Medicare Benefits Schedule - Item 12219

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)

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There are three ways benefits may be paid for professional services:

(a)              the claimant may pay the practitioner's account in full and then claim benefits from Services Australia by submitting the account and the receipt;

(b)              the claimant may submit the unpaid account to Services Australia who will then send a cheque in favour of the practitioner, to the claimant; or

(c)              the practitioner may direct-bill Medicare instead of the patient for the consultation. This is known as bulk billing.  If a practitioner direct-bills, they undertake to accept the relevant Medicare benefit as full payment for the consultation.  Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. 

Claiming of benefits

The patient, upon receipt of an practitioner's account, has two options open for paying the account and receiving benefits. 

Paid accounts

If the account has been paid in full a claimant can claim Medicare benefits in a number of ways:

• Electronically if the claimant's doctor offers this service and the claimant has completed and lodged bank account details with Medicare.
• Online through Medicare Online Services.
• At the claimant's local Services Australia Service Centre.
• By mail by sending a completed Medicare claim form (MS014) with the original accounts and/or receipts to:

Services Australia

Medicare

GPO Box 9822

In the claimant's capital city

• Over the phone by calling 132 011 and giving the claim details and then sending the accounts and/or receipts to:

Services Australia

Medicare

GPO Box 9822

In the claimant's capital city

Practitioners seeking information regarding registration to allow EFT payments and other E-Business transactions, can do so by viewing the Health Professionals section at Services Australia's website. 

Unpaid and partially paid accounts

Where the patient has not paid the account in full, the unpaid account may be presented to Medicare with a completed Medicare Claim form (MS014). In this case Medicare will forward to the claimant a benefit cheque made payable to the practitioner. 

It is the patient's responsibility to forward the cheque to the practitioner and make arrangements for payment of the balance of the account, if any. "Pay doctor" cheques involving Medicare benefits not be sent direct to practitioner, or to the claimant at an practitioner's address (even if requested by the claimant to do so). "Pay doctor" cheques are required to be forwarded to the claimant's last known address. 

When issuing a receipt to a patient for an account that is being paid wholly or in part by a Medicare "pay doctor" cheque the practitioner should indicate on the receipt that a "Medicare cheque for $..... was involved in the payment of the account". The receipt should also include any money paid by the claimant or patient. 

Itemised accounts

When a practitioner bills a patient for a service, the patient should be issued with a correctly itemised account and receipt to enable the patient to claim Medicare benefits.  Where both a consultation and another service occur these may be itemised on the same account. 

Medicare benefits are only payable in respect of professional services where it is recorded on the account setting out the fee for the service or on the receipt for the fee in respect of each service to each patient, the following information:

(a)              patient's name;

(b)              date on which the service(s) was rendered;

(c)              a description of the service(s) (e.g. "initial consultation," "subsequent consultation" or "contact lens consultation" and/or "computerised perimetry" in those cases where it is performed);

(d)              Medicare Benefits Schedule item number(s);

(e)              the name and practice address or name and provider number of the practitioner who actually rendered the service(s). Where the practitioner has more than one practice location, the provider number used should be that which is applicable to the practice location where the service(s) was given;

(f)               the fee charged for the service(s); and

(g)              the time each service began if the practitioner attended the patient on more than one occasion on the same day and on each occasion rendered a professional service relating to an MBS item, except where a perimetry item is performed in association with a consultation item, where times do not need to be specified. 

The practitioner billing for the service bears responsibility for the accuracy and completeness of the information included on accounts, receipts and assignment of benefits forms even where such information has been recorded by an employee of the practitioner. 

Payment of benefits could be delayed or disallowed if the account does not clearly identify the service as one which qualifies for Medicare benefits or that the practitioner is a registered practitioner practising at the address where the service was rendered. It is important to ensure that an appropriate description of the service, the item number and the practitioner's provider number are included on accounts, receipts and assignment of benefit forms. 

Details of any charges made other than for services, e.g. a dispensing charge, a charge for a domiciliary visit, should be shown separately either on the same account or on a separate account. 

