Medicare Benefits Schedule - Item 900

Participation by a general practitioner (not including a specialist or consultant physician) in a Domiciliary Medication Management Review (DMMR) for a patient living in a community setting, in which the general practitioner, with the patient’s consent:
(a) assesses the patient as:
(i) having a chronic medical condition or a complex medication regimen; and
(ii) not having their therapeutic goals met; and
(b) following that assessment:
(i) refers the patient to a community pharmacy or an accredited pharmacist for the DMMR; and
(ii) provides relevant clinical information required for the DMMR; and
(c) discusses with the reviewing pharmacist the results of the DMMR including suggested medication management strategies; and
(d) develops a written medication management plan following discussion with the patient; and
(e) provides the written medication management plan to a community pharmacy chosen by the patient
For any particular patient—applicable not more than once in each 12 month period, and only if item 245 does not apply in the same 12 month period, except if there has been a significant change in the patient’s condition or medication regimen requiring a new DMMR

Fee: $180.65 Benefit: 100% = $180.65

(See para AN.0.52, AN.15.3 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $500.00

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Publication date: 1 July 2025

SUMMARY

This note sets out the requirements for domiciliary medication management reviews (DMMRs), also known as home medication management reviews. DMMRs allow GPs (see GN.4.13) and prescribed medical practitioners (see AN.7.1) to refer to, and work with, a pharmacist to maximise a patient’s benefit from their medication and prevent or reduce the risk of medication-related problems.

DMMRs are for patients living in the community. Patients who are care recipients in a residential aged care facility may be eligible for a Residential Medication Management Review (see AN.7.18).

While the GP’s or prescribed medical practitioner’s work in the DMMR is supported through the MBS, the pharmacist’s participation is funded through other programs.

From 1 July 2027 DMMRs patients will require a GP chronic condition management plan to access DMMRs.

USE OF THE ITEMS

The requirements for DMMRs are set out in the Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations). The Regulations specify that a DMMR consists of the following activities, that must be undertaken by the GP or prescribed medical practitioner with the patient’s consent:

"a) assesses the patient as:

i. having a chronic medical condition or a complex medication regimen; and

ii. not having their therapeutic goals met; and

b) following that assessment:

i. refers the patient to a community pharmacy or an accredited pharmacist for the DMMR; and

ii. provides relevant clinical information required for the DMMR; and

c) discusses with the reviewing pharmacist the results of the DMMR including suggested medication management strategies; and

d) develops a written medication management plan following discussion with the patient; and

e) provides the written medication management plan to a community pharmacy chosen by the patient”

Do I need to see the patient as part of the DMMR?

Yes. The Regulations state that DMMRs are a “service provided in the course of personal attendance by a single [general practitioner/prescribed medical practitioner] on a single patient”. This means that the medical practitioner must physically see the patient as part of the DMMR service.

However, the medical practitioner’s interactions with the pharmacist can be done in writing, or by video or phone.

How often can a DMMR be provided to a patient?

Patients can have a DMMR (either item 245 or item 900) every 12 months if it is clinically appropriate. Exceptional circumstances apply if there is a significant change in the patient’s medical condition or medication management plan requiring a new DMMR, in which case a service can be provided sooner than 12 months. It is a matter for the GP or prescribed medical practitioner’s professional judgement to determine whether exceptional circumstances warrant an early DMMR.

Services Australia needs to be advised that exceptional circumstances apply to pay a benefit sooner than is generally allowable. To facilitate this the patient's invoice, Medicare voucher or the digital claim should indicate that exceptional circumstances are in play, no further explanation is required to support payment. However, the GP or prescribed medical practitioner must also ensure that their records are adequate, contemporaneous and include the nature of the exceptional circumstances.

This is a complex service. When can I bill the MBS?

An MBS claim can only be submitted once all the requirements of the DMMR have been completed (i.e. at the end of the DMMR).

Can I claim another service for the same patient on the same day as the DMMR?

In general, yes. However, there are some limitations including:

• both services must be clinically relevant and distinct services
• the other item must not have restrictions on same day claiming with an DMMR. For items requiring the attendance of the provider and the patient the date recorded as the date of service as being the date of the attendance.

If the consultation with the patient relates solely to the DMMR only the DMMR items can be claimed.

ELIGIBLE PATIENTS

Patients assessed as having a chronic medical condition and not having their therapeutic goals met are eligible for a DMMR. Patients must be living in the community. The Regulations define living in the community as meaning “the patient is not an inpatient of a hospital or a care recipient in a residential aged care facility.”

From 1 July 2027 patients will only be eligible for DMMRs if they have a GP chronic condition management plan and that plan was put in place or reviewed in the last 18 months.

ELIGIBLE PRACTITIONERS

DMMR items are available for different practitioner types:

• general practitioner items can be claimed by GPs only (see GN.4.13) – item 900
  
  
• prescribed medical practitioner items can be claimed by prescribed medical practitioners only (see AN.7.1) – item 245

RECORD KEEPING AND REPORTING REQUIREMENTS

Providers are responsible for ensuring services claimed from Medicare using their provider number meet all legislative requirements and they may be required to submit evidence for compliance checks related to Medicare claims. Practitioners should ensure they keep adequate and contemporaneous records. For information on what constitutes adequate and contemporaneous records see GN.15.39.

Clause 4.3 of the Health Insurance Act 1973 specifies that, where an item specifies the creation of a document (however described) and a document is created, the document must be retained for the period of 2 years.

RELEVANT LEGISLATION

Details about the legislative requirements of the MBS item(s) can be found on the Federal Register of Legislation at www.legislation.gov.au. items 245 and 900 are set out in the Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 245 900

Publication date: 1 July 2025

Summary

This note provides an overview of MBS items to support the management of patients with chronic conditions in general practice by general practitioners (see GN.4.13) and prescribed medical practitioners (see AN.7.1). For detailed information on the individual items, including item requirements and patient eligibility, see item-specific notes listed below. 

