TRICARE Coverage for Sleep Disorders & Sleep Apnea
Overview
TRICARE covers diagnosis and treatment of sleep disorders including obstructive sleep apnea, insomnia, and other sleep-related conditions. This includes sleep studies, CPAP machines and supplies, oral appliances, and specialist consultations.
Treatment Options Covered by TRICARE
- In-lab sleep study (polysomnography)
- Home sleep apnea testing
- CPAP machine and supplies
- BiPAP machine
- Oral/dental appliance therapy
- Sleep specialist consultation
- Cognitive behavioral therapy for insomnia (CBT-I)
- Surgical options (UPPP, inspire implant)
- Weight management for sleep apnea
How TRICARE Covers Sleep Disorders & Sleep Apnea
TRICARE covers medically necessary sleep disorder diagnosis and treatment. This includes both in-lab and home sleep studies, CPAP/BiPAP equipment and ongoing supplies, oral appliances, and surgical interventions when conservative treatments fail. CPAP supplies (masks, tubing, filters) are covered on a replacement schedule.
Coverage by Plan
TRICARE Prime
Sleep study and CPAP covered with referral and authorization. Equipment at $0 through MTF or authorized DME supplier.
TRICARE Select
Standard cost shares apply. Sleep study and equipment subject to outpatient/DME cost shares. No referral needed.
TRICARE For Life
Medicare covers sleep studies and CPAP with standard cost shares (20%). TFL covers remaining 80%. CPAP supplies covered on replacement schedule.
Estimated Costs
| Scenario | Estimated Cost |
|---|---|
| In-lab sleep study (Prime ADFM) | $0 with referral |
| Home sleep test (Prime ADFM) | $0 with referral |
| CPAP machine (Prime ADFM) | $0 with authorization |
| CPAP supplies (quarterly, Prime) | $0 |
| Sleep study (Select ADFM, network) | Standard outpatient cost share |
Authorization Requirements
In-lab sleep studies require prior authorization. Home sleep tests may or may not require authorization depending on regional contractor. CPAP and BiPAP equipment require authorization. Ongoing supplies follow a replacement schedule.
Network & Provider Notes
Sleep medicine specialists and accredited sleep labs are available in the TRICARE network. Some MTFs have sleep medicine clinics. Home sleep testing is increasingly available and preferred for straightforward sleep apnea cases.