Patients must be eligible to receive Medicare benefits and must also meet the clinical requirements outlined in the relevant item descriptors. 

Duplicate accounts

Only one original itemised account per service should be issued, except in circumstances where both a consultation and computerised perimetry occur, in which case these may be itemised on the same original account. Duplicates of accounts or receipts should be clearly marked "duplicate" and should be issued only where the original has been lost. Duplicates should not be issued as a routine system for "accounts rendered". 

Assignment of benefit (bulk billed) arrangements

Under the Health Insurance Act 1973 an Assignment of Benefit (bulk-billing) for professional services is available to all persons in Australia who are eligible for benefit under the Medicare program. This is not confined to pensioners or people in special need. 

If a practitioner bulk-bills, they undertake to accept the relevant Medicare benefit as full payment for the service. Additional charges for that service (irrespective of the purpose or title of the charge) cannot be raised against the patient. Under these arrangements:

• a patient’s assignment of benefit can be obtained before or after a service is rendered; it must be obtained by a provider before a claim is made;
• the assignment agreement must include the ‘data set’ as outlined in the Health Insurance Regulation 2018;
• the practitioner must cause the particulars relating to the professional service to be set out in the agreement before the patient signs the agreement, and if requested provide the patient with a copy of the completed agreement form as soon as practicable; and,
• the practitioner must retain a copy of the competed assignment agreement for up to 2 years following the making of a related claim.

Where a patient is unable to sign the form through either a wet or electronic signature:

• an assignor (for example a parent, partner, carer, relative, individual with power of attorney, or friend) may be requested to sign the agreement.
• should neither the patient nor an assignor provides a signature, the assignment of benefit agreement remains incomplete, and a bulk billed claim must not be submitted.

The administration of bulk billing arrangements under Medicare as well as the payment of Medicare benefits on patient claims is the responsibility of Services Australia and any enquiries in regard to these matters should therefore be directed to Services Australia.

For pathology, the patient ‘pre-assigns’ their benefits at the time of consultation/request is made, but the date of service for pathology is reported as the date of the specimen collection or, where multiple samples are taken for a single Medicare-billed test, the date of the first specimen collection.

Use of Medicare cards in bulk-billing

An eligible person who applies to enrol for Medicare benefits will be issued with a uniquely numbered Medicare card which shows the Medicare card number, the patient identification number (reference number), the applicant's first given name, initial of second given name, surname and an effective "valid to" date. These cards may be issued on an individual or family basis. Up to 5 persons may be listed on the one Medicare card, and up to 9 persons may be listed under the one Medicare card number. 

The Medicare card number must be quoted on bulk bill agreements. If the number is not available, then assignment of benefit arrangements should not be used. To do so would incur a risk that the patient is not eligible and Medicare benefits not payable.

Where a patient presents without a Medicare card and indicates they have been issued with a card but do not know the details, the patients may present a digital copy of their Medicare card from their Medicare app, providing they have a myGov account and have linked to Medicare from this account. The practitioner may also contact Services Australia to obtain the number. 

Assignment of benefit forms

From 1 July 2026, the assignment of benefit approved form (for example DB4e or DB020) will no longer be required.

Instead, assignment agreements must include the required ‘data set’ as specified in the Health Insurance Regulations 2018, ensuring patients are adequately informed when making decisions.

Services Australia has downloadable assignment agreement templates available on its website for pre and post assignment agreements for different medical specialities.  These are available for use where practitioners do not wish to create their own agreement based on the Regulations or use agreements generated by medical software.

Time limits applicable to lodgement of bulk bill claims for assigned benefits

Claims for bulk billed services rendered may be paid if the claim is made up to 1 year from the date of service. For services rendered prior to 5 September 2025, this timeframe is up to 2 years from the date of service.

Provision exists whereby in certain circumstances (e.g. hardship cases), the Minister may waive the time limits. More information is available on the Services Australia website.

Related Items: 12218 12219

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