Medicare Benefits Schedule - Note DN.1.37

MBS Item	Service Type	Study Level 1	Applicable Guidelines 2
12210	Diagnostic sleep study (0-11 years) - attended	1	Australasian Sleep Association clinical practice guidelines for performing sleep studies in children (2017) The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications
12213	Diagnostic sleep study (12-17 years) – attended
12215	Further investigation (0-11 years) - attended
12217	Further investigation (12-17 years) - attended
12218	Diagnostic or further investigation (3-11 years) - unattended	2
12219	Diagnostic or further investigation (12-17 years) - unattended

¹ Currently there are no MBS items available for Level 3 or Level 4 sleep studies.
² As of 1 July 2026.

Current Professional Guidelines

Items 12210 to 12219 require the continuous monitoring and recording of all listed parameters in accordance with current professional guidelines in force at the time the service is provided. Practitioners must refer to the most recent professional guidance issued by relevant professional bodies, including guidance that amends, replaces or supersedes earlier publications.

As at 1 July 2026, recognised sources of such guidance for paediatric sleep studies include:

• Australasian Sleep Association clinical practice guidelines for performing sleep studies in children (2017), available on the ASA website (sleep.org.au) under Resources – Position statements.

• The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications. Refer to the section on Sleep Staging Rules.

The permanent report issued on completion of an MBS-funded Level 1 or Level 2 paediatric sleep study should include, as applicable, the technical parameters, indices and findings specified in the current professional guidelines for the relevant study type.

Note: Home Sleep Apnoea Test (HSAT) requirements in the cited guidance are insufficient to satisfy the requirements of items 12218 and 12219, which require adherence to Level 2 standards.

Access pathways for paediatric sleep study items

For all paediatric sleep study items:

• The patient must be referred by a medical practitioner; and

• The need for the investigation must be determined by an appropriately qualified sleep medicine practitioner before the study is undertaken.

For unattended (Level 2) sleep study items 12218 and 12219, the qualified sleep medicine practitioner must make this determination following a professional attendance on the patient (either face‑to‑face or by video conference). For attended (Level 1) sleep study items 12210 to 12217, the determination must still be made prior to the study, and reflects the requirement for specialist oversight in paediatric sleep medicine. Unlike the adult sleep study items, there is no direct access pathway for paediatric sleep studies based on use of clinical screening tools in primary care.

The referral need not specify whether a Level 1 or Level 2 sleep study is to be performed, as the qualified sleep medicine practitioner determines the appropriate study type. As specified in items 12218 and 12219, the practitioner may only determine that a patient is suitable for a Level 2 sleep study (i.e. that an out‑of‑laboratory setting is appropriate) following a professional attendance on the patient.

Children aged 0-11 years must be assessed by a qualified paediatric sleep medicine practitioner, while adolescents aged 12-17 years may be assessed by either a paediatric or adult sleep medicine practitioner. When a professional attendance is undertaken, that attendance is not part of items 12210 to 12219, and a separate attendance item (e.g., item 110/91824 or 116/91825) may be payable, subject to the usual rules for the attendance item.

Use of unattended (Level 2) sleep studies (Items 12218 and 12219)

Medicare-funded Level 2 sleep studies may only be undertaken for reasons that align with the purposes specified in the item descriptor. A repeat investigation to assess treatment effectiveness refers to a test that is clinically relevant due to concerns about residual disease following treatment initiation. Repeat studies are not intended for routine monitoring in the absence of such clinical indications. To support appropriate use of items 12218 and 12219, the purpose of the investigation must be documented.

Equipment set‑up and overnight monitoring for unattended sleep studies (Items 12218 and 12219)

For paediatric unattended (Level 2) sleep study items, polysomnography (PSG) equipment may be applied to the patient in a range of settings prior to the overnight investigation, provided the requirements of the relevant item descriptor are met. Supported models of care include, but are not limited to:

• the patient attends a sleep clinic (or other appropriate facility) for equipment application by a sleep technician and then returns home for the overnight investigation; or

• a sleep technician attends the patient’s home or other accommodation to apply the equipment; or

• a parent or caregiver applies the equipment at home with telehealth support from a sleep technician.

In‑person equipment set‑up by a sleep technician is preferable. However, telehealth‑supported set‑up is available to all patients regardless of geographic location, and use of this option does not require justification. Where telehealth is used, a sleep technician must provide continuous support throughout the set‑up process, to ensure electrodes and other PSG equipment are correctly applied.

Videoconferencing is expected to be the default mode for telehealth support. Telephone may be used to supplement videoconferencing in geographic locations where video communication is difficult to establish or maintain.

