Eligibility and Location Specific Practice Number (LSPN) practice registration for Diagnostic Imaging (DI) and Radiation Oncology (RO) 012-41040000

DI and RO procedures help to diagnose, treat, and monitor an extensive range of illnesses and conditions. DI services include ultrasound, computed tomography, nuclear medicine, radiography (x-ray), magnetic resonance imaging (MRI) and positron emission tomography (PET). DI and RO services are provided with specialised equipment and the professional input of a radiologist, or other medical specialist, to interpret the generated images.

Location Specific Practice Number (LSPN)

Practices intending to provide Medicare eligible DI and RO services must apply to and be registered with Services Australia (the agency). As part of their registration, each practice is allocated a Location Specific Practice Number (LSPN) record to be used for claiming Medicare benefits. DI practices must also be accredited for Medicare benefits to be payable.

An LSPN is a unique identifier allocated to a practice by the agency for a:

• DI and/or RO premises, or
• base for mobile DI or RO equipment

LSPNs are used to record:

• the location DI or RO services are performed (or equipment is ordinarily located in the case of a base for mobile equipment)
• the types of equipment based at the premises
• the age of the equipment
• equipment age exemptions
• equipment upgrades
• the accreditation status of each modality
• for practices with MRI equipment:
• if the equipment is eligible for Medicare benefits, and
• which providers are listed to provide MRI services at the practice
• all other information as required under the Health Insurance Act 1973

An LSPN record is required for each practice.

Registration

To register, the proprietor must submit a correctly completed application form which includes at least one item of equipment.

Once registered, the following information is published on the publicly available LSPN register:

• the practice name and business information
• the location
• accreditation

The agency processes registration forms, allocates and administers LSPN records.

Accreditation

Once a DI practice has an LSPN record, they must apply for accreditation as specified by the Diagnostic Imaging Accreditation Scheme (DIAS). Accreditation must be attained and recorded for each modality before Medicare benefits are payable.

These approved accrediting bodies can provide accreditation:

• HDAA Australia Pty Ltd (HDAA)
• National Association of Testing Authorities Australia (NATA)
• Quality Innovation Performance (QIP)

RO is not subject to DIAS, so is an exception to accreditation requirements. Practices are still required to list RO equipment on their LSPN record.

The Resources page contains a link to the Department of Health and Aged Care (DHAC) for further details about LSPNs and DIAS.

The Medicare Benefits Schedule (MBS) together with the Diagnostic Imaging Service Table (DIST) and General Medical Services Table (GMST) (tabular lists of Medicare-subsidised DI services) provides up-to-date details about the current arrangements for the payment of Medicare benefits under the Health Insurance Act 1973.

The MBS is an up-to-date record of Medicare subsidised items and the conditions of their use including:

• Medicare Benefit Schedule fees (fee set by government). Note: DI providers are entitled to set their own fees. Therefore the actual fee charged may be different from the schedule fee
• Medicare benefits (amount patients can expect to get back from Medicare)
• description of the service
• provider, equipment and patient requirements
• request and referral requirements

Medicare diagnostic imaging item categories (modalities):

• Ultrasound – Group 11
• Computed Tomography (CT) – Group 12
• Diagnostic radiology (including x-ray) – Group 13
• Nuclear Medicine (including PET) – Group 14
• MRI (magnetic resonance imaging) – Group 15
• Management of bulk-billed services – Group 16

The General Medical Services Table lists all the radiation oncology services that are Medicare-subsidised.

An LSPN is required to receive Medicare benefits for DI and radiation oncology services. For more details about LSPN error codes on claims, see the Resources tab.

Users who have their HPOS account linked to their LSPN record are able to view, amend and renew their registration online.

For more details, see LSPN and system (PDS and HPOS).

The Health Insurance Act 1973 requires practices and bases for mobile equipment to be registered with the agency to maintain eligibility for Medicare benefits.

