medically necessary to diagnose a specific condition
- Typically covered under Part B as an outpatient diagnostic test
- Requires a referral from a healthcare provider
- May require pre-authorization from Medicare
- Medicare Part B beneficiaries
- Patients with documented sleep-related medical concerns
- Individuals with physician referrals for diagnostic testing
- Beneficiaries typically pay 20% of the Medicare-approved cost after meeting the Part B deductible
- Diagnostic sleep studies are usually covered at 80% by Medicare
- Additional costs may apply for facility or professional interpretation fees
- Must be ordered by a qualified healthcare provider
- Limited to medically necessary diagnostic testing
- May require documentation of medical necessity
- Not covered for routine screening without specific symptoms
- Consult with your primary care physician about sleep study needs
- Verify medical necessity with your healthcare provider
- Check with Medicare or your Medicare Advantage plan about specific coverage details
- Obtain a referral from a qualified healthcare professional
Last updated: 6/15/2025
Quick Information
- Provider
- Medicare
- Last Updated
- 6/15/2025
- Topics
- Medicare sleep studiessleep disorder testingMedicare diagnostic coveragesleep apnea diagnosisMedicare medical testing
Related Coverage Topics
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