Can a GP refer directly for a sleep study without a sleep physician?

Yes. Under MBS items 12203 and 12250, a GP can refer directly for a diagnostic sleep study if validated screening questionnaires indicate a high pre-test probability of symptomatic, moderate-to-severe OSA. The accepted combinations are: STOP-Bang ≥3 AND Epworth ≥8; or OSA50 ≥5 AND Epworth ≥8; or Berlin Questionnaire high risk AND Epworth ≥8. Scores must be documented in the patient record.

What is the difference between MBS 12203 and 12250?

Item 12203 is for an attended (Level 1) sleep study — performed in a sleep laboratory with a technician in continuous attendance. Item 12250 is for an unattended (Level 2) study — performed at home or without continuous technician presence. Both can be accessed via direct GP referral when screening criteria are met. The sleep provider determines which study type is appropriate, or the GP can specify if there are clinical reasons.

Are there MBS items for home sleep apnoea tests (Level 3 or 4)?

No. As of March 2026, there are no MBS items for Level 3 or Level 4 sleep studies (home sleep apnoea tests / HSAT). These are provided as private services by some sleep clinics. Only Level 1 (item 12203) and Level 2 (item 12250) attract Medicare benefits.

Sleep Study Referral — GP Guide

Direct GP referral criteria, Level 1 vs Level 2, MBS items 12203 & 12250

📋 Source: MBS Online — sleep study items 12203, 12250 and referral criteria (July 2026). Australasian Sleep Association clinical guidelines. Screening tools: STOP-Bang (Chung F et al. Anesthesiology 2008), OSA50, Berlin Questionnaire. Epworth Sleepiness Scale: Johns MW. Sleep 1991.
Your doctor or healthcare provider knows your history and circumstances — always follow their personalised advice over general information.

✅ Direct GP referral — when you can refer without a sleep physician

Under MBS 12203 and 12250, you can refer directly if one of these combinations is met and documented in the patient record:

✓STOP-Bang score ≥3 AND Epworth Sleepiness Scale (ESS) ≥8

— OR —

✓OSA50 score ≥5 AND Epworth Sleepiness Scale (ESS) ≥8

— OR —

✓Berlin Questionnaire high risk AND Epworth Sleepiness Scale (ESS) ≥8

Documentation required: Full screening questionnaire responses and scores must be recorded in the patient's clinical record — these are auditable. If questionnaires are incomplete, the sleep provider can administer them, but it is cleaner if done at the referral stage.

Level 1 vs Level 2 — which study to request

The sleep provider makes the final determination, but you can specify if clinically indicated.

🏥 Level 1 — Attended

MBS 12203 — $685.95 (75% benefit = $514.50)

Performed in sleep laboratory
Technician in continuous attendance
Full polysomnography: EEG, EOG, EMG, ECG, airflow, O₂, respiratory effort, CO₂
Minimum 8 hours duration (including setup)
Manual scoring or manually corrected computerised scoring in ≤1 min epochs
Report by qualified sleep medicine practitioner

🏠 Level 2 — Unattended

MBS 12250 — $391.10 (75% benefit)

Performed at home or without continuous tech presence
Equipment applied by technician where possible; patient-applied with written instructions if not
Same channel requirements as Level 1 (EEG, EOG, EMG, ECG, airflow, O₂, respiratory effort)
Minimum 8 hours
Report by qualified sleep medicine practitioner
More accessible, lower cost to patient

⚠️ No MBS items for Level 3 or Level 4 (HSAT). Home Sleep Apnoea Tests using simplified devices (no EEG) are not funded under Medicare as of July 2026. Some private sleep providers offer these; patients pay out of pocket. Do not confuse Level 2 (full PSG, unattended) with HSAT — they are different.

Relative contraindications to Level 2 (home/unattended) study

Per Australasian Sleep Association guidelines. If any of these apply, consider specifying Level 1 or referring to sleep physician for triage:

Intellectual disability or significant cognitive impairment
Physical disability with inadequate carer attendance
Significant comorbidities — neuromuscular disease, heart failure, advanced respiratory disease (complex sleep-disordered breathing likely)
Suspected respiratory failure requiring CO₂ monitoring
Suspected parasomnia or seizure disorder
Suspected positional OSA where body position recording is essential
Previously failed or inconclusive unattended study
Unsafe home environment or patient is homeless
Patient anxiety about home study, or significant distance/cost burden to attend clinic

Referral workflow

Administer screening tools

STOP-Bang (or OSA50 or Berlin) + Epworth. Record all responses and scores in notes.

Check if direct referral criteria met

Any validated combination (see above) with ESS ≥8 → direct referral. If not met → refer to sleep physician/respiratory physician for assessment.

Assess for Level 2 contraindications

If none → Level 2 (home/unattended) is suitable for most patients with suspected OSA. If contraindicated → request Level 1 or let sleep provider decide.

Write referral

Include: clinical indication, screening scores (with full questionnaire responses or note they're in the chart), any relevant comorbidities, whether Level 1 is specifically required. Sleep provider can determine study type if unspecified.

Results and treatment

Results must be discussed with patient by a medical practitioner before initiating therapy (CPAP, positional therapy, etc.). GP can manage ongoing CPAP — specialist not required for straightforward OSA.

Other sleep study MBS items (for reference)

Item	Description	Fee
12203	Diagnostic sleep study — Level 1 (attended, adult)	$685.95
12250	Diagnostic sleep study — Level 2 (unattended, adult)	$391.10
12204	Titration study — Level 1 (CPAP/BiPAP, adult)	Derived
12210	Diagnostic sleep study — Level 1 (paediatric, attended)	See MBS
12254	Multiple Sleep Latency Test (MSLT) — adult (narcolepsy)	See MBS
Level 3/4	Home Sleep Apnoea Test (HSAT) — no MBS items available	Private only

Fees as per MBS July 2026. 75% benefit applies to diagnostic items 12203 and 12250. Verify at mbsonline.gov.au.

Screening tools (use in clinic or send before appointment)

STOP-Bang Questionnaire

8 questions — score ≥3 + ESS ≥8 meets direct referral criteria

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OSA50 Questionnaire

5 questions — score ≥5 + ESS ≥8 meets direct referral criteria

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Epworth Sleepiness Scale

8-item daytime sleepiness score — required alongside OSA screening

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Clinician reference only. This page summarises MBS rules and clinical guidelines for GP reference. It does not constitute clinical advice. MBS item descriptors, fees, and eligibility criteria should be verified against current MBS Online before billing. Clinical decisions should be made in the context of individual patient assessment and current guidelines.