Medicare Benefits Schedule - Item 249

Participation by a prescribed medical practitioner in a residential medication management review (RMMR) for a patient who is a care recipient in a residential aged care facility—other than an RMMR for a resident in relation to whom, in the preceding 12 months, this item or item 903 has applied, unless there has been a significant change in the resident’s medical condition or medication management plan requiring a new RMMR

Fee: $98.90 Benefit: 100% = $98.90

(See para AN.7.1, AN.7.18, AN.15.3 of explanatory notes to this Category)

Extended Medicare Safety Net Cap: $296.70

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Last reviewed: 1 November 2023

A prescribed medical practitioner is a medical practitioner:

(a) who is not a general practitioner (see GN.4.13), specialist or consultant physician, and

(b) who:

a. is registered under section 3GA of the Act and is practising during the period, and in the location in respect of which the medical practitioner is registered, and insofar as the circumstances specified for paragraph 19AA(3)(b) of the Act apply; or

b. is covered by an exemption under subsection 19AB(3) of the Act; or

c. first became a medical practitioner before 1 November 1996.

Related Items: 179 181 185 187 189 191 203 206 214 215 218 219 220 221 222 223 228 231 232 235 236 237 238 239 240 243 244 245 249 272 276 277 279 281 282 283 285 286 287 301 303 733 737 741 745 761 763 766 769 772 776 788 789 792 2197 2198 2200 90092 90093 90095 90096 90098 90183 90188 90202 90212 90215

Publication date: 1 January 2025

SUMMARY

Medication management reviews are collaborative services through which a GP (see GN.4.13) or prescribed medical practitioner (see AN.7.1) works with a pharmacist to review the patient’s medications. The service is intended to support the quality use of medicines and identify patients  who may be at risk of medication misadventure.

Residential medication management reviews (RMMRs) are available to care recipients in a residential aged care facility (home).

Patients living in the community may be eligible for a domiciliary medication management review (see AN.0.52).

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

USE OF THE ITEMS

The Health Insurance (General Medical Services Table) Regulations 2021 (the Regulations) state that a RMMR is “a collaborative service provided by a general practitioner (for item 903), or a prescribed medical practitioner (for item 249), and a pharmacist to review the medication management needs of a care recipient in a residential aged care facility”. A residential aged care facility is defined with reference to the Aged Care Act 1997; the definition includes facilities formerly known as nursing homes and hostels (see GN.14.38).

The Regulations state:

1. “a medical practitioner’s involvement in a RMMR includes all of the following:

• discussing the proposed review with the resident and seeking the resident’s consent to the review;
• collaborating with the reviewing pharmacist about the pharmacist’s involvement in the review;
• providing input from the resident’s most recent comprehensive medical assessment or, if such an assessment has not been undertaken, providing relevant clinical information for the review and for the resident’s records;
• [(subject to point 2 below)] participating in a post‑review discussion if required (either face‑to‑face or by telephone) with the pharmacist to discuss the outcomes of the review including:
  • the findings of the review; and
  • medication management strategies; and
  • means to ensure that the strategies are implemented and reviewed, including any issues for implementation and follow‑up; and
• developing or revising the resident’s medication management plan after discussion with the reviewing pharmacist, and finalising the plan after discussion with the resident;
• offering a copy of the medication management plan to the resident (or the resident’s carer or representative if appropriate);
• providing copies of the plan for the resident’s records and for the nursing staff of the residential aged care facility; and
• discussing the plan with nursing staff if necessary.

2. A post‑review discussion is not required if:

• there are no recommended changes to the resident’s medication management arising out of the review; or
• any changes are minor in nature and do not require immediate discussion; or
• the pharmacist and medical practitioner agree that issues arising out of the review should be considered in a case conference.”

Do I need to see the resident as part of the RMMR?

Yes. The Regulations state that RMMRs 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 see the patient as part of the RMMR service. However, it is acknowledged that third parties, such a nurses or carers of people with communication difficulties, may need to communicate with the health professional at times during the consultation.

How often can an RMMR be provided to a patient?

Patients can have an RMMR (either item 249 or item 903) 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 RMMR in which case a service can be provided sooner than 12 months.

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 should document the reasons for the exceptional circumstances in their records.

RMMRs can be provided following admission of a new resident of residential aged care if appropriate. There is no time restriction applicable between their first RMMR and any previous domiciliary medication management reviews (items 245 and 900).

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

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

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

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 RMMR.

My patient had a domiciliary medication management review 6 months ago. Their condition has deteriorated significantly and they are now in residential aged care. How soon can they have a RMMR?

If it is clinically appropriate, the patient can have a RMMR once they are admitted to residential aged care. There is no time restriction between the provision of a domiciliary medication management review and a RMMR. It is recommended that the GP or prescribed medical practitioner document the reasons why the RMMR was clinically appropriate.

There is a pharmacist engaged through the Aged Care On-Site Pharmacist (ACOP) Measure at the facility. Is the resident still eligible for a RMMR?

Yes. Participation in the ACOP affects the source of payment for the pharmacist’s time, not the resident’s eligibility for a RMMR service. A key role of an ACOP is to review residents’ medications regularly and resolve any issues identified promptly. This is expected to reduce (but may not eliminate) the need for RMMRs.

ELIGIBLE PATIENTS

Care recipients of a residential aged care facility.

ELIGIBLE PRACTITIONERS

Item 903 can be claimed by General Practitioners (see GN.4.13).

Item 249 can be claimed by Prescribed Medical Practitioners (see AN.7.1).

RECORD KEEPING AND REPORTING REQUIREMENTS

The department undertakes regular post payment auditing to ensure that MBS items are claimed appropriately. 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 can be found on the Federal Register of Legislation at www.legislation.gov.au. Items 249 and 903 are set out in Health Insurance (General Medical Services Table) Regulations 2021.

Related Items: 249 903

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