Does Medicare Cover a Sleep Study?

Do you need to get a sleep study?

In other articles we’ve written about Medicare coverage of CPAP machines and other sleep apnea treatments. In many cases, before you get one of those treatments, you need to get a sleep study.

Sleep studies are helpful in diagnosing someone with a sleep disorder. And, once you have a diagnosis, you can get a treatment plan to help you get a better night’s sleep.

There are actually four types of sleep studies. We will cover them later in this article.

But whatever type you need, a common question many people have is, “Does Medicare cover a Sleep Study?” In this article, we answer the question in clear, plain English. You will also find the average costs of a sleep study, as well as other helpful info.

Does Medicare Cover a Sleep Study?

The short answer is yes; Medicare will cover the cost of a sleep study. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met in order for Medicare to pay for your sleep study. Below we look at what these are so you know what to expect.

Original Medicare (Medicare Part A and Part B) provides coverage for the costs of a sleep study. Coverage for a sleep study falls under Medicare Part B.

However, for Medicare Part B to provide coverage for a sleep study, certain conditions have to be met. Those conditions consist of the following:

It must be deemed as medically necessary
Your healthcare provider orders it

Sleep studies can be used to diagnose and treat sleep disorders such as obstructive sleep apnea (OSA).

In the past, Medicare Part B only covered a sleep study if it takes place in a Medicare-approved sleep lab facility. But now, they may also cover a home-based sleep study.

Home-based sleep studies are more convenient, and the results of a home-based sleep study can lead to a diagnosis when it is combined with a visit to your doctor.

Medicare Part B provides coverage for all four types of sleep studies and the necessary treatments, procedures, services, and equipment/supplies that you may need after you are diagnosed with a sleep disorder. Part B will cover 80% of the cost of a sleep study.

Medicare Advantage plans (Medicare Part C) also provide coverage for a sleep study. They cover everything Original Medicare covers as well as some additional benefits. However, out-of-pocket costs will vary depending on the specifics of your plan.

How Much Does A Sleep Study Cost?

The average cost of an in-center sleep study may range between $500 to $3,000. On the other hand, out-center or in-home sleep testing (HST) prices may range between $300 to $600.

What Are The Four Types Of Sleep Studies?

Type 1 – Type 1 sleep studies are done at a sleep lab facility and require an overnight stay.
Type 2 – Type 2 sleep studies utilize seven different channels to regulate both the body and the brain function. This includes heart rate, oxygen levels, and breathing rate. Type 2 sleep studies can be done at home or in a sleep lab facility.
Type 3 – Type 3 sleep studies measure four different metrics: airflow, heart rate, oxygen levels, and respiratory effort. These studies can be done either in an in-center sleep lab facility or out-center.
Type 4 – Type 4 sleep studies utilize three or more channels to check the activity and rest cycle, oxygen saturation in the blood, artery tone, and more. Like the Type 3 sleep tests, it can be done in an in-center sleep lab facility or out-center.

Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.