Does Medicare Cover Sleep Studies?

Medicare covers sleep studies when the test is ordered by your doctor to diagnose certain conditions, including sleep apnea, narcolepsy and parasomnia. Sleep studies can take place at a sleep clinic or in your home. Medicare Part B covers 80% of the cost for sleep studies.

Rachel Christian, writer and researcher for RetireGuide
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    Rachel Christian

    Rachel Christian

    Financial Writer and Certified Educator in Personal Finance

    Rachel Christian is a writer and researcher for RetireGuide. She covers annuities, Medicare, life insurance and other important retirement topics. Rachel is a member of the Association for Financial Counseling & Planning Education.

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    Lee Williams, senior editor for RetireGuide.com

    Lee Williams

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    Lee Williams is a professional writer, editor and content strategist with 10 years of professional experience working for global and nationally recognized brands. He has contributed to Forbes, The Huffington Post, SUCCESS Magazine, AskMen.com, Electric Literature and The Wall Street Journal. His career also includes ghostwriting for Fortune 500 CEOs and published authors.

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    Aflak Chowdhury

    Aflak Chowdhury

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    Aflak Chowdhury is a Medicare expert and independent insurance broker specializing in group health insurance. He has worked for major providers including Humana and Principal Financial Group and today works mainly in the small group market.

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  • Published: June 16, 2021
  • Updated: May 8, 2023
  • 6 min read time
  • This page features 9 Cited Research Articles
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APA Christian, R. (2023, May 8). Does Medicare Cover Sleep Studies? RetireGuide.com. Retrieved June 2, 2023, from https://www.retireguide.com/medicare/services/sleep-study/

MLA Christian, Rachel. "Does Medicare Cover Sleep Studies?" RetireGuide.com, 8 May 2023, https://www.retireguide.com/medicare/services/sleep-study/.

Chicago Christian, Rachel. "Does Medicare Cover Sleep Studies?" RetireGuide.com. Last modified May 8, 2023. https://www.retireguide.com/medicare/services/sleep-study/.

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Sleep Study Coverage at a Glance
Medicare PlanSleep Study Coverage
Part A (Inpatient)N/A
Part B (Outpatient)Covers 80% — after your deductible — of the cost of sleep studies and CPAP machine if diagnosed with an appropriate sleep condition. You are responsible for the deductible and 20% of costs.
Part C (Medicare Advantage)Coverage mirrors Part B, but plans may offer additional benefits.
Part D (Prescription Drugs)N/A
Supplemental InsuranceCan help cover out-of-pocket sleep studies and durable medical equipment costs.

Medicare Sleep Study Guidelines

Medicare covers sleep tests and studies when they are ordered by your doctor.

Sleep studies are considered diagnostic services covered by Medicare only if you have symptoms of certain conditions.

Qualifying Conditions for Medicare Sleep Study Coverage
  • Sleep apnea
  • Narcolepsy
  • Parasomnia, including sleepwalking, night terrors and rapid eye movement (REM) sleep behavior disorders

Your sleep study can take place at a sleep disorder clinic or a clinic affiliated with a hospital or overseen by a physician.

Polysomnography is the medical term for a sleep study. Polysomnography records your brain waves, heart rate and breathing, as well as the oxygen level in your blood and eye and leg movements during sleep.

Medicare does not cover sleep studies used to diagnose patients with chronic insomnia.

Sleep Studies for Diagnosing Obstructive Sleep Apnea (OSA)

Sleep studies are often required to formally diagnose patients with sleep apnea.

You must undergo a face-to-face evaluation with your doctor prior to your sleep study. Your obstructive sleep apnea symptoms must be documented in your medical record before your doctor writes an order or referral for a sleep study.

Four Types of Sleep Studies Covered by Medicare
Type I
This type of attended sleep study is covered by Medicare when it is performed at a facility with the oversight of a sleep technologist to aid the diagnosis of obstructive sleep apnea. Type I, which is typically performed in a facility, is considered the reference standard for diagnosing obstructive sleep apnea.
Type II
Type II is a home sleep test performed using a portable monitor with a minimum of seven channels. Medicare covers Type II testing to diagnose obstructive sleep apnea whether it is performed attended or unattended by a sleep technologist.
Type III
Type III is a home sleep test performed using a portable monitor with a minimum of four channels. Medicare covers Type III testing to diagnose obstructive sleep apnea whether it is performed attended or unattended by a sleep technologist.
Type IV
Type IV uses at-home sleep study devices that measure, at a minimum, three channels: airflow, heart rate and oxygen saturation. Medicare covers Type IV testing to diagnose obstructive sleep apnea whether it is performed attended or unattended by a sleep technologist.

Your Cost for a Sleep Study Under Medicare

Sleep studies are considered diagnostic tests and must be ordered by your doctor to qualify for Medicare coverage.

Sleep studies are covered by Medicare Part B. You will owe 20% of the Medicare-approved cost of the study, and the Part B deductible applies.

You may owe less if you have supplement insurance, such as Medicaid or a Medigap policy.

If you’re enrolled in a Medicare Advantage plan, you may be restricted to sleep centers and clinics within your plan’s provider network.

