Billing Disparities in Home Sleep Testing: The Role of Sleep Medicine Board Certification and Practice Setting

Background: The financial burden of diagnostic testing for obstructive sleep apnea (OSA) represents a substantial barrier to treatment initiation, with cost-related access disparities disproportionately affecting the low-income and underinsured population. Home sleep testing (HST) offers a cost-effective diagnostic alternative, yet economic patterns across provider types remain unclear. This study assessed whether board-certified sleep medicine provider (BCSMP) status is associated with differences in provider-billed HST charges and evaluated how organizational and payment contexts influence these charges. Methods: A retrospective cross-sectional analysis was conducted using 2019 data from Optum's de-identified Clinformatics^® Data Mart Database (N = 61,531 adult HST claims). The main exposure was provider status (BCSMP vs. non-BCSMP). The outcome was total provider-requested charge per HST procedure. Generalized Linear Models with a gamma distribution estimated adjusted charge differences, controlling for organizational context, place of service, and payer type. Results: BCSMP encounters had significantly lower adjusted mean HST charges than non-BCSMPs (mean difference: -$78.04; 95% CI: -$89.06 to -$67.02; p < 0.001). Individual practitioners charged $168.48 less than hospital-affiliated providers, while group practices and other facilities charged more (all p < 0.001). Fee-for-service arrangements were associated with lower charges than commercial and Medicare Advantage plans (p < 0.001). Conclusions: Board-certified sleep medicine providers and individual practice settings were associated with lower billed charges for home sleep testing; however, these findings do not necessarily reflect actual cost reduction. To translate these baseline charge differences into equitable clinical protocols and healthcare policies, future research must analyze negotiated reimbursement rates, billing structures, and practice environments to determine how these cost parameters impact the overall cost of an OSA diagnosis.