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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.
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.
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.
Although the final item number has not yet been allocated, the criteria for assessing eligibility is listed below:
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;
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.
I will be able to discuss this in more detail with you at your consultation.
Medicare does not cover cosmetic procedures. A ‘Abdominoplasty’ 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.
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.
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.
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.
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.
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.
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.
Choosing the right procedure and surgeon is important. I believe that helping my clients make informed decisions is key to a great result so if you have a question or would like to know more about something specific, please let me know – Regards, Alex.