diff --git a/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcher.java b/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcher.java
new file mode 100644
index 00000000000..e89ef96091c
--- /dev/null
+++ b/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcher.java
@@ -0,0 +1,39 @@
+package ca.uhn.fhir.mdm.rules.matcher;
+
+import ca.uhn.fhir.context.FhirContext;
+import org.hl7.fhir.instance.model.api.IBase;
+import org.hl7.fhir.instance.model.api.IBaseExtension;
+import org.hl7.fhir.instance.model.api.IBaseHasExtensions;
+import org.hl7.fhir.r4.model.Extension;
+import org.hl7.fhir.r4.model.StringType;
+
+import java.util.List;
+
+public class ExtensionMatcher implements IMdmFieldMatcher{
+	@Override
+	public boolean matches(FhirContext theFhirContext, IBase theLeftBase, IBase theRightBase, boolean theExact, String theIdentifierSystem) {
+		List<? extends IBaseExtension<?, ?>> leftExtension = null;
+		List<? extends IBaseExtension<?, ?>> rightExtension = null;
+		if (theLeftBase instanceof IBaseHasExtensions && theRightBase instanceof IBaseHasExtensions){
+			leftExtension = ((IBaseHasExtensions) theLeftBase).getExtension();
+			rightExtension = ((IBaseHasExtensions) theRightBase).getExtension();
+		}
+		else{
+			return false;
+		}
+
+		boolean match = false;
+
+		for (IBaseExtension leftExtensionValue : leftExtension) {
+			if (leftExtensionValue.getUrl().equals(theIdentifierSystem) || theIdentifierSystem == null) {
+				for (IBaseExtension rightExtensionValue : rightExtension) {
+					if (rightExtensionValue.getUrl().equals(theIdentifierSystem) || theIdentifierSystem == null) {
+						match |= ((StringType) ((Extension) leftExtensionValue).getValue()).getValueAsString().equals(((StringType) ((Extension) rightExtensionValue).getValue()).getValueAsString())
+							&& leftExtensionValue.getUrl().equals(rightExtensionValue.getUrl());
+					}
+				}
+			}
+		}
+		return match;
+	}
+}
diff --git a/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/MdmMatcherEnum.java b/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/MdmMatcherEnum.java
index e95a2d961e3..458387d14d3 100644
--- a/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/MdmMatcherEnum.java
+++ b/hapi-fhir-server-mdm/src/main/java/ca/uhn/fhir/mdm/rules/matcher/MdmMatcherEnum.java
@@ -50,7 +50,8 @@ public enum MdmMatcherEnum {
 
 	IDENTIFIER(new IdentifierMatcher()),
 
-	EMPTY_FIELD(new EmptyFieldMatcher());
+	EMPTY_FIELD(new EmptyFieldMatcher()),
+	EXTENSION_ANY_ORDER(new ExtensionMatcher());
 
 	private final IMdmFieldMatcher myMdmFieldMatcher;
 
diff --git a/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/config/MdmRuleValidatorTest.java b/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/config/MdmRuleValidatorTest.java
index 514d4da0eb6..755bd168814 100644
--- a/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/config/MdmRuleValidatorTest.java
+++ b/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/config/MdmRuleValidatorTest.java
@@ -151,6 +151,16 @@ public class MdmRuleValidatorTest extends BaseR4Test {
 		}
 	}
 
