Polysomnography and Other Sleep Studies

Medicare covers attended facility-based (Type I) polysomnography and unattended/attended Type II–IV sleep tests for diagnosis of obstructive sleep apnea when beneficiaries have clinical signs or symptoms indicative of OSA, with home sleep testing limited to patients with a high pretest probability of moderate-to-severe OSA and no excluded comorbidities. Narcolepsy testing (overnight PSG plus MSLT), split-night CPAP titration (when AHI/RDI and event thresholds and titration-duration criteria are met), and follow-up PSG to evaluate therapy response are covered under specified clinical and documentation requirements; multiple or repeat studies generally require persuasive medical justification and specific documentation/credentialing. Non-covered indications include polysomnography for chronic insomnia, many circadian and primary insomnia-related diagnoses, certain parasomnia and seizure scenarios, duplicative testing, and home testing for patients with significant cardiopulmonary or neuromuscular comorbidities or for disorders other than OSA.