The legislation provides a mechanism to collect details about the rendering of DI and RO services and assists the Australian Government and the diagnostic imaging industry to:

• monitor the services provided
• assess compliance for benefits by ensuring that where applicable, the equipment used meets the eligibility requirements for a particular Medicare claim
• develop future programs to maintain and improve patient access to high quality services

Primary details

Sections 23DZV and 23DZZU of the Health Insurance Act 1973 (the Act) requires proprietors of practices to tell the agency in writing of any change to primary information within 28 days of the change. They must complete an Application to register or amend a diagnostic imaging or radiation oncology practice (HW061) form and provide the details of the change.

Primary information is:

• practice business details, including:
• proprietor
• business name
• Australian Business Number (ABN), and
• Australian Company Number (ACN)
• the premises or base for mobile equipment address
• the types of DI or RO equipment ordinarily located at the premises or base
• details of legal agreements to use equipment within the premises

Equipment

Practices must notify the agency of any change to the type of equipment located at the registered premises or base within 28 days to comply with sections 23DZV and 23DDU of the Act.

Sections 16D and 16F of the Act outline the conditions which need to be met before practices and equipment are eligible to perform Medicare eligible DI and RO services. This includes the requirement under subsections 16D(1) and 16F(1) that equipment must be located at and listed for the premises on the date of service. This means a practice can comply with its primary information obligations and still not be eligible to claim using equipment it recently installed.

An authorised delegate of the Minister can determine Medicare benefits are payable if a backdate request is received from the practice. The Pathology and Diagnostic Imaging team considers these requests, some of which need to be made by an EL2 or above officer.

The types of DI and RO equipment are outlined in the Explanatory Memorandum to Health Insurance Amendment (Diagnostic Imaging, Radiation Oncology and Other Measures) Bill 2002. The Resources page has a table with more information.

Annual renewal process

Sections 23DZW and 23DZZV of the Act requires practices to respond to requests for information made by the agency. Annual reminder letters are automatically sent to practices each year, which requires them to:

• confirm all details on the LSPN register are correct and up to date, or
• submit a HW061 form so the register is up to date

Practices can renew their registration in HPOS if no changes are required.

Once the required information is received, the practice's registration is renewed for an additional 12 months.

Registration suspension for failing to respond

Failure to respond to this request by the date specified in the notice (which is the registration End Date in PDS), results in:

• Medicare benefits not being payable until a response is received
• a Work Item being created in PaNDA which prompts an APS5 delegate to consider suspension of registration in line with sections 23DZX or 23DZZW of the Act

Suspensions are actioned by the Provider Engagement team. A letter is automatically sent to the practice advising of the suspension, and that the practice's registration will be cancelled if it fails to respond within 3 months after the registration End Date (the response period).

A response within this 3 month period results in the practice's registration being reinstated and renewed for an additional 12 months from the End Date.

Registration cancellations for failing to respond

Sections 23DZY and 23DZZX of the Act states the agency must cancel the practice's registration if the practice:

• was suspended in accordance with 23DZX or 23DZZW, and
• fails to respond within 3 months after its registration End Date (the response period)

A work item is created in PaNDA for the LSPN record to be referred to an EL1 delegate.

Cancellations are actioned by an EL1 in the Provider Engagement team or the Pathology and Diagnostic Imaging Team. A letter is sent to the practice advising the:

• practice's registration has been cancelled
• proprietor will not be entitled to request registration of the practice for 12 months from the decision date

Sections 23DZZC and 23DZZZB of the Act allow a proprietor to write and ask for permission to register the premises within 12 months of a decision to cancel. All requests must be made to the Pathology and Diagnostic Imaging Team as instructed in the cancellation letter. This includes requests to:

• re-register
• amend, or
• renew registration

The References page contains a link to the Health Insurance Act 1973.

When applying for an LSPN record, diagnostic imaging (DI) or radiation oncology (RO) practices must register as a premises or as a base for mobile equipment.

Premises

• A DI and/or RO premises is a building or part of a building where DI procedures and/or RO services are carried out under a single business name
• Each premises must have its own LSPN record
• Where different business entities operate from the same premises, they must be registered separately

For example, a medical centre has suites that are leased to 2 private medical practices. Both practices have DI equipment in their suites, have different owners and operate independently of each other. Even though these practices operate from the same premises, each practice must have its own LSPN record.

