New Medicare item number for post-partum muscle separation
We are pleased to inform women who require a tummy tuck (abdominoplasty) surgery to address muscle separation after pregnancy that the Medicare rebate for this procedure has been reinstated.
In 2016, Medicare discontinued coverage for the surgical repair of abdominal muscles following concerns about its misuse for cosmetic purposes. However, the Australian Society of Plastic Surgeons and its members have diligently worked towards reintroducing this coverage to assist mothers dealing with excess skin and muscle separation. Effective from 1 July 2022, a new item number, 30175, has been introduced by Medicare.
This development is a significant achievement for women experiencing post-partum rectus diastasis (tummy muscle split).
Eligibility criteria
To be eligible for the new Medicare item number 30175, the below criteria must be met:
- Cause – The rectus diastasis was caused by pregnancy.
- Timing – You 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 – You must have documented symptoms of pain or discomfort at the site and/or low back pain or urinary symptoms.
- Other treatment has failed – You must have tried and failed to respond to non-surgical 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.
Your Specialist Plastic Surgeon will make the final decision on whether or not you meet the criteria.
Your GP will need to provide you with a referral to see us and it should be well-documented in the referral the non-surgical management and treatment options that have been undertaken. Your GP can also refer you for the required ultrasound and include the radiologist’s report with your GP referral.
What is my next step?
The ideal initial step is to make an appointment with your GP to discuss and/or be referred for non-surgical treatment alternatives or symptom management.
It is also recommended you review your private health insurance options to see if there are any waiting period required to be completed prior to claiming this procedure.
If you have private health insurance, your policy will need to cover Plastic and reconstructive surgery (medically necessary). Most plastic and reconstructive surgery (medically necessary) is only covered by Silver-level or above coverage. This means that if you have Bronze-level health insurance, your private health fund is unlikely to contribute to this surgery. We recommend that you look into your private health insurance coverage to see if it would be more cost-effective to increase your coverage before undergoing surgery. This is largely dependent on your unique circumstances. Please keep in mind that you will still have some out-of-pocket expenses.
Cost of Procedure
The factors listed below will impact how much you will pay:
- Medicare eligibility (if you do not have Medicare, this recent announcement won’t change how you access this procedure and you will still need to pay full fees)
- Private health insurance level and coverage
- Specialist Plastic Surgeon’s fee
- Final amount Medicare will cover
- Private hospital facility costs
- Anaesthesia fees
- Prescriptions for medication
- Post-surgery garments
Your surgeon and their secretary will be able to discuss this in more detail with you during your initial consultation and provide you with a full surgical fee estimate.
Please contact us online or call us on (08) 9380 0333 and one of our medical secretaries can provide you with more information. Please note that pricing does vary from case to case.