MBS and management of patients with chronic conditions

There are a range of MBS items for clinically relevant services provided in general practice for patients with chronic conditions. These include: 

• time-tiered attendance items (see AN.0.9), which can be used when a more specific MBS item does not apply

• health assessment items for early detection and prevention of chronic conditions in specific patient cohorts (see AN.0.36, AN.0.43, AN.14.2 and AN.14.3)
  
  
• items to support general practitioners and prescribed medical practitioners to develop and review plans the care of patients with a chronic condition and, where relevant, refer patients to MBS-supported allied health services (see AN.0.47 for chronic condition management plans and AN.15.7 and AN.15.8 for multidisciplinary care plans)
  
  
• medication management reviews to support quality use of medicines and minimise the risk of medication misadventure (see AN.0.52 and AN.7.18)
  
  
• case conferencing items to support multidisciplinary team care (see AN.0.49).

Patients with a mental health condition or eating disorder may be eligible for treatment through the Better Access mental health items (see AN.0.56) or eating disorder items (see AN.36.2).

It is important to note that:

• some of these items have specific eligibility criteria that are detailed in the item-specific explanatory notes, and
  
  
• all MBS services must be clinically relevant, meaning they are generally accepted in the medical profession as necessary for the appropriate treatment of the patient

General practitioners and prescribed medical practitioners in primary care can also refer patients to specialists where appropriate as part of the management of their chronic condition.

GP chronic condition management plans and multidisciplinary care plans 

GP chronic condition management plans and multidisciplinary care plan items allow GPs/prescribed medical practitioners to develop and periodically review structured plans for patients with a chronic condition. 

Patient Eligibility 

These items are available to patients that have at least one medical condition that has been (or is likely to be) present for at least 6 months, or is terminal. There is no list of eligible conditions. It is up to the GP or prescribed medical practitioner’s clinical judgment to determine whether an individual patient with a chronic condition would benefit from a structured plan for the management of their condition. 

In considering the need for a structured plan, GPs and prescribed medical practitioners need to ensure the service is clinically relevant, which is a requirement of the Health Insurance Act 1973. The Act defines a clinically relevant services as “a service rendered by a medical or dental practitioner or an optometrist that is generally accepted in the medical, dental or optometric profession (as the case may be) as being necessary for the appropriate treatment of the patient to whom it is rendered.”

GP chronic condition management plans

A GP chronic condition management plan is a plan that is developed collaboratively between the general practitioner/prescribed medical practitioner and the patient for the management of the patient’s chronic condition(s). Patients registered with a practice through MyMedicare must access these services through the practice at which they are registered. Patients that are not registered can access these services from their usual medical practitioner See AN.0.47 for detailed information on GP chronic condition management plans. 

Multidisciplinary care plans

Multidisciplinary care plans allow for the general practitioner/prescribed medical practitioner to contribute to a plan which may be coordinated by another person. MBS items 232, 731, 92027 and 92058 are available for patients living in a residential aged care facility; MBS items 231, 729, 92026 and 92057 are available for patients not in residential aged care.

Patients living in residential aged care who have a multidisciplinary care plan have the same access to allied health and other services as patients with a GP chronic condition management plan.

See AN.15.7 and AN.15.8 for detailed information.

Services available under GP chronic condition management plans and multidisciplinary care plans

A range of MBS-supported multidisciplinary services may be available to patients with a GP chronic condition management plan or a multidisciplinary care plan, where those services are consistent with the plan.

Patients who had a GP management plan and/or team care arrangement prior to 1 July 2025 can continue to access the services outlined below until 30 June 2027 under those plans. For more information about the transition arrangements for GP chronic condition management plans see AN.15.5.

Services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner

Patients with a GP chronic condition management plan or a multidisciplinary care plan can access up to 5 services per calendar year provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner on behalf of a medical practitioner to support management of their chronic condition (MBS items 93201, 93203 and 10997). The services provided must be consistent with the patient’s plan. See MN.12.4 for detailed information about the use of these items.

For follow up services provided by a practice nurse or Aboriginal and Torres Strait Islander health practitioner, on behalf of a medical practitioner, for a person of Aboriginal or Torres Strait Islander descent who has received a health assessment see MN.12.3.

Individual allied health services

Patients with a GP chronic condition management plan or care recipient of an aged care facility that have a multidisciplinary care plan can access up to 5 (10 for a person of Aboriginal or Torres Strait Islander descent) individual MBS supported allied health services per calendar year. The allied services provided must be consistent with the patient’s plan and a referral is required.

For more information on the types of allied health services available see AN.15.4.

For detailed information about the allied health items see MN.3.1.

For information on referral requirements for allied health see AN.15.6.

Group allied health service for patients with type 2 diabetes

Patients with type 2 diabetes who have a GP chronic condition management plan, or are a care recipient of an aged care facility and have a multidisciplinary care plan, can be assessed for their suitability for group diabetes education, exercise physiology or dietetics services. Patients are eligible for one assessment per calendar year and, if they are found suitable, up to 8 group services per calendar year.

For detailed information on suitability assessments and group allied health services see MN.9.1 and MN.9.2.

Related Items: 231 232 245 249 392 393 729 731 900 903 965 967 10950 10951 10952 10953 10954 10955 10956 10957 10958 10959 10960 10962 10964 10966 10968 10970 10997 81100 81105 81110 81115 81120 81125 81300 81305 81310 81315 81320 81325 81330 81335 81340 81345 81350 81355 81360 92026 92027 92029 92030 92057 92058 92060 92061 93201 93203