Medicare will reimburse unattended home-based sleep studies for children and adolescents from 1 July, with two new MBS items targeting patients who do not require supervised laboratory investigations.

Items 12218 and 12219 cover overnight sleep investigations of at least eight hours for children aged 3–11 and adolescents aged 12–17 respectively. Both are restricted to out-of-hospital settings and require a GP referral to a sleep medicine practitioner, who determines whether an unattended study is appropriate.

The studies must include continuous monitoring of airflow, EMG, ECG or heart rate, EEG, EOG, oxygen saturation, and respiratory effort. Equipment can be applied by a parent or caregiver, provided a sleep technician delivers continuous telehealth support during set-up and the process is documented.

The Medicare fee is $489.90 (85% benefit: $416.45) for item 12218 and $455.25 (85% benefit: $387.00) for item 12219. Both items share a frequency limit of three investigations per 12-month period in combination with existing attended paediatric sleep study item 12210.

The listing follows a July 2025 recommendation by the Medical Services Advisory Committee, initiated by an application from the Australasian Sleep Association.

The Department of Health said the changes had been implemented following consultation with TSANZ and other medical bodies along with the private health insurance lobby Private Healthcare Australia.

“Increasing access to sleep studies in the community will reduce waiting times for patients who don’t need a supervised laboratory sleep study, and help families who cannot easily travel from rural or remote locations to a hospital or sleep clinic,” it said.

It said providers should note that MBS items for neurology (11000–11005), respiratory (11503), and cardiovascular (11704–11717, 11723, 11735) services would be amended to prevent separate claiming where a sleep study was the sole service provided.