Polysomnography and Other Sleep Studies

Medicare covers polysomnography and other sleep studies when performed in accredited, physician-directed sleep clinics for patients with clinical signs or symptoms of covered sleep disorders (notably obstructive sleep apnea and narcolepsy) and when documentation supports medical necessity. Coverage specifies device-type requirements (Type I–IV and home sleep testing limitations), physician/technician credentials, split-night and CPAP titration criteria (including AHI/RDI thresholds and event counts), prohibitions for specific indications (e.g., chronic insomnia, certain comorbidities), and requirements for repeat testing and re-qualification after PAP therapy failure.

"Diagnostic sleep testing is covered when performed in a clinic affiliated with a hospital or under the direction and control of physicians."

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