Quick answer

In Australia, you don’t get “accredited for a Medicare code” as an individual for mammograms. Instead:

  • Individual doctors (GPs, specialists, breast clinicians) need to be recognised by Services Australia and have a Medicare provider number to request Medicare‑rebated mammography.
  • Imaging practices that perform mammograms must be accredited under the Diagnostic Imaging Accreditation Scheme (DIAS) and have a Location Specific Practice Number (LSPN) for Medicare benefits to be payable.

If you’re asking how your practice can offer Medicare‑rebated mammography, the key steps are around practice registration, DIAS accreditation, and equipment eligibility. If you’re asking how you as a clinician can refer for Medicare‑rebated mammograms, it’s about professional recognition and provider numbers. Below is a step‑by‑step breakdown for both situations.

1. If you’re an imaging practice wanting to offer Medicare‑rebated

mammography

Mammography is a diagnostic imaging service , so Medicare benefits are only payable if your practice meets specific accreditation and registration requirements.

Step 1 – Register your practice and get an LSPN

Before seeking accreditation, your practice must be registered with Services Australia and issued a Location Specific Practice Number (LSPN).

You need to:

  • Complete the Application to register or amend a diagnostic imaging or radiation oncology practice form (HW061).
  • Include:
    • Full details of all mammography equipment (make, model, serial numbers).
    • Practice address and contact details.
    • All required date fields completed.
  • Submit via:
    • Health Professional Online Services (HPOS) (preferred), or
    • Paper form to Services Australia.

If approved, Services Australia will:

  • Allocate an LSPN to your practice.
  • List your equipment.
  • Activate your LSPN record and send you confirmation.

You can check your registration and accreditation status on the LSPN Register on the Medicare website.

Step 2 – Get DIAS accreditation for diagnostic imaging

To attract Medicare benefits for mammography, your practice must be accredited under the Diagnostic Imaging Accreditation Scheme (DIAS) , administered via the Australian Commission on Safety and Quality in Health Care (ACSQHC).

Key points:

  • Accreditation is site‑specific (tied to your LSPN).
  • You can be accredited against:
    • Entry‑level Standards (for new practices), then must achieve full accreditation within 2 years, or
    • Full suite of Standards directly (required for re‑accreditation).
  • Full accreditation is valid for 4 years , after which you must be re‑accredited.

You apply through one of three Approved Accreditation Agencies :

  • HDAA Australia (HDAA) – 1800 601 696
  • National Association of Testing Authorities (NATA) – 1800 621 666
  • Quality Innovation Performance (QIP) – 1300 888 329

You can apply by providing either:

  • Documentary evidence of compliance with DIAS standards, or
  • Evidence of accreditation under the Medical Imaging Accreditation Program (MIAP) run by RANZCR and NATA , which is recognised under DIAS.

Once granted accreditation, your site can provide Medicare‑rebated diagnostic imaging services, including mammography, from that date.

The accreditor sends your accreditation report to Services Australia; your LSPN record is updated within about 5 working days. You’ll need to factor this into your Medicare claiming processes.

Step 3 – Ensure your equipment and services are MBS‑eligible

Not every type of breast imaging automatically qualifies for a Medicare rebate. For example:

  • Standard screening and diagnostic mammography items exist in the MBS (e.g. item 59302 for higher‑risk screening mammography, plus other diagnostic items).
  • Some newer techniques (e.g. contrast‑enhanced mammography) may not have a specific MBS item yet, meaning patients may face out‑of‑pocket costs.

Your practice should:

  • Confirm which MBS item numbers apply to the mammography services you intend to offer.
  • Ensure your equipment is listed on your LSPN and meets the technical requirements for those items.

Step 4 – Set up Medicare claiming and inform patients

Once your practice is:

  • Registered with an LSPN , and
  • Accredited under DIAS ,

you can:

  • Claim Medicare benefits for eligible mammography services using your LSPN on claims.
  • Use HPOS to manage your LSPN details and keep information up to date.

Important legal requirement:

  • If your practice is not accredited , you must tell patients before the service that:
    • The practice is not accredited, and
    • The service does not attract a Medicare benefit.

More detail on DIAS standards and processes is available at:

2. If you’re a clinician wanting to refer for Medicare‑rebated mammograms

As an individual doctor or authorised practitioner, you don’t seek “accreditation for a mammogram code”. Instead, you need to be recognised for Medicare and have a provider number so your requests can attract a rebate when performed at an accredited practice.

Step 1 – Be professionally recognised under Medicare rules

To provide services or request services under the Medicare Benefits Schedule (MBS) , you generally must:

  • Hold appropriate qualifications (e.g. medical degree, fellowship, specialist registration).
  • Be registered with the relevant national board via Ahpra (e.g. Medical Board of Australia).
  • Meet eligibility under the Health Insurance Act 1973 and related regulations.