Where used, telehealth support forms part of the sleep study service, and a separate attendance item may not be billed.

Meaning of ‘at least 8 hours’

The requirement ‘for at least 8 hours’ means the overnight investigation (including patient set-up time and actual period of recording) must be of at least 8 hours duration. Providers must keep evidence of the duration of the overnight investigation (including set-up time and period of recording) as part of their records for Medicare-funded sleep studies.

Treatment options following a diagnostic sleep study

The results and treatment options following any diagnostic sleep study should be discussed during a professional attendance with a medical practitioner before any therapy commences. If there is uncertainty about the significance of diagnostic sleep study results or appropriate management of the patient, then referral to a sleep medicine practitioner or consultant respiratory physician is recommended. This professional attendance is not part of the sleep study and may be billed separately.

Who can provide the service

MBS items 12210 to 12219 are designed to support delivery of sleep studies using established sleep laboratory and home‑based models of care.

Technical components of the investigation (such as applying the equipment for PSG or providing telehealth support to parents/caregivers, providing telehealth support during overnight monitoring, and technical analysis and scoring of data) may be performed by appropriately trained personnel, where permitted by the item descriptor. Where parts of the service are performed by a person other than a medical practitioner, this must occur under the supervision of a medical practitioner and in accordance with accepted medical practice. For MBS item 12218, the supervising medical practitioner must be a qualified paediatric sleep medicine practitioner, and for MBS item 12219, either a qualified paediatric or adult sleep medicine practitioner.

Where an item descriptor assigns a function to a particular type of medical practitioner (such as a qualified paediatric or adult sleep medicine practitioner), that function must be personally performed by a medical practitioner with the specified qualifications. The paediatric sleep study items allocate distinct medical practitioner functions across the service pathway, including determining the need for the investigation and whether an out-of-laboratory setting is appropriate, clinical supervision of the investigation, and interpretation of the recorded data and preparation of the permanent report. These functions need not be performed by the same individual; however, each function must be performed by a medical practitioner of the specified type(s).

For Medicare benefits to be payable, medical practitioners must be physically located in Australia when performing any component of the service assigned to them under the relevant item descriptor. Where a medical practitioner provides clinical supervision of the investigation, that practitioner must be in Australia during the period of the overnight sleep study. Where a medical practitioner interprets the recorded data and prepares the permanent report, they must be in Australia at the time the interpretation and report are prepared.

Billing and record keeping for compliance purposes

Providers are responsible for ensuring Medicare services claimed using their provider number meet all legislative requirements. All Medicare claiming is subject to compliance checks and providers may be required to submit evidence about the services they bill. For sleep studies, this would include a full copy of the PSG record, including the raw data, and the permanent report issued on completion of the sleep study. This report should include all of the requirements specified in the relevant clinical guidelines for the sleep study level being billed. Providers should also retain records that demonstrate when practitioner-assigned components of the service were performed, including the date the permanent report was prepared. More information about the department’s compliance program can be found on its website at Medicare compliance.

MBS items 12210, 12215 and 12218 may be billed only by a qualified paediatric adult sleep medicine practitioner, and items 12213, 12217 and 12219 by either an adult or paediatric sleep medicine practitioner, as specified in the item descriptor. Other medical practitioners are not eligible to bill these items.

The date of service for the purposes of items 12210 to 12219 is deemed to be the day of the morning the overnight investigation is completed.

Note that sleep studies that fail for technical reasons, such as unacceptable signal loss, and cannot meet the item descriptor in full are not eligible for Medicare reimbursement. Billing for the service should therefore only occur once all of the requirements of the item have been fulfilled, including data interpretation and preparation of a permanent report.

Items 12210 to 12219 do not support a figurehead billing arrangement. Figurehead or ‘headline’ billing is where one practitioner’s provider number is used to bill patients for the services provided by other practitioners.

While individual components of the sleep study do not need to be performed by the same qualified sleep medicine practitioner, the qualified sleep medicine practitioner who prepared the report on the results of the investigation should bill the relevant item. This reflects that the reporting practitioner is in a position to verify that the service has been completed to professional standards, matches the item being billed, and all elements of the item descriptor have been met.

Benefits are not payable for items 12210 to 12219 where the interpretation and preparation of a permanent report is provided by a technician or other supervised staff, or generated solely by artificial intelligence, rather than by a qualified sleep medicine practitioner.

