Polysomnography and Other Sleep Studies

Medically necessary polysomnography (Type I–IV) and home sleep testing are covered primarily to diagnose obstructive sleep apnea (OSA) when beneficiaries have clinical signs or symptoms indicative of OSA; Type I PSG is required for attended sleep-lab diagnosis and home testing is limited to patients with high pretest probability of moderate to severe OSA and without specified comorbidities. PSG plus MSLT is covered for narcolepsy when preceded by an overnight PSG; split-night studies and CPAP titration are covered when AHI/RDI thresholds and titration documentation (including >3 hours of CPAP and elimination of events) are met. Several uses are excluded, including polysomnography for chronic insomnia, many circadian disorders, certain parasomnias when uncomplicated, and home testing for patients with significant comorbidities or for non-OSA diagnoses.

"Type I attended facility-based polysomnography (PSG) is covered to aid diagnosis of obstructive sleep apnea (OSA) when the beneficiary has clinical signs or symptoms indicative of OSA and the study..."