+	@Test
+	public void testMatcherExtensionJson() throws IOException {
+		try {
+			setMdmRuleJson("rules-extension-search.json");
+		}
+		catch (ConfigurationException e){
+			fail("Unable to validate extension matcher");
+		}
+	}
+
 	private void setMdmRuleJson(String theTheS) throws IOException {
 		MdmRuleValidator mdmRuleValidator = new MdmRuleValidator(ourFhirContext, mySearchParamRetriever);
 		MdmSettings mdmSettings = new MdmSettings(mdmRuleValidator);
diff --git a/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcherR4Test.java b/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcherR4Test.java
new file mode 100644
index 00000000000..3b437794adc
--- /dev/null
+++ b/hapi-fhir-server-mdm/src/test/java/ca/uhn/fhir/mdm/rules/matcher/ExtensionMatcherR4Test.java
@@ -0,0 +1,73 @@
+package ca.uhn.fhir.mdm.rules.matcher;
+
+
+import org.hl7.fhir.r4.model.Patient;
+import org.hl7.fhir.r4.model.StringType;
+import org.junit.jupiter.api.Test;
+
+import static org.junit.jupiter.api.Assertions.assertFalse;
+import static org.junit.jupiter.api.Assertions.assertTrue;
+
+public class ExtensionMatcherR4Test extends BaseMatcherR4Test {
+	@Test
+	public void testPatientWithMatchingExtension(){
+		Patient patient1 = new Patient();
+		Patient patient2 = new Patient();
+
+		patient1.addExtension("asd",new StringType("Patient1"));
+		patient2.addExtension("asd",new StringType("Patient1"));
+
+		assertTrue(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, null));
+	}
+
+	@Test
+	public void testPatientWithoutMatchingExtension(){
+		Patient patient1 = new Patient();
+		Patient patient2 = new Patient();
+
+		patient1.addExtension("asd",new StringType("Patient1"));
+		patient2.addExtension("asd",new StringType("Patient2"));
+
+		assertFalse(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, null));
+	}
+
+	@Test
+	public void testPatientSameValueDifferentUrl(){
+		Patient patient1 = new Patient();
+		Patient patient2 = new Patient();
+
+		patient1.addExtension("asd",new StringType("Patient1"));
+		patient2.addExtension("asd1",new StringType("Patient1"));
+
+		assertFalse(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, null));
+	}
+
+	@Test
+	public void testPatientWithMultipleExtensionOneMatching(){
+		Patient patient1 = new Patient();
+		Patient patient2 = new Patient();
+
+		patient1.addExtension("asd",new StringType("Patient1"));
+		patient1.addExtension("url1", new StringType("asd"));
+		patient2.addExtension("asd",new StringType("Patient1"));
+		patient2.addExtension("asdasd", new StringType("some value"));
+
+		assertTrue(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, null));
+	}
+
+	@Test
+	public void testSpecificIdentifierSystem(){
+		Patient patient1 = new Patient();
+		Patient patient2 = new Patient();
+
+		patient1.addExtension("asd",new StringType("Patient1"));
+		patient1.addExtension("url1", new StringType("asd"));
+		patient2.addExtension("asd",new StringType("Patient1"));
+		patient2.addExtension("asdasd", new StringType("some value"));
+		patient2.addExtension("url1", new StringType("some value 123"));
+
+		assertTrue(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, null));
+		assertTrue(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, "asd"));
+		assertFalse(MdmMatcherEnum.EXTENSION_ANY_ORDER.match(ourFhirContext, patient1, patient2, false, "url1"));
+	}
+}
diff --git a/hapi-fhir-server-mdm/src/test/resources/rules-extension-search.json b/hapi-fhir-server-mdm/src/test/resources/rules-extension-search.json
new file mode 100644
index 00000000000..706180de603
--- /dev/null
+++ b/hapi-fhir-server-mdm/src/test/resources/rules-extension-search.json
@@ -0,0 +1,17 @@
+{
+	"version": "1",
+	"mdmTypes": ["Organization"],
+	"candidateSearchParams" : [],
+	"candidateFilterSearchParams" : [],
+	"matchFields" : [ {
+		"name" : "Organization-extension",
+		"resourceType" : "Organization",
+		"resourcePath" : "identifier",
+		"matcher" : {
+			"algorithm": "EXTENSION_ANY_ORDER"
+		}
+	}],
+	"matchResultMap" : {
+		"Organization-extension" : "MATCH"
+	}
+}