Home-based Sleep Study Guide – Item 12250
New Medicare Requirements Effective 1st November 2018
Item 12250: Overnight diagnostic sleep study to confirm the diagnosis of OSA.
Pre-study requirement: Medical referral to a qualified adult sleep medicine practitioner or consultant respiratory physician where approved assessment tools indicate a high probability for moderate to severe OSA (using STOP-BANG or OSA-50 or Berlin Questionnaire and an elevated Epworth Sleepiness Scale ³ 8); or professional attendance (face-to-face or via telehealth) with a qualified adult sleep medicine practitioner or consultant respiratory physician to confirm necessity for test, irrespective of questionnaire results.
Bulk-Billing restriction: 1 service per patient (aged 18 years & older) in a 12 month period.
What does this mean for general practitioners?
General practitioners can directly refer eligible patients for diagnostic home-based sleep studies for obstructive sleep apnoea when an approved assessment tool has been used.
General practitioners can also continue to refer eligible patients with suspected sleep disorders to qualified adult sleep medicine practitioners and consultant respiratory physicians for further investigation.
General practitioners who want to directly refer patients for a diagnostic home-based sleep study to confirm a diagnosis of sleep apnoea will need to determine a patient’s eligibility by using approved assessment tools and meeting the criteria below.
Either one of:
- STOP-BANG score ≥ 4 (Heartscope preferred assessment tool)
- OSA-50 score ≥ 5
- Berlin Questionnaire – high risk
- Epworth Sleepiness Scale score ≥ 8 (Mandatory additional assessment tool)
Note: Please see questionnaires below
In accordance with the new requirements, Heartscope has printed new referral forms that complies with these Medicare requirements for bulk-billing & rebate claim.
To assess that the patient meet the eligibility criteria for suspected sleep disorders please ensure that both questionnaires on the back of the referral form are completed, and both sides of the form are faxed to us.
Once a referral has been received that meets these guidelines, our sleep physician will approve it and the patient can be booked in for the study, and will be bulk-billed.
For further information or to request for referral pads, please call on 1800 202 111.
Please fax referrals to (03)8669 4575.
|EPWORTH SLEEPINESS SCALE QUESTIONNAIRE (to be completed with patient)|
|How likely are you to doze off or fall asleep in the following situations, in contrast to feeling just tired? This refers to your usual way of life in recent times. Even if you haven’t done some of these things recently try to work out how they would have affected you.|
|Situation (It is important that you answer each question as best you can)||Chance of Dozing (0-3)||Use the following scale to choose the most appropriate number for each situation:
|Sitting and reading|
|Watching TV||0 = would never doze|
|Sitting, inactive in a public place (e.g. a theatre or a meeting)|
|As a passenger in a car for an hour without a break||1 = slight chance of dozing|
|Lying down to rest in the afternoon when circumstances permit|
|Sitting and talking to someone||2 = moderate chance of
|Sitting quietly after a lunch without alcohol|
|In a car, while stopped for a few minutes in the traffic||3 = high chance of dozing|
0 – 7 = Normal
8 – 24 = Abnormal (qualifies for Medicare Bulk-billing rebate)
|STOP-BANG SLEEP QUESTIONNAIRE (to be completed with patient)|
|Please answer all the questions||Yes||No|
|Do you SNORE loudly (louder than talking or loud enough to be heard through closed doors)?|
|Do you often feel TIRED, fatigued, or sleepy during daytime?|
|Has anyone OBSERVED you stop breathing or choking during your sleep?|
|Do you have or are you being treated for high blood PRESSURE?|
|BMI more than 35kg/m2?|
|AGE over 50 years old?|
|NECK size large? ** (Males:43cm+ & Females:41cm+)|
|A STOP-BANG score of 4-8 identifies patients with high probability of moderate/severe OSA, and qualifies for Medicare Bulk-billing rebate||Total Score =>|