Medicare eligibility to provide diagnostic imaging and radiation oncology services

Your practice must register for a Location Specific Practice Number (LSPN) and be accredited to be eligible for Medicare benefits.

Eligibility

You and your patients can only claim Medicare benefits for diagnostic imaging or radiation oncology services at a practice that:

  • has registered for an LSPN
  • is accredited to provide diagnostic imaging services.

Radiation oncology services don’t need to be accredited.

Register

You must register for an LSPN before you can get accreditation.

To register for a LSPN, download and complete the registration for a Location Specific Practice Number form.

To avoid delays, make sure you’ve included all equipment details and completed all date fields on the form.

Once we receive your registration form, we’ll update the LSPN Register by:

  • allocating an LSPN to your practice site
  • registering your equipment
  • activating your LSPN from the date we get your form, or a future date if nominated.
  • We’ll 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 to us using the form upload function through HPOS Messages. Read more about uploading forms in HPOS.

Accreditation

Once you know your LSPN, you’ll need to apply for accreditation.

You must be accredited before doctors or your patients can claim Medicare benefits.

You need to let your patients know if they can’t claim a Medicare benefit because your practice isn’t accredited. It’s an offence if you don’t tell your patients before providing the service.

Your practice must be accredited as specified in the Diagnostic Imaging Accreditation Scheme (DIAS). This is a requirement in order to provide services in the Diagnostic Imaging Services Table (DIST).

You must get accreditation from one of these bodies:

You don’t need to be accredited to provide radiation oncology services.

Maintain your LSPN registration

It’s important that you maintain current information for your LSPN registration. You must list your equipment on the LSPN Register and be accredited before you can perform Medicare claimable services.

Renew your registration

We’ll ask you to update your LSPN details annually to maintain registration. 

We’ll send you a reminder letter asking you to update your details on the register for your LSPN. If you don’t respond to update notices on time, we’ll suspend your LSPN registration and won’t pay Medicare benefits.

Change of circumstances

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

Primary information includes:

  • the business name
  • the Australian Company Number (ACN)
  • the Australian Business Number (ABN)
  • details of the equipment on the premises or base for mobile equipment
  • the address of the proprietor for mobile bases - if applicable
  • information about any provider who:
    • isn’t employed or contracted to provide services at the practice
    • has a financial interest in any of the equipment listed on the LSPN Register.

Advise us of any changes by completing a request to amend Location Specific Practice Number form.

Changes to authorised representative

If the nominated authorised representative changes, tell us on the LSPN amendment form. If the current authorised representative or proprietor is unable to sign the form, the responsible executive e.g. CEO, general manager, or director will need to sign the form to approve the changes.

If the authorised representative isn’t changing but can’t sign the amendment or declaration forms because they’re sick or on leave:

  • have the forms signed by someone in a managerial position at the practice e.g. CEO, general manager, director, or responsible executive
  • include a cover letter on practice stationery if a person other than the recorded authorised representative outlining the change signs the declaration form.

Changes to equipment

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

  • add new or extra equipment
  • tell us the date you upgraded your existing equipment
  • ask to replace existing equipment
  • remove equipment.

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

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

Dates for equipment registration

The table below explains what dates you can use to commence and cease equipment registration.

Type Eligible date
  • New equipment
  • Extra or additional equipment
  • Replacing same type of equipment

Whichever is later:

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

The date you specify on the form

MRI equipment

If you’re unsure whether your MRI is eligible, contact Health before you register it with us.

If you’re registering an MRI that isn’t eligible for Medicare benefits, correctly indicate on the form that it’s ineligible.

Find out about MRI eligibility on Health’s website.

MRI provider eligibility

If your site has an eligible MRI and doctors at your practice wish to provide MRI services you’ll need to provide their details. Use an LSPN form and confirm that they:

  • are specialists in diagnostic radiology
  • participate in the Royal Australasian College of Radiologists Quality and Accreditation Program
  • will provide MRI services on the eligible MRI equipment located at the LSPN.  

We can’t pay Medicare benefits for MRI services on ineligible MRI equipment. However, practitioners may be able to claim for MRI services on Department of Veterans’ Affairs (DVA) patients. If you want to provide MRI services to a DVA patient on ineligible MRI equipment, contact DVA to let them know you intend to claim.

Changes to location or ownership

You’ll need a new LSPN if you either:

  • sell or takeover a registered practice site
  • move to another location as LSPNs are location specific.

To make sure there are no gaps between billing dates please close your existing LSPN registration and register your new premises.

Close your existing LSPN registration by:

Register your new premises by:

Please make sure you cross-reference both forms and submit them together.

When we tell you about the new LSPN, you’ll need to organise accreditation before we can pay you Medicare benefits.

Claim Medicare benefits

When claiming Medicare benefits, include your LSPN on:

  • patient accounts and receipts
  • each claim for diagnostic imaging or radiation oncology services.

Your LSPN and accreditation must be current on the date you performed the service and be specific to the location.

Read about online options for health professionals.

Go to Health’s MBS Online to find appropriate MBS item numbers and payment rates for DIST Category 5 services.

Payment rates

There are different Medicare items for diagnostic imaging services listed in the DIST depending on:

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

For services you perform on newer or upgraded equipment, use schedule K items.

For services you perform on older equipment, use schedule NK items. The Medicare Benefits Schedule (MBS) fee for NK items is approximately 50% of the corresponding K item MBS fee.

Your equipment may be eligible for an exemption depending on the practice location if either:

  • the equipment hasn’t been upgraded and is older than the applicable effective life age
  • the upgraded equipment is older than the maximum extended life age.

There are two types of exemptions:

  • automatic exemptions - these apply to practices located in Remoteness Area categories of outer regional, remote and very remote
  • exemptions Health grants - these are for inner regional locations.

Health is responsible for this application process.

On Health’s website, you can read more about:

Provider eligibility to provide Positron Emission Tomography (PET) services

To be eligible to claim Medicare rebates for PET items, you must:

Remote area exemption for providing diagnostic imaging services without a request

You can apply for a remote area exemption so you don’t need a written referral to claim R‑type diagnostic imaging services. They can do this if there are no equivalent NR-type diagnostic imaging items.

They may get an exemption if:

  • applying the requirements would cause a patient physical or financial hardship
  • they’re participating in either
    • the Royal Australian Collect of General Practitioners’ (RACGP) Quality Assurance and Continuing Medical Education Program
    • the Australian College of Rural and Remote Medicine (ACRRM) Development Program
  • the location is in a remote area.

To apply, use the application for remote area exemption for R-type diagnostic imaging services for a medical practitioner form.

You need to be aware of your obligations when making a request for diagnostic imaging services.

Find out more about requesting diagnostic imaging services and diagnostic imaging under Medicare on Health’s website.

Go to Health’s MBS Online to find the rules and requirements when applying for a remote area exemption.

Supporting legislation

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

Page last updated: 22 February 2019