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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101.

The rules say that effective for claims with dates of service on and after March 3, 2009, the Centers for Medicare & Medicaid Services finds that the evidence is sufficient to determine that the results of the sleep tests identified below can be used by a beneficiary's treating physician to diagnose obstructive sleep apnea (OSA), that the use of such sleep testing technologies demonstrates improved health outcomes in Medicare beneficiaries who have OSA and receive the appropriate treatment, and that these tests are thus reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act.

1. Type I PSG is covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed attended in a sleep lab facility. 
2. Type II or Type III sleep testing devices are covered when used to aid the diagnosis of OSA in beneficiaries who have clinical signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. 
3. Type IV sleep testing devices measuring three or more channels, one of which is airflow, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility. 
4. Sleep testing devices measuring three or more channels that include actigraphy, oximetry, and peripheral arterial tone, are covered when used to aid the diagnosis of OSA in beneficiaries who have signs and symptoms indicative of OSA if performed unattended in or out of a sleep lab facility or attended in a sleep lab facility.

You can find this rule in National Coverage Determination (NCD) for Sleep Testing for Obstructive Sleep Apnea (OSA) (240.4.1) - Effective March 3, 2009. 

The rules say that repeat polysomnography (PSG) diagnosing sleep apnea requires documentation justifying the medical necessity for the repeated test. It may be indicated:

-if the first study is technically inadequate due to equipment failure; 
-if the subject could not sleep or slept for an insufficient amount of time to allow a clinical diagnosis; 
-if initiation of therapy or confirmation of the efficacy of prescribed therapy is needed; or 
-if the results were inconclusive or ambiguous.

You can find this rule in Local Coverage Determination (LCD): Polysomnography (L36593) - Effective December 3, 2020. 

The rules say that a follow up study is not routinely indicated for patients treated with continuous positive airway pressure (CPAP), whose symptoms continue to be resolved with CPAP treatment. Follow-up PSG may be indicated, however, under the following circumstances:

-After substantial weight loss has occurred in patients on CPAP for treatment of sleep-related breathing disorders to ascertain whether CPAP is still needed at the previously titrated pressure; 
-After substantial weight gain has occurred in patients previously treated with CPAP successfully, who are again symptomatic despite the continued use of CPAP, to ascertain whether pressure adjustments are needed; 
or 
-When clinical response is insufficient or when symptoms return despite a good initial response to treatment with CPAP.

You can find this rule in Local Coverage Determination (LCD): Polysomnography (L36593) - Effective December 3, 2020.

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.

The Plan contract says that the Plan covers items and services in accordance with Medicare rules.