Positive News For Women – Medicare funding confirmed for Abdominoplasty

After reaching out to the community and to its Members in October 2021, The Australian Society of Plastic Surgeons (ASPS) campaigned to secure important support for their application to create a new MBS item number for abdominoplasty with repair of rectus diastasis after pregnancy.

Having this procedure added to the MBS is a welcome change, and one that will positively impact many women at a vulnerable time in their lives. This Medicare benefit is available to mothers who fit the criteria for reconstruction of abdominal separation that physio, diet or exercise can’t impact. This benefit may also be available if back pain and incontinence becomes a chronic problem.

The item number 30175 is now available on the MBS (as of 1 July 2022).

What is the eligibility criteria in order to receive the Medicare subsidy?

The descriptor includes the following criteria:

• Cause. The rectus diastasis (tummy muscle split) was caused by pregnancy
• Timing. The patient must be at least 12 months post-partum at the time of receiving the surgery
•  Gap measurement. The gap between abdominal muscles must be at least 3cm as evidenced by an ultrasound
• Symptoms. The patient must have documented symptoms of pain or discomfort at the site and/or low back pain or urinary symptoms
•  Other treatment failed. The patient must have tried and failed to respond to nonsurgical treatment options such as physiotherapy.
• Other examples of non-surgical treatment may be: symptomatic management with pain medication, lower back braces, lifestyle changes, physiotherapy and/or exercise.

Who decides if I’m eligible?

To qualify for the procedure under Medicare, the decision ultimately sits with the Specialist Plastic Surgeon you see to determine whether you meet the criteria. However, ASPS expect the following medical practitioners would have also been consulted with. ASPS would also expect those practitioners would provide the operating surgeon with confirmation of whether each patient may be eligible.

1. GP would have been seen for non-surgical management and treatment options. GPs would also need to make the referral to the Specialist Plastic Surgeon who will perform the surgery.

2. Physiotherapist or other Allied Health practitioner such as an Exercise Physiologist may be seen if the patient tried physiotherapy or exercise programs

3. Radiologist must have conducted an ultrasound to measure and confirm the gap between the abdominal muscles.

Impact of Item Number 30175

The introduction of item number 30175 on the MBS is a significant advancement for post-pregnancy healthcare in Australia. It offers relief to many women suffering from rectus diastasis, reducing the financial burden and improving their quality of life. This acknowledgment of the condition’s impact underscores the necessity of accessible surgical intervention.

Looking Ahead

As the implementation of item number 30175 begins, the medical community will continue to refine the referral and treatment processes. This initiative is a triumph for patient advocacy, setting a precedent for future advancements in women’s health and emphasizing the power of community-driven healthcare improvements.