Sleep studies may be billed privately or bulk billed. Where a medical practitioner chooses to bulk bill for an overnight sleep study, the practitioner undertakes to accept the relevant Medicare benefit as full payment for the service, and additional charges cannot be raised. These include, but are not limited to, booking (or other) fees to be paid prior to the service, any consumables required to perform the service, overnight accommodation for attended sleep studies, professional services during equipment set up (either in person or via telehealth) and overnight monitoring, and return shipping of PSG equipment for unattended sleep studies (see explanatory note GN.7.17 – Billing Procedures). Patients must not be charged separately by the billing practitioner, or any other person or entity involved in providing the service, for any component of a service for which the Medicare payment has been accepted as full payment (bulk billed).

Co-claiming restrictions

Only one sleep study item can be claimed in respect of a sleep study service. Where more than one item could potentially apply, the item claimed should be the one that best describes the service provided.

Overnight sleep study items in the range 12210 to 12219 are not to be used for Multiple Sleep Latency Testing (MSLT) and Maintenance of Wakefulness Testing (MWT). Separate items for MSLT and MWT in the range 12261 to 12272 provide for an overnight sleep study followed by relevant daytime investigations.

Polygraphic and other physiological data obtained as part of a sleep study item in the range 12210 to 12219 cannot be used for the purpose of claiming any of the following items:

• Group D1, Subgroup 1 – Neurology: 11000 to 11005.
• Group D1, Subgroup 4 – Respiratory: 11503.
• Group D1, Subgroup 6 - Cardiovascular: 11704 to 11717, 11723 and 11735.

Where the date of service for a sleep study item is the same as, or the day following the date of service of any items 11000 to 11005, 11503, 11704 to 11717, 11723 or 11735, for a benefit to be payable, there must be written notification on the account confirming that the service under any of those items was not part of the sleep study.

Related Items: 12210 12213 12215 12217 12218 12219

• Previous - Note DN.1.36
• Next - Note DR.1.1

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

For each particular patient—applicable only in relation to the first 3 investigations to which this item or item 12218 applies in any 12 month period

Fee: $840.10 Benefit: 75% = $630.10 85% = $735.60

(See para DN.1.37 of explanatory notes to this Category)

Overnight paediatric investigation, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

For each particular patient—applicable only in relation to the first 3 investigations to which this item or item 12210, 12218 or 12219 applies in any 12 month period

Fee: $756.80 Benefit: 75% = $567.60 85% = $652.30

(See para DN.1.37 of explanatory notes to this Category)

Overnight paediatric investigation, for at least 8 hours, for a patient less than 12 years of age, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified paediatric sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified paediatric sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified paediatric sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period in which item 12210 or 12218 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which item 12210 or 12218 applied for the patient, and further titration of respiratory support is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which item 12210 or 12218 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided

Fee: $840.10 Benefit: 75% = $630.10 85% = $735.60

(See para DN.1.37 of explanatory notes to this Category)

Overnight paediatric investigation, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner; and

(b) the necessity for the investigation is determined by a qualified sleep medicine practitioner before the investigation; and

(c) there is continuous monitoring of oxygen saturation and breathing using a multi‑channel polygraph, and recordings of the following are made, in accordance with current professional guidelines:

(i) airflow;

(ii) continuous EMG;

(iii) ECG;

(iv) EEG (with a minimum of 4 EEG leads or, in selected investigations, a minimum of 6 EEG leads);

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory movement of rib and abdomen (whether movement of rib is recorded separately from, or together with, movement of abdomen);

(viii) measurement of carbon dioxide (either end‑tidal or transcutaneous); and

(d) a sleep technician, or registered nurse with sleep technology training, is in continuous attendance under the supervision of a qualified sleep medicine practitioner; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, and maturation of sleep indices, arousals, respiratory events and assessment of clinically significant alterations in heart rate and body movement) with manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(f) interpretation and report are provided by a qualified sleep medicine practitioner based on reviewing the direct original recording of polygraphic data from the patient; and

(g) a further investigation is indicated in the same 12 month period in which item 12210, 12213, 12218 or 12219 applies to a service for the patient, for a patient using Continuous Positive Airway Pressure (CPAP) or non‑invasive or invasive ventilation, or supplemental oxygen, in either or both of the following circumstances:

(i) there is ongoing hypoxia or hypoventilation on the third study to which any of items 12210, 12213, 12218 and 12219 applied for the patient, and further titration is needed to optimise therapy;

(ii) there is clear and significant change in clinical status (for example lung function or functional status) or an intervening treatment that may affect ventilation in the period since the third study to which any of items 12210, 12213, 12218 and 12219 applied for the patient, and repeat study is therefore required to determine the need for or the adequacy of respiratory support; and

