This guide is written from the Medicare Benefits Schedule (MBS) entries for item 12250 and item 12203, and ResMed Australia’s guidance on funding, read 14 October 2026.
The sleep study
Home study: MBS item 12250
Item 12250 covers an unattended adult sleep study, the kind usually done at home.
| Amount | |
|---|---|
| Schedule fee | $401.25 |
| Medicare benefit at 75% | $300.95 |
| Medicare benefit at 85% | $341.10 |
| Frequency | Once in any 12-month period |
Lab study: MBS item 12203
Item 12203 covers an attended study, with a sleep technician in continuous attendance under a sleep physician’s supervision. It applies, for example, where suspected obstructive sleep apnoea makes you unsuitable for an unattended study.
| Amount | |
|---|---|
| Schedule fee | $703.80 |
| Medicare benefit at 75% | $527.85 |
| Medicare benefit at 85% | $599.30 |
Any gap between what the provider charges and the Medicare benefit is yours to pay.
Getting referred
Item 12250 can be claimed in two ways:
- Screening route. Your doctor refers you to a qualified adult sleep medicine practitioner or a consultant respiratory physician, who decides you have a high probability of symptomatic moderate-to-severe OSA. That needs an Epworth Sleepiness Scale score of 8 or more, plus one of:
- a STOP-Bang score of 3 or more
- an OSA50 score of 5 or more
- a high-risk result on the Berlin Questionnaire
- Specialist route. After seeing you, in person or by video, the sleep or respiratory specialist decides a study is needed to confirm the diagnosis.
The study must be supervised and reported by a qualified adult sleep medicine practitioner who reviews the raw data. The MBS notes the questionnaires are available from Sleep Central.
Paying for the CPAP
The MBS items cover the investigation, not the machine. Funding for the equipment comes from elsewhere:
- State programs. ResMed Australia says public funding of CPAP differs between states, each with its own criteria. In NSW, EnableNSW supplies CPAP for a $100 annual co-payment for pensioners and lower earners, though waiting periods vary.
- Private health insurance extras. ResMed says extras cover may pay a rebate towards a CPAP and sometimes a mask. The amount varies widely; some funds want a doctor’s letter, and all need an eligible invoice. Ask your fund for a quote before buying.
- Buying. CPAP machines and masks can be sold GST-free; see GST-free CPAP and oxygen and CPAP machine prices in Australia.
Renting or trialling first
ResMed’s Australian online shop lists an AirSense 11 AutoSet trial at $35, with a separate ongoing-fee listing. ResMed says the rented machine comes with up to two masks to try and check-ins from its sleep coaches, and asks you to contact its team to book. The listing does not state the billing period, so confirm the full cost before you start.