Medicare Benefits Schedule - Item 12203

Overnight diagnostic assessment of sleep, for at least 8 hours, for a patient aged 18 years or more, to confirm diagnosis of a sleep disorder, if:

(a) either:

(i) the patient has been referred by a medical practitioner to a qualified adult sleep medicine practitioner or a consultant respiratory physician who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnoea based on a STOP‑Bang score of 3 or more, an OSA50 score of 5 or more or a high risk score on the Berlin Questionnaire, and an Epworth Sleepiness Scale score of 8 or more; or

(ii) following professional attendance on the patient (either face‑to‑face or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, the qualified adult sleep medicine practitioner or consultant respiratory physician determines that assessment is necessary to confirm the diagnosis of a sleep disorder; and

(b) the overnight diagnostic assessment is performed to investigate:

(i) suspected obstructive sleep apnoea syndrome where the patient is assessed as not suitable for an unattended sleep study; or

(ii) suspected central sleep apnoea syndrome; or

(iii) suspected sleep hypoventilation syndrome; or

(iv) suspected sleep‑related breathing disorders in association with non‑respiratory co‑morbid conditions including heart failure, significant cardiac arrhythmias, neurological disease, acromegaly or hypothyroidism; or

(v) unexplained hypersomnolence which is not attributed to inadequate sleep hygiene or environmental factors; or

(vi) suspected parasomnia or seizure disorder where clinical diagnosis cannot be established on clinical features alone (including associated atypical features, vigilance behaviours or failure to respond to conventional therapy); or

(vii) suspected sleep related movement disorder, where the diagnosis of restless legs syndrome is not evident on clinical assessment; and

(c) a sleep technician is in continuous attendance under the supervision of a qualified adult sleep medicine practitioner; and

(d) there is continuous monitoring and recording, performed in accordance with current professional guidelines, of the following measures:

(i) airflow;

(ii) continuous EMG;

(iii) anterior tibial EMG;

(iv) continuous ECG;

(v) continuous EEG;

(vi) EOG;

(vii) oxygen saturation;

(viii) respiratory movement (chest and abdomen);

(ix) position; and

(e) polygraphic records are:

(i) analysed (for assessment of sleep stage, arousals, respiratory events, cardiac abnormalities and limb movements) 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 preparation of a permanent report is provided by a qualified adult sleep medicine practitioner with personal direct review of raw data from the original recording of polygraphic data from the patient; and

(g) the overnight diagnostic assessment is not provided to the patient on the same occasion that a service described in any of items 11000, 11003, 11004, 11005, 11503, 11704, 11705, 11707, 11713, 11714, 11716, 11717, 11723, 11735 or 12250 is provided to the patient

Applicable only once in any 12 month period

Fee: $703.80 Benefit: 75% = $527.85 85% = $599.30

(See para DN.1.17 of explanatory notes to this Category)

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MBS Item	Service Type	Study Level 1	Applicable Guidelines 2
12203	Adult sleep study - attended	1	Australasian Sleep Association 2024 Guidelines for sleep studies in adults The American Academy of Sleep Medicine (AASM) Manual for the Scoring of Sleep and Associated Events: Rules, Terminology and Technical Specifications An Australasian Commentary on the AASM Manual for the Scoring of Sleep and Associated Events (2020)
12204
12205
12207
12208
12250	Adult sleep study - unattended	2

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 12203 to 12208 and 12250 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 of 1 July 2026, recognised sources of such guidance for adult sleep studies include:

• Australasian Sleep Association 2024 guidelines for sleep studies in adults, 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.

• An Australian Commentary on the AASM Manual for the Scoring of Sleep and Associated Events, available on the Australasian Sleep Association (ASA) website (sleep.org.au) under Resources – Position statements.

The permanent report issued on completion of an MBS-funded Level 1 or Level 2 adult 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 item 12250, which requires adherence to Level 2 standards.

Access pathways for items 12203 and 12250

Items 12203 and 12250 apply to patients who require a diagnostic sleep study. The items provide two access pathways, depending on how the need for the investigation is determined.

GP‑initiated pathway based on clinical screening tools

Pathway (a)(i) enables GP‑initiated access to diagnostic sleep studies while maintaining specialist oversight of eligibility. It is appropriate where validated screening questionnaires indicate that there is a high probability that a patient has symptomatic, moderate to severe obstructive sleep apnoea (OSA). In this case, a medical practitioner may refer a patient for a diagnostic sleep study without requiring clinical assessment by a sleep medicine specialist.

