Dear Provider: Please see the attached referral form. 

Please note that all insurances require medical necessity to authorize ANY type of sleep testing. 

• This MUST include an office visit note that documents at least 2 symptoms related to a suspected sleep disorder.

• Your documentation that you PLAN to prescribe sleep testing. 

• The office note must be within 6 months of the referral for testing. 

 

Example of documentation on a referral for formal sleep testing: 

The patient c/o snoring with daytime sleepiness and morning headaches.  Will order formal sleep testing.

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Example of documentation on a referral for nocturnal oximetry: 

The patient c/o fatigue and snoring.  Plan to order a sleep oximetry.  If that is abnormal, we will proceed with formal sleep testing.