A bulk billed sleep study: who qualifies.

The rules

For an adult home sleep study (Medicare item 12250), all of these need to be true. The medical history form checks them for you.

• You're 18 or over.
• You have a green Medicare card or a blue interim card. Reciprocal health care cards aren't eligible.
• You haven't had a Medicare-funded home sleep study in the last 12 months.
• Your Epworth Sleepiness Scale score is 8 or more, plus a STOP-BANG score of 3 or more, an OSA50 score of 5 or more, or a high risk result on the Berlin questionnaire.
• You have a GP referral: upload your own, or opt in to our in-house GP referral service ($20).

The screening questionnaires

Medicare uses a few short questionnaires to decide whether a home study is the right test. They're part of the form, so you don't need to do them first.

Epworth Sleepiness Scale

How likely you are to doze off in eight everyday situations, like reading or sitting in traffic.

STOP-BANG

Snoring, tiredness, whether anyone has seen you stop breathing, blood pressure, BMI, age, neck size and gender.

OSA50

Waist size, snoring, stopped breathing and age.

Berlin questionnaire

Snoring, daytime tiredness, and blood pressure or BMI, scored as high or low risk.

You need an Epworth score of 8 or more, plus a STOP-BANG score of 3 or more, an OSA50 score of 5 or more, or a high risk result on the Berlin questionnaire.

The GP referral

A GP referral is what gets your study bulk billed. Upload your GP referral with the form, or opt in to organise one via our in-house GP referral service, for $20.

A dentist can recommend a study, and plenty of our patients come to us that way, but the referral for a Medicare study comes from a GP.

Your Medicare card

A green Medicare card, or a blue interim card, is eligible. Reciprocal health care cards (for visitors from countries with a reciprocal agreement) aren't eligible for a home sleep study.

You also can't have had a Medicare-funded home sleep study in the last 12 months.

Who is better tested in a sleep lab

The Australasian Sleep Association's guidelines for sleep studies in adults list people who may not suit a home study. They include:

1. People with a low chance of moderate to severe obstructive sleep apnoea.
2. People with symptoms of a condition other than sleep disordered breathing that needs more monitoring, such as parasomnias, narcolepsy, periodic limb movement disorder or nocturnal epilepsy.
3. People with any of these, where nocturnal hypoventilation or central sleep apnoea is likely: a neuromuscular disease; severe COPD or restrictive lung disease; low oxygen or high carbon dioxide at rest, or needing oxygen therapy; significant obesity or suspected obesity hypoventilation syndrome; significant heart disease, such as a recent hospital stay for a heart attack, unstable angina, heart failure or atrial fibrillation; chronic narcotic use.
4. People who can't do an overnight study without someone there, for example because of significant active psychiatric illness, cognitive problems or a physical limitation.

The form asks about these. If a lab study is the better test for you, we'll tell you. Read the guidelines (PDF).

If you don't qualify

You can still have a private study. Call us on (02) 8090 4358 for the fee. Under 18? See the sleep study for children and teens.