Medicare eligibility to provide diagnostic imaging and radiation oncology services

Register for a Location Specific Practice Number (LSPN) and get accreditation to claim Medicare benefits.

Apply

Before you or your patients can claim Medicare Benefits for diagnostic imaging services or radiation oncology services you must:

  1. Register for a Location Specific Practice Number (LSPN)
  2. Get accreditation

You can register for an LSPN by submitting a completed registration form.  You need to:

Once we get your registration form, we update the LSPN Register and:

  • allocate an LSPN to your practice site
  • register your equipment
  • activate your LSPN from the date we get your submission, or you can nominate a future date
  • write to you to confirm your LSPN

You and your patients can use the LSPN Register to find registered practices.

You can send forms and supporting documents directly to us using the form upload function through HPOS Messages. Read more about uploading forms in HPOS.

Get accreditation

After you get your LSPN, you’ll need to apply for accreditation.

You must be accredited before you or your patients can claim Medicare benefits. It’s an offence if you don’t let your patients know they can’t claim a Medicare benefit because your practice isn’t accredited.

Under the Diagnostic Imaging Accreditation Scheme (DIAS), your practice must be accredited for services listed in the Diagnostic Imaging Services Table (DIST) by:

Radiation oncology services don’t need accreditation.

Maintain your LSPN registration

We’ll ask you to renew your registration on the Diagnostic Imaging Register every 12 months.

You must respond by the due date or:

  • your registration will be suspended or cancelled, and
  • you won’t be able to provide Medicare funded services

You also need to let us know within 28 days if there has been a change to your practice’s primary information.

Primary information includes:

  • the business name
  • the Australian Company Number (ACN) [only if the proprietor is a company]
  • 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
  • the address of the proprietor for mobile bases
  • information about any provider who has a financial interest in any of the equipment listed on the LSPN register that isn’t employed or contracted to provide services at the practice

To change your information, complete the Request to amend Location Specific Practice Number form.

Change of premises

You’ll need to tell us about any changes to your practice address within 28 days of the change. You’ll need a new LSPN if you sell a registered site or you move to another physical location.

To update your address details, complete the Location Specific Practice Number form and include a letter using your practice stationery with:

  • the signature of the Proprietor or authorised representative
  • an outline of the situation
  • the current LSPN
  • closure and opening dates
  • a request to remove the equipment, and
  • other important information

When we give you a new LSPN, you’ll need to:

  • organise accreditation
  • then use the new LSPN when you make claims

Changes to equipment

Use the Request to amend Location Specific Practice Number form to:

  • add new or extra equipment
  • advise of the date you upgrade your existing equipment
  • request a replacement of existing equipment
  • remove equipment

If you need a list of equipment for your practice, the proprietor or authorised representative can email a request to lspn@humanservices.gov.au. Please allow 30 days for processing.

You can read more about equipment upgrades on the Department of Health website.  

Effective dates for equipment updates

Before you can perform Medicare funded services, you must have listed your equipment on the LSPN Register. The table below explains what date to apply.

Type Eligible date
  • New equipment
  • Extra/additional equipment (if you already have the same type of equipment registered)

Whichever is later, the date:

  • you specify
  • when we get the form
  • Upgrading existing equipment
  • Removing equipment
The date you specify on the form

MRI equipment

Contact the Department of Health about the eligibility of your MRI machine before you register it with us.

If you’re registering an ineligible MRI machine, please write on the form that the machine is ineligible.

Find out about MRI eligibility on the Department of Health website.

Claiming Medicare benefits

When claiming Medicare benefits:

  • include your LSPN on patient accounts and receipts and each claim for diagnostic imaging or radiation oncology services
  • your LSPN must be current on the date you performed the service and be specific to the location

Read about claiming choices for health professionals.

Payment rates

There are different payment rates for diagnostic imaging services listed in the DIST depending on:

  • the age of the equipment used for the service
  • if you upgraded the equipment, and
  • if your practice has a location based exemption from equipment age requirements

The Medicare benefit for:

  • schedule K items, performed by newer or upgraded equipment is 100% of the MBS Fee
  • schedule NK items performed on aged equipment is approximately 50% of the corresponding K item

Read more about rules for claiming schedule K and NK items as part of the Capital Sensitivity Measure for Diagnostic Imaging Equipment on the Department of Health website.

To claim Positron Emission Tomography (PET) items, an eligible provider needs to be credentialed by the Joint Nuclear Medicine Credentialing and Accreditation Committee (JNMCAC).

Once credentialed, the Positron Emission Tomography – Statutory Declaration form will need to be completed and submitted by the provider.

Search the Department of Health’s MBS Online for:

  • appropriate MBS item numbers and payment rates for DIST Category 5 services
  • the rules and requirements when applying for a remote area exemption

Supporting legislation

You can search the Federal Register of Legislation and read the supporting legislation for diagnostic imaging and radiation oncology services that incur a Medicare benefit.

Related payments and services

Page last updated: 17 October 2017