Bases for mobile equipment

A base for mobile DI or RO equipment is:

• the premises where DI and/or RO equipment is usually located when not in use, and
• DI and/or RO services are not carried out at the premises, or are frequently carried out off the premises under the same business name

Mobile equipment doesn’t need to be stored at the registered address to be listed as part of the LSPN record. If the equipment is usually located at a depot or is kept at another premises that is within 50km of the depot when not being used:

• the equipment stored within that vehicle can be listed on the depot’s LSPN record

When equipment is usually stored more than 50km from the depot:

• the premises at which the equipment is stored needs to be registered as a base for mobile equipment

Note: mobile equipment can be temporarily stored further than 50km from the registered address if required to perform services. There is no limit to the distance it can travel as long as it regularly returns to the base.

Radiation oncology practices

RO practices are included under the LSPN practice registration arrangements to:

• streamline the practice registration process under the one system and
• standardise the details collected across public and private RO practices

Note:

• only practices that provide RO services by or under the supervision of specialist radiation oncologists must be registered
• practices that perform superficial or orthovoltage radiation oncology services, for example dermatologists, ophthalmologists and general practitioners, and who have no other DI or RO equipment as part of their practice, do not require registration

To be eligible for Medicare benefits, individual providers must include the LSPN of the practice on patient accounts/receipts or bulk billing claims, including electronic claims.

The Medicare claiming system checks each claim for a current LSPN with equipment and accreditation recorded that is eligible for the item(s) claimed on the date of service.

See Claims for Location Specific Practice Number (LSPN) for Medicare for more details.

Details about the equipment and who has a financial interest in the equipment are collected under the relevant modality classification:

• ultrasound
• computed tomography (details of gantry only)
• nuclear medicine
• diagnostic radiology (includes x-ray with image intensifier - recorded as fluoroscopy, mammography, orthopantomography and angiography)
• magnetic resonance imaging (MRI) Full and Partial Medicare- eligible must be recorded on the LSPN register
• MRI - Ineligible for Medicare is optional for recording on the LSPN register for the purposes of Medicare benefits, but is required for some Veterans’ Affairs payments
• radiation oncology equipment

When supplying the equipment details, the practice must supply the serial number of the equipment being listed and the age of the equipment (date of manufacture or date first installed in Australia). If the serial number is unavailable, an accountable asset or other number is required that must also be displayed on the equipment.

Practices often use dual modality equipment. This can perform the functions of two or more equipment types as defined in the DIST. Dual modality equipment must be listed as separate machines on the LSPN register to make sure the practice can claim for all services the equipment can perform. The same serial number can be used for each modality.

Note: the agency cannot record the equipment if all required information is not supplied. The application is not processed until these details are provided. This may affect Medicare eligibility.

The Process page includes more information about the required information for each equipment type.

To be eligible for Medicare benefits, an MRI service must be provided by a DI practice that has:

• eligible MRI equipment that meets the capital sensitivity requirements
• MRI accreditation, and
• meets the definition of a comprehensive practice as defined in the Health Insurance (Diagnostic Imaging Services Table) Regulations (No. 2) 2020 (the DIST) by having the following equipment listed:
• X-ray
• ultrasound, and
• computed tomography

In addition to these requirements, a practice must also be:

• allocated Medicare eligibility by the Department of Health and Aged Care (DHAC) which provides either full or partial eligibility, or
• located in an MM2-7 location (from 1 November 2022)

DHAC is responsible for provision of MRI eligibility. This gives DI practices the ability to claim Medicare benefits for practices in MM1 locations. Before 1 November 2022, this was a requirement for all MRI equipment in Australia.

For practices in MM1 areas, the agency must ensure an MRI license has been issued by DHAC to a DI practice before adding an eligible MRI to the LSPN Register. The Pathology and Diagnostic Imaging team consults with DHAC to administer MRI licences.

