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Does TRICARE cover sleep studies?
Verified by TRICARE.com Editorial Team
Updated 2024-12-01
AI-assisted (gemini)
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.
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