While recognized by The American Academy of Sleep Medicine (AASM) as an aid for the effective evaluation and treatment of circadian rhythm disorders, coverage and reimbursement for circadian phase assessments, also known as melatonin testing, varies by providers and in some cases may not qualify as a covered service.
In general, coverage is usually based on meeting one or more of the following criteria:
- A comprehensive sleep evaluation, performed by a qualified sleep health provider in conjunction with a high probability of a moderate to severe circadian rhythm sleep disorder.
- Sufficient training and qualifications have been met for this healthcare provider to provide this assessment.
- The assessment is deemed reasonable and necessary with a high probability of aiding in treatment of the patient’s condition.
It is recommended that you and your patient verify these specific guidelines before submitting claims for these services.
To simplify the process, please review the laboratory requisition form for potential insurance reimbursement below.