If you experience muscle separation, you may be wondering whether your surgery is covered by Medicare.
Previously, there has been no way for women who experience postpartum Rectus Diastasis (tummy muscle separation) to claim this surgery through Medicare.
Amazingly though, from TODAY (1st of July 2022), there is now a Medicare item number for Abdominoplasty surgery for women. This is fantastic news for many women who have been experiencing the challenges of muscle separation.
Abdominoplasty (also referred to as a tummy tuck) is a surgery that consists of the removal and tightening of the abdomen skin, removal of excess fat where appropriate, AND repositioning or tightening of the rectus abdominis muscles if required, with the aim of creating a smooth, flat and firmer abdomen.
The Medicare descriptor for eligibility are as follows:
30175 – Item Descriptor
Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, where the patient has an abdominal wall defect as a consequence of pregnancy, if:
(a) The patient:
(i) Has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
(ii) has symptoms of at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use and/or low back pain or urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service; and
(iii) Has failed to respond to non-surgical conservative treatment including physiotherapy; and
(iv) Has not been pregnant in the last 12 months
(b) the service is not a service associated with a service to which item 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies.
The reinstatement of this Medicare item number is such amazing news and a huge win for those women who require surgery to help repair their muscles and damage to their abdomens after giving birth.
If you are considering surgery please contact Avery on 02 4002 4150 for further information or to arrange your consultation with Dr Gary Avery (FRACS).