Medicare eligibility to provide diagnostic imaging and radiation oncology services
Practices that provide diagnostic imaging services, including radiation oncology, must be registered with us and have a Location Specific Practice Number (LSPN) to claim Medicare benefits.
Diagnostic Imaging Register
The Diagnostic Imaging Register (the Register) can be used to find registered practices. You and your patients may find this useful. The Register is also known as the LSPN Register.
If your practice is in a hospital, check to see if it’s already registered.
Applying for registration
Begin the registration process by completing the Registration for a Location Specific Practice Number form (HW061).
When you register your diagnostic imaging equipment with us, we will provide you with a Location Specific Practice Number (LSPN). LSPNs are used for claiming Medicare benefits.
It is an offence not to advise patients, before you provide diagnostic imaging services, that they cannot claim a Medicare benefit because your practice is not registered.
You must apply for registration before you apply for accreditation, as the accreditor will need to know your LSPN. You must be accredited before you or your patients can claim Medicare benefits.
Radiation oncology services do not need to be accredited.
To claim Medicare benefits for diagnostic imaging services, your practice must be accredited under the Diagnostic Imaging Accreditation Scheme (DIAS) for services listed in the Diagnostic Imaging Services Table (DIST).
The following approved accreditors can accredit your practice under the DIAS.
- HDAA Australia Pty Ltd (HDAA)
- National Association of Testing Authorities Australia (NATA)
- Quality Innovation Performance (QIP)
If your practice is not accredited, you and your patients cannot claim Medicare benefits, other than radiation oncology services. It is an offence not to advise patients, before you provide diagnostic imaging services, that they cannot claim a Medicare benefit because your practice is not accredited.
The DIST covers the following groups of services:
- Ultrasound - Groups I1
- Computed Tomography (CT) - Group I2
- Diagnostic Radiology (X-ray) - Group I3
- Orthopantomography (OPG) - Group I3, Subgroup 3
- Mammography - Group I3, Subgroup 10
- Angiography - Group I3, Subgroup 13
- Fluoroscopy - Group I3, Subgroup 15
- Nuclear Medicine Imaging (including Positron Emission Tomography (PET) - Group I4
- Magnetic Resonance Imaging (MRI) - Group 15
Maintaining your registration
To maintain your registration, you must inform us of any changes to the information you have previously provided to us by completing the Request to amend Location Specific Practice Number form (HW072). If information is out of date, incorrect or incomplete, you and your patients may not be able to claim Medicare benefits.
If you submit a Request to amend Location Specific Practice Number form (HW072) and include your email address, you will receive a confirmation email once your application has been processed.
Every 12 months we’ll ask you to confirm or update your details. If you don’t respond by the due date:
- your registration will be suspended and may be subsequently cancelled, and
- you will not be able to provide Medicare funded services
If your registration is suspended and subsequently reinstated, you are not eligible to provide Medicare funded services during the time your registration was suspended.
There are specific timeframes you must meet to ensure your registration is maintained.
If you have an LSPN and require a list of equipment currently listed for your practice, the proprietor or authorised representative can email a request to firstname.lastname@example.org.
Allow 30 days for your request to be processed.
Changes to your practice’s primary information must be provided to us within 28 days of the change. The changes will be effective as of the date you specify, provided we received the Request to amend Location Specific Practice Number form (HW072) within 28 days of the change.
Primary information includes:
- details of the proprietor, including its Australian Company Number (ACN) where the proprietor is a company
- the business name under which diagnostic imaging procedures are carried out
- the Australian Business Number (ABN) under which diagnostic imaging procedures are carried out
- details of the equipment located on the:
- premises, or
- base for mobile equipment - where equipment is ordinarily located when not in use and is not ordinarily located at diagnostic imaging premises
- details relating to trial or substitute equipment or the replacement of existing equipment
- the address of the practice or location of the base for mobile diagnostic imaging equipment
- the address of the proprietor
- information about any provider not employed at, or contracted to provide services for the site or base for mobile equipment, who has a financial interest in any of the equipment listed on the register
- add new or additional equipment to the Register - these are effective as of the date you specify, or the date the form is received, whichever is later
- advise us of an upgrade to your existing equipment listed on the Register
- request a replacement of existing equipment listed on the Register - these are effective as of the date you specify, providing the form is received within 28 days of the change occurring, and
- remove equipment from the Register - these are effective from the date you specify on the form
- New equipment is when a practice requests angiography equipment to be listed when they don’t currently have any angiography equipment listed on the Register
- Additional equipment is when a practice requests angiography equipment to be listed when they already have angiography equipment listed on the Register
- Replacement equipment is when a piece of equipment is being replaced by another of the same type. The form should include the details of the new equipment as well as the equipment that is being decommissioned
Equipment must be listed on the Register on the date of service to be eligible to perform Medicare funded services.
For more information about upgrades, refer to Frequently Asked Questions: Capital Sensitivity Measure for Diagnostic Imaging Equipment on the Department of Health website.
Claiming Medicare benefits
Your LSPN must be submitted with each Medicare claim for diagnostic imaging or radiation oncology services. It should also be included on patient accounts and receipts so they may claim a Medicare benefit.
The LSPN you include on your claims must be current on the date the service was performed. It cannot be suspended or cancelled. The LSPN must also be for the specific location where the service was performed.
There are some occasions when we may need to give you a new LSPN. We will inform you if this is the case. Once we provide you with a new LSPN, you must use the new number when you make claims.
There are different payment rates for diagnostic imaging and radiation oncology services listed in the DIST. The rate of payment will depend on:
- the age of the equipment you used for the service
- whether the equipment has been upgraded, and
- whether your practice has received a location based exemption from equipment age requirements
You will receive 100% of the Medicare benefit for services that are listed as schedule K items performed by newer or upgraded equipment. Medicare benefits for schedule NK items are approximately 50% of the corresponding K item performed on aged equipment.
Read more about rules for claiming schedule K and NK items as part of the Capital Sensitivity Measure for Diagnostic Imaging Equipmenton the Department of Health’s website.
Search for the appropriate MBS item numbers and payment rates for DIST Category 5 services on the MBS Online, a Department of Health website.
You can search the Comlaw website and read the supporting legislation for diagnostic imaging and radiation oncology services that incur a Medicare benefit. Supporting legislation includes:
- Health Insurance Act 1973
- Health Insurance Regulations 1975
- Health Insurance (Diagnostic Imaging Services Table) Regulation 2013