From the 1st November 2018, Medicare are rolling out changes to item codes 12250 (Home Based Sleep Study) and 12203 (Laboratory Based Sleep Study).
New rules apply to refer patients suspected of sleep apnea for either a diagnostic home or laboratory-based sleep study, with the requirement of two diagnostic assessment tools to accompany the referral. The patient must satisfy the criteria outlined below, before the referral can be accepted:
As stated in the MBS guidelines for November 2018: “The patient must be referred by a medical practitioner to a qualified sleep medicine practitioner who has determined that the patient has a high probability for symptomatic, moderate to severe obstructive sleep apnea based on the Epworth Sleepiness Scale of 8 or more and a STOP BANG score of 4 or more.”
What does it mean for General Practitioners and their patients?
General Practitioners can refer eligible patients for a diagnostic Home Based (unattended) or Laboratory Based Sleep Study for obstructive sleep apnea when an approved assessment tool has been used.
To be eligible for a Medicare subsidised sleep study, GP's must now screen patients for symptomatic, moderate to severe obstructive sleep apnea using approved screening tools, along with the referral. The following criteria must be met.
Either one of:
Non-eligible patients now require either:
GP's can also continue to refer eligible patients with suspected sleep disorders to qualified adult sleep medicine practitioners and consultant respiratory physicians for further investigation.
Unfortunately GP's can no longer direct refer for a titration or reassessment study. These patients must be seen by a Sleep Physician in consultation first.
Air Liquide Healthcare offers a comprehensive range of diagnostic and treatment options. If in doubt about patient eligibility, fax through the patient referral form and Air Liquide Healthcare will triage the patient and carry out further investigation.
New referral pads which include the three screening tools are now available. Editable PDF and Electronic format (RTF) versions of the referral form are also available to download.