Does TRICARE cover sleep studies?
Quick Answer
TRICARE covers sleep studies when medically necessary to diagnose conditions like sleep apnea. Home and facility-based studies are covered.
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Key Takeaways
- Covered when medically necessary
- Home and facility options
- CPAP covered if needed
- May need authorization
Detailed Answer
Sleep studies are covered for diagnostic purposes.
Covered Studies
- Polysomnography (facility)
- Home sleep testing
- MSLT (daytime sleepiness)
- Titration studies
When Covered
- Symptoms present
- Provider referral
- Medically necessary
- Diagnostic purpose
For Sleep Apnea
- Diagnostic study covered
- CPAP if diagnosed
- Follow-up care
- Equipment included
Cost
- Standard cost shares
- May need authorization
- Network preferred
- DME costs for equipment
Getting a Study
- Primary care referral
- Sleep specialist evaluation
- Prior authorization (some)
- Facility vs home options
Related Questions
What services require prior authorization?
Prior authorization is needed for many inpatient stays, some surgeries, specialty services, DME, and certain high-cost procedures regardless of plan.
How does TRICARE cover durable medical equipment (DME)?
TRICARE covers medically necessary durable medical equipment like wheelchairs, CPAP machines, and oxygen equipment with authorization.
What do most military families add to their TRICARE coverage?
Supplemental health insurance is the most common addition — it covers dental, vision, and out-of-pocket costs that TRICARE leaves uncovered. Life insurance and a legal will are also highly recommended.
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