Outpatient Sleep Studies

Medicare covers facility-based polysomnography, MSLT, and properly supervised out-of-center sleep testing for diagnosed or suspected narcolepsy and obstructive sleep apnea when specified clinical criteria are met (AHI/RDI thresholds, documented symptoms, or high pretest probability) and when tests are performed/supervised by accredited centers and qualified physicians/technologists. Home/OCST testing is allowed only under defined circumstances (high pretest likelihood of moderate–severe OSA, absence of contraindicating comorbidities, or inability to undergo in-lab testing) and must record airflow, respiratory effort, and oximetry; several specific indications (e.g., chronic insomnia, routine screening, certain preoperative evaluations) and patient groups (e.g., significant cardiopulmonary or neuromuscular comorbidity) are excluded from coverage.

"Narcolepsy: facility-based overnight polysomnography followed by a facility-based MSLT is covered to confirm narcolepsy, including assessment of nighttime sleep, first REM latency, MSLT, and presen..."