Facility Based Sleep Studies - Medicare Advantage

Policy covers facility‑based polysomnography (attended sleep studies; CPT 95807, 95808, 95810, 95811) to record physiologic signals and perform sleep staging for evaluation/diagnosis of sleep disorders and assessment of therapy response (e.g., suspected obstructive sleep apnea, snoring, choking/gasping during sleep, CPAP titration, and other sleep disorders such as narcolepsy/parasomnias). Coverage is limited to services that meet Medicare medical necessity and the applicable CMS NCD/LCD/LCA and MAC jurisdictional criteria (studies must be technologist‑attended, CPT 95810/95811 are age ≥6 per code descriptors, and Humana applies LCD L36902 in jurisdictions without an LCD); services not meeting those criteria are not payable.

"Facility-based sleep study requests (both Part A and Part B services) are governed by and payable only when consistent with the applicable Medicare Administrative Contractor's (MAC's) Local Coverag..."