Medicare has introduced two new items that allow eligible children and teenagers to undergo unattended sleep studies, effective July 1, 2026. General practitioners (GPs) can now refer young patients for Medicare-funded assessments that may lead to overnight sleep studies conducted outside of a laboratory.
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The new items focus on Level 2 polysomnography for medically uncomplicated young individuals investigating sleep-disordered breathing who do not require overnight professional supervision. This change is expected to save families a night in a sleep laboratory by expanding options for diagnosing suspected sleep disorders.
There are specific arrangements for children aged three to 11 years and those aged 12 to 17 years. However, GPs are unable to directly order the unattended studies. Instead, a GP must refer patients to a qualified sleep medicine practitioner, who will assess whether a Level 2 study is appropriate for the individual.
The Department of Health, Disability and Ageing has stated that these new items are intended for children and adolescents who do not need overnight supervision. Level 2 polysomnography allows for the recording of various physiological parameters during sleep without the need for continuous staff presence from a sleep laboratory.
The arrangements aim to address sleep-disordered breathing conditions, including obstructive sleep apnoea. Importantly, while GPs gain access to a Medicare-funded pathway for pediatric sleep testing, the pathway requires specialist involvement for assessment.
Children with clinical needs that require closer supervision will still need laboratory-based assessments. Furthermore, the age-specific items acknowledge that investigations for younger children and adolescents are not interchangeable.
Home-based sleep testing already exists within Medicare for select adults, but the referral process is different. GPs can refer eligible adult patients directly for diagnostically needed home-based or laboratory-based sleep studies using specified assessment tools. The new pediatric items emphasize that specialist involvement is essential after the GP referral.
This change aims to alleviate logistical challenges for families who may prefer not to have their child undergo an attended overnight laboratory study, provided the child meets the criteria for unattended testing. Notably, amendments have also been made to existing MBS sleep-study items to clarify co-claim restrictions related to the introduction of these pediatric items. The new arrangements have been implemented nationally since July 1.