For most medical practitioners:

  • If you’re a GP with:
    • A Medicare provider number , and
    • Specialist registration in General Practice with Ahpra,
      you do not need a separate application to be recognised as a GP for Medicare.
  • If you’re a specialist , you typically need:
    • Fellowship with an Australasian specialist college, and
    • General or specialist registration with Ahpra (or other accepted forms of registration).

You must send a copy of your Ahpra registration certificate with your first provider number application.

Step 2 – Obtain a Medicare provider number

Apply through Services Australia for a Medicare provider number. This is what you use when:

  • Billing for your own services, and
  • Writing requests/referrals for services like mammography that attract Medicare rebates.

You can manage many of these tasks via Health Professional Online Services (HPOS).

Step 3 – Use the correct MBS items and clinical criteria

When referring for mammography, you must:

  • Specify the clinical indication clearly on the request (e.g. symptomatic breast lump, surveillance, high‑risk screening).
  • Ensure the patient meets the MBS eligibility criteria for the item you’re invoking.

Examples (non‑exhaustive):

  • Item 59302 – Screening 3D mammography for women at increased risk (e.g. significant family history, moderate/high risk).
  • Item 63464 – Screening breast MRI for women under 60 at very high risk (lifetime risk >30% or 10‑year risk >5%).
  • Other diagnostic mammography items exist for symptomatic or follow‑up imaging.

Some private breast clinics (e.g. Melbourne Comprehensive Breast Care) help by:

  • Calculating risk (e.g. using IBIS models).
  • Issuing compliant requests that meet MBS criteria.
  • Coordinating with accredited imaging providers.

As a referrer, your role is to:

  • Confirm the patient meets the risk/clinical criteria.
  • Write a clear, compliant request with the correct clinical details.
  • Send the patient to a DIAS‑accredited imaging practice with an LSPN.

3. Common scenarios and what “accreditation” means in each

Who you are| What you actually need| Who accredits / recognises you
---|---|---
Imaging practice doing mammograms| - LSPN from Services Australia
- DIAS accreditation for diagnostic imaging
- Eligible equipment| - Services Australia (LSPN)
- HDAA / NATA / QIP (DIAS) 13
GP or specialist referring| - Ahpra registration
- Medicare provider number
- Recognition under Health Insurance Regulations| - Ahpra (registration)
- Services Australia (provider number/recognition) 46
BreastScreen service| - Accreditation under the BreastScreen Australia national standards (separate from DIAS/MBS)| - State/territory BreastScreen programs & national standards 27

Note: BreastScreen Australia is a government screening program with its own accreditation standards and is separate from private Medicare‑rebated mammography, though both involve mammography.

4. Practical checklist if you’re setting up a mammography service

If your goal is to run a clinic or imaging centre that offers Medicare‑rebated mammography , your action list looks like:

  1. Register the practice
    • Complete HW061 form.
    • Submit via HPOS with full equipment details.
    • Obtain your LSPN.
  1. Achieve DIAS accreditation
    • Choose an approved accreditor (HDAA, NATA, or QIP).
    • Prepare documentation or MIAP evidence.
    • Undergo assessment and achieve at least entry‑level, then full accreditation.
  1. Confirm MBS eligibility
    • Identify which mammography MBS items you will offer.
    • Ensure your equipment and protocols meet requirements for those items.
  1. Set up claiming and compliance
    • Link your LSPN to your billing system.
    • Train staff on when Medicare benefits are and aren’t payable.
    • Implement the legal requirement to inform patients if you’re not accredited.
  1. Maintain accreditation
    • Participate in the DIAS maintenance program.
    • Plan for re‑accreditation every 4 years.

5. Where to get official information

  • Services Australia – Diagnostic imaging and radiation oncology
    • LSPN registration, forms, and guidance: servicesaustralia.gov.au (search “diagnostic imaging and radiation oncology”)
  • Medicare Benefits Schedule (MBS) Online
    • Search for specific mammography item numbers and notes (e.g. 59302, 55700, etc.).
  • BreastScreen Australia (for population screening program info)
    • health.gov.au – BreastScreen Australia Program

TL;DR

  • Individual clinicians : Get Ahpra registration, Medicare provider number, and be recognised under Medicare rules; then you can refer for Medicare‑rebated mammography using the correct MBS items.
  • Imaging practices : Register for an LSPN , obtain DIAS accreditation via HDAA/NATA/QIP, ensure eligible equipment, and then Medicare benefits are payable for mammography services.

Information gathered from public forums or data available on the internet and portrayed here.