For this pathway:

• The initiating medical practitioner should administer screening questionnaires to the patient; and

• Provide the questionnaire responses and final scores to the sleep study provider.

Before the diagnostic sleep study can be undertaken, a qualified adult sleep medicine practitioner or a consultant respiratory physician must review the questionnaire results and determine that the patient meets the eligibility criteria specified in the item descriptor. This review and determination provide a threshold assessment of eligibility for a sleep study and do not constitute a specialist attendance, unless a separate consultation with the patient is arranged.

Pathway based on specialist clinical assessment of the patient

Under pathway (a)(ii), the need for a diagnostic sleep study is determined following a professional attendance (either face‑to‑face or by video conference) by a qualified adult sleep medicine practitioner or a consultant respiratory physician, where the practitioner determines, based on direct clinical assessment of the patient, that the investigation is necessary to confirm the diagnosis of a sleep disorder.

This professional attendance is not part of items 12203 or 12250, 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.

Clinical screening tools

For the purpose of items 12203 and 12250, a high probability of symptomatic, moderate to severe OSA is indicated by one of the following clinical screening tool outcomes:

An Epworth Sleepiness Scale score of 8 or more AND:

• A STOP-Bang score of 3 or more; OR

• An OSA50 score of 5 or more; OR

• A high-risk score on the Berlin Questionnaire.

The Epworth Sleepiness Scale and the STOP-Bang, OSA50 and Berlin questionnaires can be accessed at https://sleepcentral.org.au/Central/Contents/Questionnaires.aspx

Evidence of the screening questionnaires being administered to the patient in full, including their responses and test scores, must be included in the sleep study provider’s clinical record for the patient, as this documentation may be subject to audit.

If questionnaire scores do not meet the thresholds for direct access to a sleep study, the direct GP-initiated access pathway cannot be used for a Medicare funded study. If a Medicare-funded study is required, a specialist consultation should be arranged, as per pathway (a)(ii). For a referred attendance item to be billed, the GP would need to provide a referral to the specialist.

Direct referrals made without (or with incomplete) screening questionnaires (Items 12203 and 12250)

If a patient has been directly referred for a sleep study without the use of screening questionnaires, the questionnaires may be administered to the patient by the sleep study provider (e.g., by a sleep technician or other practice staff), and the results used by the qualified sleep medicine practitioner or consultant respiratory physician to determine eligibility for a Medicare-funded sleep study under pathway (a)(i).

Where screening questionnaires are provided with the referral but are incomplete (for example, where a threshold score was reached before all questions were answered), it is at the sleep study provider’s discretion whether they wish to contact the patient to obtain responses to the remaining questions. The sleep medicine practitioner or respiratory physician reviewing the results would still need to be satisfied that the threshold scores have been reached and the patient is eligible for a Medicare-funded sleep study.

Patient suitability for attended (Level 1) versus unattended (Level 2) sleep studies

For an MBS benefit to be paid, the service must be clinically relevant. Therefore, patients should receive the type of sleep study that will address the clinical question being asked, taking into account recognised contraindications for unattended sleep studies. The qualified adult sleep medicine practitioner or consultant respiratory physician who determines that the sleep study is necessary is also responsible for ensuring that the patient receives the most suitable study type (i.e., Level or Level 2).

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 12203 to 12208 and item 12250 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 polysomnography (PSG)), overnight monitoring and recording, 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.

Where an item descriptor assigns a function to a particular type of medical practitioner (such as a qualified sleep medicine practitioner or consultant respiratory physician), that function must be personally performed by a medical practitioner with the specified qualifications. The adult sleep study items allocate distinct medical practitioner functions across the service pathway, including determining the need for the investigation, 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. As above, these need not be the same individual for a given sleep study.

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.

Sleep study items 12203 to 12208 and 12250 may be billed only by qualified adult sleep medicine practitioners, 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 12203 to 12208 and item 12250 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 12203 to 12208 and item 12250 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 12203 to 12208 and item 12250 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, and overnight accommodation for attended 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 12203 to 12208 and item 12250 are not to be used for Multiple Sleep Latency Testing (MSLT) and Maintenance of Wakefulness Testing (MWT). Separate items for MSLT (12254) and MWT (12258) 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 12203 to 12208, or item 12250, 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 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: 12203 12204 12205 12207 12208 12250