Is home sleep testing covered by Medicare?

Yes. Medicare covers home sleep apnea testing under HCPCS G0398 when ordered by a treating physician for an appropriate indication. Standard Medicare deductible and 20% coinsurance apply. Medicare Advantage plans usually cover it but may require prior authorization.

Does Medi-Cal cover home sleep testing?

Yes. Medi-Cal — including managed care plans like LA Care, Anthem Medi-Cal, and Inland Empire Health Plan — covers home sleep testing when ordered by a participating physician. Coverage rules vary slightly by managed care plan; we verify before shipping.

What's the typical out-of-pocket cost?

On commercial plans after deductible, copays usually run $20 to $80. Medicare beneficiaries pay 20% coinsurance after the Part B deductible. For self-pay, the rate is typically $150 to $400 depending on the device and provider. We give you a written cost estimate before we ship anything.

Can I appeal a denial?

Yes. Medicare and commercial plans both have appeals processes. The most common reason for an initial denial is missing prior authorization or insufficient clinical documentation from the ordering physician. Appeals that include a letter of medical necessity — listing your symptoms and risk factors — succeed roughly two-thirds of the time.

How to Check Your Insurance Coverage for a Home Sleep Test

Quick answer: Yes, home sleep apnea testing is covered by Medicare, Medi-Cal, and nearly every major commercial plan in California when your doctor orders it. The relevant codes are CPT 95800, 95801, or HCPCS G0398 (Medicare). Out-of-pocket cost depends on your deductible, copay, and whether prior authorization is required. Call your member services line with the CPT code in hand for a fast verification.

Coverage isn't really the question, almost every California plan covers home sleep testing when there's a physician order on file. The question is what you'll actually pay, which depends on where you are in your deductible, your copay structure, whether the lab is in-network, and whether the plan needs prior authorization first. This walkthrough is everything you need to verify your coverage in one phone call before scheduling.

Is home sleep testing covered by insurance?

Yes, in nearly every case. Medicare covers it under HCPCS G0398. Major commercial carriers (Anthem Blue Cross, Blue Shield of California, Aetna, Cigna, UnitedHealthcare, Kaiser external referrals, and most regional plans) cover it under CPT 95800 or 95801. Medi-Cal covers it through the Medi-Cal managed care plans or fee-for-service. Coverage isn't the variable, what you pay is.

What CPT codes do you need to know?

Asking your insurer about specific codes gets you faster, more accurate answers than asking generally about "sleep tests." Three codes cover almost everything:

CPT 95800, unattended sleep test recording oxygen, heart rate, and airflow. Used for type III home sleep tests including ApneaLink and most WatchPAT configurations. This is the most common billing code.
CPT 95801, unattended sleep test, minimum recording (oxygen saturation, heart rate). Used for simpler home tests including some Night Owl configurations.
HCPCS G0398, Medicare-specific code for type II home sleep test. Medicare beneficiaries should ask about this rather than 95800 or 95801.

How do you verify your coverage in one call?

Call the member services number on the back of your insurance card. Before you dial, have these ready: member ID, group number, the CPT code that applies (95800, 95801, or G0398), and the diagnosis code your physician used (G47.33 for obstructive sleep apnea is the most common one).

Step 1: Call member services on the back of your card.
Step 2: Open with: "I'm calling to verify coverage for a home sleep apnea test, CPT code 95800. My doctor has ordered the test."
Step 3: Run through the questions in the next section.
Step 4: Note the representative's name and the call reference number — useful if anything gets disputed later.

What questions should you ask?

The five surface every potential gotcha:

Is CPT 95800 (or G0398 for Medicare) a covered service under my plan?
What's my remaining deductible for the year, and does this test apply to it?
What's my copay or coinsurance for this code after the deductible is met?
Is prior authorization required, and if so, who initiates it — me or my physician?
Is Advanced Sleep Medicine Services (NPI on request) in network with my plan?

What if you don't have insurance?

Self-pay rates for home sleep testing run $150 to $400, substantially less than in-lab polysomnography (which can clear $2,000). Many providers offer payment plans. Worth checking: California's Medi-Cal expansion accepts new applicants mid-year, and the CalHEERS portal will tell you in about five minutes whether you qualify based on income and household size.

What insurance surprises catch patients off guard?

Three issues come up over and over in our intake calls:

Prior authorization denials. Some plans (especially Medicare Advantage and a handful of HMOs) require prior auth. Your physician's office handles the submission, but it adds 5 to 10 business days to the timeline. Always ask whether prior auth is required so you can plan accordingly.
Out-of-network billing. If the testing provider is out of network, you may pay more or face an outright denial. Always ask whether the provider is in network before scheduling, and get the answer in writing.
Deductible reset. If your test crosses a plan year (December into January), the second year applies against a fresh deductible. For elective testing, scheduling early in the plan year, after your deductible has been met by other care, saves real money.

Advanced Sleep Medicine Services is in network with more than 100 California insurance plans. Our intake team verifies your specific coverage and out-of-pocket cost before we ship a device, so there are no billing surprises after the fact. Call (877) 775-3377 to talk to intake.

How to Check Your Coverage for a Home Sleep Test