Medicare AdvantageCoverageMedium impact
Facility Based Sleep Studies - Medicare Advantage (Revised)
Humana·Sleep Medicine, Pulmonology·Medicare Advantage
Effective date
Apr 1, 2026
We identified it
Jun 24, 2026
Summary
This is a revised policy for facility-based sleep studies under Medicare Advantage plans, updating coverage determinations and criteria for polysomnography services. The policy clarifies medical necessity requirements for sleep studies including OSA diagnosis, narcolepsy, and parasomnias, with specific jurisdiction-based LCD applications.
Action Required
Before April 1, 2026: Billing team must review and update sleep study billing procedures to align with revised medical necessity criteria for CPT codes 95807, 95808, 95810, and 95811. Ensure documentation meets jurisdiction-specific LCD requirements for Medicare Advantage plans. Verify MAC jurisdiction requirements based on practice location for proper coverage determination.