(h) the investigation is not provided to the patient on the same occasion that a service to which item 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723 or 11735 applies is provided to the patient

Applicable once in the 12 month period that starts when the first of the 3 studies mentioned in subparagraph (g)(i) or (ii) is provided

Fee: $756.80 Benefit: 75% = $567.60 85% = $652.30

(See para DN.1.37 of explanatory notes to this Category)

Overnight investigation of sleep, for at least 8 hours, for a patient aged at least 3 years but less than 12 years, if:

(a) the patient is referred by a medical practitioner to a qualified paediatric sleep medicine practitioner; and

(b) following professional attendance on the patient (either face-to-face or by video conference), the qualified paediatric sleep medicine practitioner determines that:

(i) the investigation is necessary for a purpose mentioned in paragraph (c); and

(ii) an unattended sleep study is appropriate for the investigation; and

(c) the purpose of the investigation is documented and is any of the following:

(i) to confirm diagnosis of sleep apnoea;

(ii) as a repeat investigation to assess treatment effectiveness;

(iii) as a repeat investigation to determine respiratory support needs following a significant change in clinical status; and

(d) during a period of sleep, there is continuous monitoring and recording of at least the following measures:

(i) airflow;

(ii) EMG;

(iii) ECG or heart rate;

(iv) EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(e) the investigation is provided:

(i) under the supervision of a qualified paediatric sleep medicine practitioner; and

(ii) in accordance with current professional guidelines (including in relation to interpreting polygraphic data and preparing a report); and

(f) before the investigation commences, a parent or caregiver of the patient is given:

(i) written or video instructions on how to monitor the patient overnight; and

(ii) a way of contacting a sleep technician to enable trouble shooting overnight; and

(g) the equipment is applied to the patient by:

(i) a sleep technician; or

(ii) the parent or caregiver of the patient if:

(A) before the set-up process commences, the parent or caregiver is given written or video instructions for how to apply the equipment; and

(B) there is continuous telehealth support from a sleep technician throughout the set-up process; and

(C) the use of telehealth is documented; and

(h) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) using manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(i) interpretation and preparation of a permanent report are provided by a qualified paediatric sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient

Applicable in relation to the first 3 investigations to which this item or item 12210 applies in any 12 month period

Fee: $489.90 Benefit: 85% = $416.45

(See para AN.0.12, DN.1.37 of explanatory notes to this Category)

Overnight investigation of sleep, for at least 8 hours, for a patient aged at least 12 years but less than 18 years, if:

(a) the patient is referred by a medical practitioner to a qualified sleep medicine practitioner; and

(b) following professional attendance on the patient (either face-to-face or by video conference), the qualified sleep medicine practitioner determines that:

(i) the investigation is necessary for a purpose mentioned in paragraph (c); and

(ii) an unattended sleep study is appropriate for the investigation; and

(c) the purpose of the investigation is documented and is any of the following:

(i) to confirm diagnosis of sleep apnoea;

(ii) as a repeat investigation to assess treatment effectiveness;

(iii) as a repeat investigation to determine respiratory support needs following a significant change in clinical status; and

(d) during a period of sleep, there is continuous monitoring and recording of at least the following measures:

(i) airflow;

(ii) EMG;

(iii) ECG or heart rate;

(iv) EEG;

(v) EOG;

(vi) oxygen saturation;

(vii) respiratory effort; and

(e) the investigation is provided:

(i) under the supervision of a qualified sleep medicine practitioner; and

(ii) in accordance with current professional guidelines (including in relation to interpreting polygraphic data and preparing a report); and

(f) before the investigation commences, a parent or caregiver of the patient is given:

(i) written or video instructions on how to monitor the patient overnight; and

(ii) a way of contacting a sleep technician to enable trouble shooting overnight; and

(g) the equipment is applied to the patient by:

(i) a sleep technician; or

(ii) the parent or caregiver of the patient if:

(A) before the set-up process commences, the parent or caregiver is given written or video instructions for how to apply the equipment; and

(B) there is continuous telehealth support from a sleep technician throughout the set-up process; and

(C) the use of telehealth is documented; and

(h) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events and cardiac abnormalities) using manual scoring, or manual correction of computerised scoring in epochs of not more than 1 minute; and

(ii) stored for interpretation and preparation of a report; and

(i) interpretation and preparation of a permanent report are provided by a qualified sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient

Applicable in relation to the first 3 investigations to which this item or item 12210, 12213 or 12218 applies in any 12 month period

Fee: $455.25 Benefit: 85% = $387.00

(See para AN.0.12, DN.1.37 of explanatory notes to this Category)