Medicare Coverage for Treating Sleep Apnea

Medicare covers the diagnosis and treatment of obstructive sleep apnea when certain criteria are met.

Sleep apnea is a serious medical condition in which a patient stops breathing during sleep. It is often underdiagnosed.

The prevalence of sleep apnea increases with age. Up to 10% of people aged 65 and older have the condition.

Complications associated with sleep apnea include:
  • Excessive daytime sleepiness
  • Concentration difficulty
  • Coronary artery disease
  • Stroke

A continuous positive airway pressure, or CPAP, machine, is the treatment of choice for obstructive sleep apnea.

Medicare Part B partially covers the cost of a CPAP machine as durable medical equipment.

In order to receive a CPAP machine through Medicare, you must first undergo a sleep study.

After the sleep study, your primary care doctor will review the results with you during a follow-up appointment.

Your doctor will use the data gathered to determine a formal diagnosis and discuss any treatment or further evaluations you may need.

Other Criteria to Receive a CPAP Machine through Medicare
  • The CPAP must be ordered by your doctor.
  • Your doctor must teach you or your caregiver how to use the machine before you receive it.
  • Your obstructive sleep apnea diagnosis must include a clinical evaluation of a sleep study performed in a sleep laboratory or an unattended home sleep test with a Type II, Type III or Type IV home sleep monitoring device.

Medicare initially limits coverage of a CPAP machine to a 12-week rental period during which your doctor assesses any improvement in your conditions as a result of using the machine.

Surgery is another treatment option for sleep apnea. Your doctor may recommend surgery if using a CPAP machine proves ineffective in treating your condition.

When you meet specific criteria, Medicare Part A should cover the surgery.

Medicare should cover several types of sleep apnea surgeries, including:
  • Uvulopalatopharyngoplasty
  • Mandibular maxillary osteotomy advancement
  • Genioglossus advancement with or without hyoid suspension

If your sleep apnea is caused by abnormalities in your upper airway — such as enlarged tonsils or an enlarged tongue — Medicare will cover surgery to fix these abnormalities. The surgery must be deemed medically necessary and supported by documentation in your medical record for you to qualify for coverage.

Medicare does not cover laser-assisted uvuloplatoplasty surgery.

Medicare Sleep Study Coverage FAQs

Will Medicare cover another test if you couldn't fall asleep during their required sleep test?
Medicare Part B covers sleep studies when ordered by your doctor or to diagnose certain sleep related conditions. It will only cover Type I tests in a sleep lab facility, but it will also cover home studies in some cases. This may be an option for people who can’t sleep in unfamiliar settings.
How old can a sleep study be for Medicare?
Medicare requires that a sleep study be no more than 12 months old for coverage. Other insurance may allow two to three years, and some may allow studies as old as five years.
Does Medicare pay for sleep apnea devices?
Medicare Part B will cover a three-month trial period of CPAP therapy, including devices and accessories, once you have been diagnosed with obstructive sleep apnea. Medicare may continue coverage afterwards if you meet with your doctor in person and your doctor documents in your medical record that the CPAP treatment is helping you. After you meet your Part B deductible, Medicare will pay 80% of the cost.
Last Modified: May 8, 2023

9 Cited Research Articles

  1. United Healthcare. (2022, February 15). Sleep Apnea: Diagnosis and Treatment. Retrieved from https://www.uhcprovider.com/content/dam/provider/docs/public/policies/medadv-coverage-sum/sleep-apnea-diagnosis-treatment.pdf
  2. Centers for Medicare & Medicaid Services. (2022, September). Polysomnography (Sleep Studies). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/medicare-provider-compliance-tips/medicare-provider-compliance-tips.html#Sleep
  3. Mayo Clinic. (2020, December 1). Polysomnography (sleep study). Retrieved from https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877
  4. Florida Dental Sleep Disorders. (2019, October 16). Do I Need a Doctor’s Referral to Undergo a Sleep Test? Retrieved from https://bocaratondentalsleepmedicine.com/blog/2019/10/do-i-need-referral-sleep-testing-vero-beach/
  5. Centers for Medicare & Medicaid Services. (2019). Provider Compliance Tips for Polysomnography (Sleep Studies). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceTipsforPolysomnography-MLN4013531Print-Friendly.pdf
  6. Centers for Medicare & Medicaid Services. (n.d). Decision Memo for SLEEP TESTING for Obstructive SLEEP Apnea (OSA) (CAG-00405N). Retrieved from https://www.cms.gov/medicare-coverage-database/view/ncacal-decision-memo.aspx?proposed=N&NCAId=227&ver
  7. Cleveland Medical Devices. (n.d.). Type I, Type II, Type III Sleep Monitors, CMS AASM Guidelines. Retrieved from https://clevemed.com/cms-aasm-guidelines-for-sleep-monitors-type-i-type-ii-type-iii/
  8. Medicare.gov. (n.d.). Sleep studies. Retrieved from https://www.medicare.gov/coverage/sleep-studies
  9. National Government Services, Inc. (n.d.). LCD for Polysomnography and Sleep Studies (L26428). Retrieved from https://aasm.org/resources/pdf/ngspoly.pdf