Key takeaways

  • Medicare covers sleep tests when you show clinical signs and symptoms of specific disorders, including sleep apnea, narcolepsy, or parasomnia.
  • Medicare covers different types of sleep studies (Types I-IV) for obstructive sleep apnea when ordered by your primary doctor and done in a Medicare-approved facility.
  • Medicare also covers follow-up sleep studies to assess treatment effectiveness, evaluate changes needed after significant weight fluctuations, or address treatment failures.

Polysomnography, also known as a sleep study, is a test in which a doctor observes you while you’re sleeping. Doctors use this test to identify possible sleep disorders.

A doctor may perform different types of sleep studies, and Medicare covers any of them when used to diagnose sleep apnea. It may also provide coverage for some studies to screen for a few other sleep-related conditions.

Read on to learn about Medicare coverage for sleep studies, who’s eligible, and your anticipated cost.

Polysomnographies are divided into four types: I, II, III, and IV. Type I is the standard test in which you spend the night in a sleep clinic. The other types involve devices that you take home to perform the test yourself while you sleep in your own bed.

Medicare Part B covers any of these sleep studies to screen for obstructive sleep apnea when you have clinical signs and symptoms of the condition. You also have to meet the following criteria:

  • The sleep study is done in a clinic or hospital that accepts Medicare, if it is a type I test.
  • Your primary doctor refers you.
  • Medical evidence, such as lab results or records of physical exams, confirms that you need a sleep test.

Medicare may also cover a split-night study, in which you first sleep without a continuous positive airway pressure (CPAP) machine and then sleep with it for comparison.

Other conditions covered

In addition, Medicare may cover a type I sleep study for one of the following conditions:

Narcolepsy

Medicare will cover a narcolepsy sleep study with proof from the sleep clinic that the condition significantly affects your health and well-being. You may need up to three tests for diagnosis, and Medicare must approve each test before coverage.

Parasomnia

Medicare will cover a parasomnia sleep study if your doctor suspects seizures to be the underlying cause or if you’re experiencing violent episodes during sleep.

Coverage of follow-up testing

Medicare may pay for a follow-up sleep study under the following circumstances:

  • to assess the effectiveness of apnea treatment such as CPAP, oral appliances, or surgery
  • after significant weight loss to determine whether you still need a CPAP machine
  • after significant weight gain to see if your CPAP machine needs adjustment
  • if treatment doesn’t work or your symptoms return despite initial improvement with a CPAP machine

If you have Original Medicare (parts A and B), your coverage will happen through Part B. To get coverage, you have to meet your deductible of $257 in 2025. In addition, to keep your coverage, you need to pay your monthly premium of $185 in 2025.

Remember that lab studies tend to cost between $1,000 and $3,500, whereas at-home study kits are potentially more affordable at a few hundred dollars per test.

Once you meet your deductible, Part B will pay for 80% of the cost of your sleep study. If you have Medicare Advantage (Part C) instead of Original Medicare, you should get the same coverage, but your premium and deductible will depend on the plan you select.

Medicare doesn’t cover sleep studies related to insomnia or actigraphy during a sleep study. Actigraphy is a test that measures movement to identify periods of wakefulness and sleep.

Other situations in which Medicare won’t cover a sleep study are:

  • for an evaluation before laser surgery for snoring, unless sleep apnea is suspected
  • for diagnosing chronic lung disease
  • if you have an uncomplicated sleep disorder where the diagnosis is clear
  • if you have epilepsy but no complaints related to a sleep disorder
  • if you have symptoms of periodic limb movement disorder or restless leg syndrome, unless they are suspected to be connected to a covered indication
  • for diagnosing circadian rhythm sleep disorders

Medicare will cover sleep tests if you show clinical signs and symptoms of specific disorders: sleep apnea, narcolepsy, or parasomnia.

However, what type of sleep study you can get covered depends on the diagnosis that you’re seeking. For sleep apnea, you can get both a lab study or a home study covered. For narcolepsy and parasomnia, you can only get a lab test covered under certain conditions. Other sleep disorders don’t qualify for sleep study coverage with Medicare.