From 1 November 2022, MRI equipment in MM 2-7 locations do not require a licence to be fully eligible for Medicare rebateable services if the other requirements are met. Practices are required to declare they:

• are in a MM2-7 location as shown on DoctorConnect, and
• have, and will maintain a comprehensive practice as defined in the DIST

The agency receives advice from DHAC about MRI eligibility. Changes are made to MRI equipment in the LSPN register without further action from the practice if the equipment is already listed as ineligible.

Practices must:

• apply for eligibility to DHAC
• wait for confirmation eligibility to be granted
• submit an Application to register or amend a diagnostic imaging or radiation oncology practice (HW061) form only after confirmation is received from DHAC and if equipment needs to be added or removed

The Department of Health and Aged Care (DHAC) notifies the agency when an MRI Medicare eligibility has been approved to be transferred from:

• one LSPN location to another, or
• between MRI equipment at the same practice

DHAC notifies the Pathology and Diagnostic Imaging team of each approved transfer, including the:

• LSPN record(s) involved in the transfer
• MRI equipment details (make, model, serial number), and
• eligibility start and end dates

The MRI transfer details must be recorded on the equipment table of the relevant LSPN record. Once an MRI Medicare eligibility is transferred to other MRI equipment, the previous equipment ceases to be eligible.

Once eligible MRI equipment is replaced, the original equipment ceases to be eligible. If Medicare eligibility is transferred to other equipment, the practice is not required to submit a request to update their equipment unless it is being removed from the practice.

Note: for a transfer of eligibility, the MRI equipment's start date as fully eligible cannot overlap the end date of the previous MRI equipment’s eligibility.

Occasionally an MRI license is temporarily transferred from one practice to another. This happens when equipment is temporarily unavailable due to technical reasons, for example, maintenance and/or upgrades.

Where MRI Medicare eligibility is temporarily transferred, DHAC also provides the details for the return of eligibility.

The same applies if equipment has partial eligibility and the practice is temporarily granted full eligibility for Medicare equipment. The equipment with partial eligibility will retain this eligibility during and after the transfer has ceased. This means the MBS items claimable on the partially eligible MRI can be claimed on the fully eligible MRI.

Ineligible MRI equipment is optional information, as Medicare benefits are not payable for services provided on this equipment. Ineligible MRI equipment is not defined as ‘primary information’ for the purposes of registration under the Health Insurance Act 1973 (the Act). However, if details are provided by the practice, the equipment is recorded on the LSPN register.

Where ineligible MRI equipment exists on a practice’s LSPN record and Medicare eligibility is being transferred to it for a limited period, it is not necessary to end date any ineligible MRI equipment.

Ineligible equipment is not assessed for Medicare purposes and the LSPN register will not restrict a duplicate serial number, make and model if the equipment codes are different.

The DVA pays benefits for services on ineligible MRI equipment for eligible DVA patients. The listing of this equipment on the LSPN Register allows MRI providers to be linked to the LSPN record as an MRI provider.

See MT items for Veterans' Affairs Processing (VAP) for more information.

To provide services on eligible MRI equipment, a specialist must have ongoing participation in the Royal Australian College of Radiologists' quality and accreditation program. Failure to do so results in the cancellation of Medicare eligibility to provide MRI services.

The proprietor or authorised representative of a practice with MRI equipment listed must advise the agency of the eligible specialists that will provide MRI services at that practice by completing these details on the Application to register or amend a diagnostic imaging or radiation oncology practice (HW061) form.

Providers can only have their provider number linked to an LSPN record if the address details clearly describe the same premises.

Provider eligibility is effective from the date a complete HW061 form is received by the agency or a future date if specified. Requests to backdate or remove an MRI provider from an LSPN record should be escalated to Provider Engagement for consideration by the Pathology and Diagnostic Imaging team.

Eligible providers must have the specialty code 655 added to their provider stem in PDS to enable Medicare claiming for the following MBS items:

• 63395
• 63396
• 63397
• 63398

A provider is eligible to claim the above items if the provider is:

• a specialist in diagnostic radiology or a consultant physician; and
• recognised by the Conjoint Committee for Certification in Cardiac MRI

The Department of Health and Aged Care (DHAC) sends the agency details of providers that have been certified by the Conjoint Committee for Certification in Cardiac MRI. The agency then confirms the provider is a recognised specialist in diagnostic radiology or a consultant physician in PDS. The specialty code 655 is added to the provider’s stem in PDS if these requirements are met.

