Changes to Medicare for Home Sleep Study Testing

There are new changes to Medicare from November 1, 2018, which will affect how GPs can order sleep studies and how they follow up the results. These changes have been introduced by the MBS Review Taskforce and Government to improve doctor assessment and management of a patient having a sleep study.

What are the new Medicare changes?

From November 1 2018:

  • GPs will need to administer screening questionnaires before directly ordering a Medicare rebatable sleep study.
  • Only if these screening questionnaires are positive, can GPs refer directly for a Medicare rebatable sleep study test.
  • The screening questionnaires restrict testing to patients with a “high probability for symptomatic, moderate to severe obstructive sleep apnoea”.
  • Following sleep study testing, “the results and treatment options following any diagnostic sleep study should be discussed during a professional attendance with a medical practitioner before the initiation of any therapy”.

If the screening questionnaires are not positive, patients will need to be referred to Sleep or Respiratory Physicians for assessment and testing.

Diagnostic sleep studies can only be rebated once a year.

Why were the changes made?

 The MBS Review Taskforce noted a very large growth in sleep study testing, especially home sleep study testing, and were concerned that better access to testing has been associated with less appropriate referrals for testing.

The Taskforce noted a lack of Sleep or Respiratory Physician review of patients for advice regarding the diagnosis and treatment ...

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