New MBS items open the door to out-of-lab polysomnography for children and adolescents with suspected sleep-disordered breathing.
Respiratory and sleep physicians have a new Medicare-funded option for investigating sleep-disordered breathing in children, with two MBS items now covering unattended Level 2 polysomnography outside the sleep laboratory.
The new items, introduced on 1 July, cover out-of-laboratory studies for children aged three to 11 years and adolescents aged 12 to 18 years.
They are intended for medically uncomplicated young patients being investigated for sleep-disordered breathing who are considered suitable for a study without professional supervision overnight.
The change gives respiratory and sleep specialists another option when investigating conditions such as obstructive sleep apnoea, while potentially sparing suitable children and their families the inconvenience of an overnight stay in a sleep laboratory.
“The Australasian Sleep Association made an application to the MSAC for MBS listing of paediatric home-based sleep study services,” the Department of Health, Disability and Ageing said in a statement.
“The following organisations were consulted on the application: Thoracic Society of Australia and New Zealand, Australia and New Zealand Sleep Science Association, Private Healthcare Australia, Australian Society of Otolaryngology Head and Neck Surgery, Sleep Health Foundation, and Prader Willi Research Foundation Australia.”
However, the new pathway does not amount to open access to paediatric home sleep testing.
Unlike Medicare arrangements for selected adults with suspected obstructive sleep apnoea, GPs cannot directly refer children for the new Level 2 studies.
Instead, patients must be referred to a qualified sleep medicine practitioner, who determines whether an unattended investigation is clinically appropriate.
That puts specialist assessment and patient selection at the heart of the new arrangements, with children who have more complex medical needs or require professional supervision overnight remaining outside the intended population for the new items.
Level 2 polysomnography records multiple physiological variables during sleep but, unlike an attended Level 1 laboratory study, does not require a sleep technician to continuously supervise the patient overnight.
For paediatric respiratory medicine, the addition is significant because suspected obstructive sleep apnoea and other forms of sleep-disordered breathing can present across childhood, while the practicalities of laboratory testing can pose an additional hurdle for families.
The DoHDA has created separate items for younger children and adolescents, rather than extending the existing adult home sleep study arrangements to paediatric patients.
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Adult Medicare rules already allow GPs to directly refer eligible patients for diagnostic home-based or laboratory-based sleep studies for suspected OSA, provided approved screening tools are used and patients meet specified criteria.
These include thresholds using tools such as STOP-BANG, OSA-50, or the Berlin Questionnaire in combination with the Epworth Sleepiness Scale.
The paediatric pathway retains specialist oversight rather than adopting that model. For respiratory physicians, that means the new items expand the testing options available after specialist assessment rather than changing the initial referral pathway.
The distinction is particularly important because suitability for an unattended study depends on more than the presence of symptoms suggestive of OSA. The new items are specifically directed at medically uncomplicated patients who can safely and effectively undergo testing without overnight professional supervision.
Children who do not meet those requirements may still require an attended laboratory investigation.
The changes also come with amendments to existing sleep study items to clarify restrictions on co-claiming relevant services.
According to the July MBS update, the two new paediatric items form part of broader changes to the schedule and were introduced specifically for investigating sleep-disordered breathing in children and adolescents using Level 2 out-of-laboratory polysomnography.
The new pathway may be particularly useful where access to attended paediatric sleep laboratory services is difficult, although the MBS changes themselves do not remove the need for appropriate specialist assessment or guarantee that home testing will be suitable for an individual patient.
For more information see the MBS overview on the two new items here.
