Sleep Study

Sleep studies in a facility or sleep study center are a covered benefit when medically necessary for the following conditions: narcolepsy, obstructive sleep apnea (OSA), impotence or parasomnias (abnormal sleep behavior, such as bruxism, sleepwalking, enuresis, and seizure disorder evaluations related to sleep disturbances). Services must be at an authorized facility or sleep study center.  

For active duty service members only, see also Maintenance of Wakefulness Testing.

Sleep studies in the home are a covered benefit when performed for OSAS. Sleep studies in the home are also covered when a diagnosis of OSAS has been established, therapy has begun and response to treatment is being evaluated if all of the following requirements are met:

• The study is ordered by a provider.
  
• The patient has significant symptoms of OSAS.
• No sleep disorders other than OSAS are suspected.
• No significant conditions exist that could impact the accuracy of the study (for example, moderate pulmonary disease, neuromuscular disease, congestive heart failure).
• Use of an FDA-approved Type II or Type III portable monitoring device has been validated for home environment (Type IV is not covered).
• The study is reviewed and interpreted by a physician board-eligible/board-certified in sleep medicine.

To expedite the review process, providers may attach a Letter of Attestation in lieu of clinical documentation to the authorization request. 

Cost Information