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After petitioning Medicare to reinstate the abdominoplasty number, I am glad to report that it will be returning to the MBS on 1st July this year! It will help thousands of women who have significant issues related to this issue who don’t fall under the category of massive weight loss.

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.

In response to recommendations from the Independent Medical Services Advisory Committee (MSAC), the Government has announced it will invest $6.6 million to reintroduce Abdominoplasty to the MBS as part of the 2022/23 budget.

This represents a major win for women who experience post-partum rectus diastasis.

The item number will be available on the MBS from the 1st of July 2022.

 

Timeline

This timeline shows the journey to date, beginning in 2016 when the Medicare benefit was removed. Funding has been confirmed for this item number in the 2022-23 Budget and the item number is set to come into effect from 1st of July 2022. Please note the official item number has not yet been allocated: If you would like to be kept informed of this date, please complete the contact us form below.

Frequently asked questions

1. What do the recent announcements around surgical repair of rectus diastasis mean?

The Medical Services Advisory Committee (MSAC) is the authoritative body that advises the Minister for Health and the Commonwealth Department of Health on what procedures should be partially covered by Medicare (i.e. subsidised). Surgery to sew the abdominal muscles back together after pregnancy used to be covered by Medicare but was removed from the Medicare Benefits Schedule (MBS) in 2016 after concerns it was being misused for cosmetic purposes.

The fact that MSAC has made a ruling to support an MBS item for the repair of rectus diastasis (tummy muscle split) for some women after pregnancy is a major win for those women.

Allocation for funds to support an item number for the procedure has been formally announced in 2022-23 Federal Budget.

The commencement date for the item number has been set for 1 July 2022. Although the item number has not yet been allocated, you may be able to see the eligibility criteria below.

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

Although the final item number has not yet been allocated, the criteria for assessing eligibility is listed below:

  • 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 diagnostic imaging.
  • 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 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.

3. 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.

You will need to;

  • See your GP for non-surgical management and treatment options.
  • Obtain a Drs Referral from your GP
  • Have failed to respond to non-surgical conservative treatment including physiotherapy.

4. What does being covered by Medicare mean to me & what are the likely costs?

Medicare is a Commonwealth Government scheme to provide rebates for treatment by registered health providers for procedures that have been agreed upon as affecting people’s health as well as for consultations and other health services. All Australian permanent residents and citizens have access to Medicare. However, for temporary residents or visitors, access to Medicare depends on your specific visa conditions.

If you do not have Medicare or Medicare rights, this recent announcement won’t change how you access this procedure and you will still need to pay full fees.

The factors listed below will impact how much you will pay.

  • Medicare eligibility
  • Private Health Insurance status and coverage
  • Surgeon’s fee
  • Final amount Medicare cover (this is called the ‘Schedule Fee’). The fee that has been allocated on the MBS schedule is $1025.60 with a benefit of 75% =$769.20 – this is an indication only.
  • Hospital or surgical facility costs
  • Anaesthesia fees
  • Prescriptions for medication
  • Post-surgery garments
  • Medical tests, such as ultrasounds
  • Any costs associated with non-surgical prior treatment, such as physiotherapy

I will be able to discuss this in more detail with you at your consultation.

5. What if I just don’t like the look of my tummy after pregnancy?

Medicare does not cover cosmetic procedures. A ‘tummy tuck’ is considered cosmetic. Those women seeking to improve the aesthetic appearance of their bodies rather than address a functional impairment will continue to have to pay the full cost of this procedure with no subsidy by Medicare or private health insurers.

This is why there are such tight eligibility criteria – to ensure it cannot be misused at the expense of public money. We know that the procedure was removed from the MBS in 2016 due to concerns it was being used for cosmetic purposes. So we are urging patients and surgeons to ensure the criteria is clearly met before claiming this item to avoid the misuse of Medicare funding.

Medicare will also be conducting a review of usage of this procedure 2 years after it is implemented. If there is concern it is being misused for cosmetic purposes, we risk it being removed once again from the MBS to the detriment of those women who genuinely need this procedure for functional reasons.

6. When can I access this through Medicare?

As is indicated in the Timeline below, this is a long and complex process. We can formally confirm that the item number will be available from the 1st of July 2022.

7. What can I do to prepare for this surgery whilst awaiting its availability?

The number is set to come into effect from 1st of July 2022. There are a few things you can do in the meantime if you think you may be eligible.

  1. See your GP to discuss non-surgical treatment options or management of symptoms. These may include, but are not limited to: physiotherapy and/or exercise, symptomatic management with pain medication, lifestyle changes, lower back braces, etc. Bear in mind it will most likely be a requirement that you have tried to treat your rectus diastasis with non-surgical options before considering surgery. Your GP may refer you to a physiotherapist or other health professional to try non-surgical treatment options.
  2. Look into your Private Health Insurance options so any wait times for claiming certain procedures can be ticking over whilst awaiting this procedure to become available. See the above question – What does being covered by Medicare mean to me & what are the likely costs? For some information that might help you decide.

8. How can I make sure I don’t miss out on important updates and details?

If you would like us to update you by email when the new Medicare item number for abdominoplasty with repair of rectus diastasis after pregnancy has been allocated, please complete the contact form below.

9. My doctor tells me I won’t be eligible. What can I do now?

Given the tight eligibility criteria for this item number, it is expected there will be some women who may be experiencing some symptoms related to rectus diastasis but will not be eligible for this abdominoplasty under Medicare.

If you do not meet the Medicare eligibility criteria you can still have this procedure but will have to self-fund the full costs. Below are some other treatment or management options that may be applicable. As with any medical or health issue, this is just a list of some of the possible options and whether they are the right options for you will require a detailed discussion with your health care provider so your individual circumstances can be considered.

  • GP management of symptoms
  • Physiotherapy programs tailored to you and your symptoms (rectus diastasis, urinary incontinence, back pain etc.)
  • Exercise programs aimed at improving core stability and functionality
  • Sometimes rectus diastasis and hernias are related and there are some hernia procedures covered by Medicare so it might be worth discussing whether your symptoms could be managed through hernia repair with your GP.
  • There are also currently existing item numbers for abdominoplasty but they are limited to patients who have experienced massive weight loss (not postpartum weight loss) and where there was an intraabdominal tumour that caused the rectus diastasis.

We understand that finding out about this news and discovering you may not be eligible can be hard to hear, so encourage you to talk with family, friends, and health care providers.

Keeping you informed

Would you like us to keep you updated on the progress?

If you would like us to update you by email when the new Medicare item number for abdominoplasty with repair of rectus diastasis after pregnancy has been allocated, please contact us.

 

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