Medicare Requirements for Sleep Studies

For people with sleep disorders getting a "good eight hours" is a dream. Sleep disorders include insomnia, snoring, restless legs syndrome, periodic limb movement, narcolepsy and obstructive sleep apnea. Medicare will pay for some sleep study tests and related equipment such as a continuous positive airway pressure test, but requirements vary from state to state.

Home Test

• After a full clinical evaluation determining that you are at risk for obstructive sleep apnea, a medical doctor may order a home sleep test. Medicare expanded its coverage of home sleep tests in March 2008. However, restrictions apply. The test must be requested by a medical doctor and carried out by an accredited member of the American Academy of Sleep Medicine.

Overnight Sleep Test

• An overnight test is conducted at a sleep disorders center by a qualified AASM professional. The overnight test can detect obstructive sleep apnea and other disorders that a home test might miss because tests at disorders centers use at least 12 channels of information.

Continuous Positive Airway Pressure Device

• If supported by a facility-based sleep study, you may be eligible to purchase a CPAP device from a supplier enrolled in the Medicare system. If, however, the supplier is not enrolled in Medicare and does not have a Medicare supplier number, you may end up with the entire bill, including the Medicare share. Medicare in Alabama, for example, will pay 80 percent of the price for a CPAP if the patient temporarily stops breathing (obstructive sleep apnea) while asleep.

Costs

• As of 2010, newchoicehealth.com estimates that costs for a sleep test range from $2,325 to $4,500. CPAPs can vary in price from $150 to $5,000. If you want Medicare to cover the costs, be sure to check the requirements in your state before booking a sleep test. For more information about sleep studies and coverage, call 1-800-MEDICARE (1-800-633-4227).