Clarification on the billing of home-based sleep studies

From 1 October 2008, qualified sleep medicine practitioners were able to bill new interim MBS item 12250 for overnight sleep apnoea studies conducted in patients’ homes. In conjunction with the listing of item 12250, from 1 October 2008, the Health Insurance (General Medical Services Table) Regulations 2008 were amended to prohibit the billing of home-based sleep studies under any other category 2 MBS item, by any practitioner.

Page last updated: 16 December 2008

Interim item 12250 will remain listed on the MBS during the course of the Medical Services Advisory Committee’s (MSAC’s) evaluation of the safety, clinical effectiveness and cost-effectiveness of home-based sleep studies. If MSAC advises the Minister for Health and Ageing that public funding for home-based sleep studies should be supported, the Department of Health and Ageing will consult the profession to inform a subsequent Government decision in relation to the permanent listing of an MBS item (or items) for home-based sleep studies.

Under interim item 12250, the patient must be referred for the service by a medical practitioner and a qualified sleep medicine practitioner must determine the necessity for the investigation prior to home-based sleep studies being conducted. Generally, it is expected that the necessity for the service will be determined by the qualified sleep medicine practitioner attending the patient for a consultation prior to the service being initiated. If it is impractical for a patient to do so, the referring doctor must liaise with the sleep specialist and both practitioners should retain evidence of the way in which the necessity for the service was determined. The sleep medicine practitioner must establish quality assurance procedures for the data acquisition, and must personally analyse the findings, prepare the report and bill the item. It is expected that any clinical decision in relation to the need for treatment, informed by the results of the home-based sleep study, will be undertaken in the context of a face-to-face consultation between the patient and the qualified sleep medicine practitioner.

Please keep an eye on the latest news or subscribe to receive free email updates about changes to MBS Online.