For TRICARE to cover a sleep study, you must be referred to a sleep disorder center by an attending physician and the need for diagnostic testing must be confirmed by medical evidence.
Diagnostic sleep studies are covered as an outpatient visit and only for the following conditions:
- Narcolepsy (If the patient has had documented episodes of cataplexy, diagnostic testing for narcolepsy would not be necessary and would not be covered.)
- Obstructive Sleep Apnea Syndrome
- Abnormal Sleep Behavior (i.e. bruxism, sleepwalking, enuresis, and seizure disorder evaluations when the distinction between seizure activity and other forms of sleep disturbances is uncertain)
TRICARE covers home/portable sleep studies as an alternative to in-facility studies for the diagnosis of obstructive sleep apnea in an adult when certain criteria are met. Check with your regional contractor for details.
TRICARE doesn't cover:
- Electrosleep Therapy
- Study, Grant, or Research Programs
- Studies for patients whose complaint is of short duration or who do not experience functional disability during the day
- Duplicative diagnostic testing
- Diagnostic testing for any of the following conditions:
- Drug dependency
- Hypersomnia (pathologically excessive sleep)
- Night terrors or dream anxiety attacks
- Nocturnal myoclonus (muscle jerks)
- Restless leg syndrome
- Shift work and schedule disturbances
- Migraine headaches
- Somnoplasty System for obstructive sleep apnea
- Testing for patients who have had documented episodes of cataplexy
This list of covered services is not all inclusive. TRICARE covers services that are medically necessaryTo be medically necessary means it is appropriate, reasonable, and adequate for your condition. and considered proven. There are special rules or limits on certain services, and some services are excluded.
Last Updated 3/20/2022