Medicare Benefits Schedule - Note AN.0.52

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

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Participation by a prescribed medical practitioner in a Domiciliary Medication Management Review (DMMR) for a patient living in a community setting, in which the 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 the patient’s 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 900 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: $144.50 Benefit: 100% = $144.50

(See para AN.0.52, AN.7.1, AN.15.3 of explanatory notes to this Category)

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)