As of the 1st of July 2022, women who meet the Medicare criteria for surgical repair of muscle separation as a result of pregnancy will now be able to access support from Medicare and Private Health Funds. The new abdominoplasty or tummy tuck medical item number and descriptions are yet to be defined, however, the government has confirmed postpartum women can once again access medical abdominoplasty from 1 July 2022.
Item Number 30175
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
Medicare has not specified the timing for an abdominal ultrasound scan, however, Dr Cheng would suggest a scan as soon as you have identified any symptoms of muscle separation. Your GP or surgeon can arrange a referral for this scan.
The muscle separation must be formally scanned and reported by a diagnostic imaging practice. As such, a physiotherapist does not qualify.
Acceptable examples of non-surgical treatment may include:
What is the minimum timeframe I must try non-surgical conservative treatment before I can qualify for an abdominoplasty?
Medicare does not dictate a minimum timeframe, however, you must be at least 12 months post-partum and have undergone and failed to respond to non-surgical conservative treatment including physiotherapy before qualifying for abdominoplasty.
It is still not clear as yet, which level of cover will be required, however, it is likely to be similar to post weightloss surgery items requiring gold tier cover.