Note: the Provider does not need to be linked to an LSPN record to access Cardiac MRI item numbers.

The Resources page contains MRI provider processing workflow, links to forms, HPOS user guide and links to letters.

The purpose of the capital sensitivity provisions is to encourage practices to regularly upgrade, and replace their equipment to ensure patients have access to higher quality equipment.

With the exception of equipment that has a current approved exceptional circumstances exemption (ECE), DI services are no longer payable when using equipment that has exceeded its:

• effective life age, or
• maximum extended life age

This is in place for almost all DI equipment providing services (excluding Positron Emission Tomography (PET) services) under Medicare.

DHAC administers ECE applications, which are entered into PDS by the Pathology and Diagnostic Imaging team.

Age of equipment is calculated from the date:

• the equipment was first installed in Australia; or
• of the manufacture of the oldest component, if the equipment was imported as used equipment

Note: if both the date of manufacture and the date of installation in Australia are provided, the age of equipment is calculated from date of manufacture. If neither date is recorded, the equipment is ineligible for Medicare benefits.

A table to assist with calculating the effective life age and maximum extended life age can be found on the Resources page.

Upgrades

DI equipment has been upgraded if:

• an additional reasonable investment has been made for the DI equipment that improves the overall performance of the imaging system. This makes it equivalent to new DI equipment supplied in Australia at the time of the improvement:
• within the effective life age of the equipment, or
• during an exemption period approval by DHAC
• the DI equipment is currently accredited under The Royal Australian and New Zealand College of Radiologists' Mammography Quality Assurance Program

Note: only the first upgrade extends a machine’s life age and there is no way to further extend Medicare eligibility without an exemption granted by DHAC.

For full details about the rules for exemptions and the age requirements for equipment , providers should access the DHAC website. See the Resources page for:

• a link to the DHAC website
• a table for calculating the effective life age of equipment

The Health Insurance Act 1973 allows the agency to publish an extract of the LSPN Register on the Services Australia website and requires the agency to make available, on request, an extract of the Register to a person for the purpose of determining whether Medicare benefits are likely to be payable.

The LSPN register includes the following publicly available details:

• LSPN
• Practice name
• Address
• Suburb
• Registration start date
• Registration end date

Accreditation:

• Modality
• Accreditation start date
• Accreditation end date
• Accreditor's name

For all other information related to an LSPN record, an enquirer must pass the relevant security check before information is provided to them.

See Performing practice staff security check for the Diagnostic Imaging/Location Specific Practice Number (LPSN) register for security check procedures.

The Resources page contains a link to the LPSN register.

Comments must be saved in PDS and/or PaNDA when a decision is made or any other relevant action is taken. It’s important to ensure clear and accurate records are kept when decisions are reviewed, or an applicant calls to ask for more information. Recording comments in both systems (when relevant) makes it possible to quickly understand the decisions that have been made without locating records in multiple locations.

Events and decisions which should result in a comment include, but are not limited to:

• Recommendations by Service Officers to a delegate to register a new LSPN
• Delegate decisions to register a new LSPN
• Delegate decisions to not register a new LSPN, including the reason(s) the application was refused and any additional information that was considered
• The reason the delegate decision is different to the recommendation made by the Service Officer
• The reason an application or part of an application was not processed
• Conversations with the applicant or authorised representative about the record or application, including the name of the caller, the reason for the enquiry and the advice that was provided
• Updates to the LSPN record, for example, renewal, changes to equipment and accreditation, MRI providers, authorised contacts or Administrator/Staff access to HPOS

Multiple changes made in response to a single request can be noted in one comment.

The Resources page contains the Comments template for many of these scenarios.

Note: some actions, including renewal, suspension and cancellation of an LSPN are automatically recorded in PDS comments and do not require manual intervention.