Medicare win for mothers

The good news

As of 1 July 2022, a Medicare item number for performing abdominoplasty to treat post-partum rectus diastasis is being reintroduced. The item number will make abdominoplasty a more accessible solution for women whose stomach muscles split during pregnancy.

Abdominoplasty for treating post-partum rectus diastasis – commonly confused with a ‘tummy tuck’ – was previously covered by Medicare until 2016, when it was removed for fear that it was being used for cosmetic purposes. However, Medicare support (30175) is being re-introduced from 1 July 2022.

Dr Andre Safvat is proud to support women who need surgery to treat post-partum rectus diastasis by providing Medicare-supported treatment under the new regulation. Read on to determine your eligibility and how to access the procedure.

What is abdominal rectus diastasis?

Rectus diastasis is when the rectus muscle at the front of the abdominal wall (also called the 6 pack abs muscles) separate. It is often called ‘abdominal separation’ or ‘ab gap’. The two muscles from each side are usually connected by a thin band of tissue called the linea alba. Pregnancy places a lot of extra pressure on these muscles, which can cause the linea alba to stretch or tear and your abdominal muscles to grow apart.

Diastasis recti most often develops in the third trimester and often does not become visible until after you have given birth. The rectus abdominis muscles separation may make your belly stick out or bulge out. If affected, you will feel a gap between your left and right belly muscles which you can generally fit one or two fingers in. Even with exercise you can make the muscles stronger but generally you cannot fix the stretching of the linea alba and hence the muscle separation. Repairing this not only the abdomen and waist line a better cosmetic look but also helps with the core function.

Who is eligible?

According to the Medicare item number listing, you may be eligible if:

• The rectus diastasis was caused by pregnancy (no other factors)
• You gave birth at least 12 months ago
• The gap between your abdominal muscles is at least 3 centimetres (proven by diagnostic imaging for example an ultrasound)
• You have tried other treatments (such as physiotherapy or pain medication) and they have not adequately improved your symptoms.

The decision on whether or not you are eligible ultimately lies with the specialist plastic surgeon who will perform the procedure. However, it helps if you have affirmation from other medical professionals before you can go ahead. These people include:

• Your GP, with whom you will need to trial other management options and get a referral to see a plastic surgeon
• A radiologist, who needs to conduct an ultrasound and determine that the gap between the rectus muscles is over 3cm to warrant surgery
• A physiotherapist or exercise physiologist, who will guide you through other non-operative management techniques and attest to whether they are successful.

How much will it cost to get an abdominoplasty?

The full cost of getting an abdominoplasty can vary greatly depending on exactly what needs to be done as well as on your private healthcare cover.

If you qualify under the new item number, you will receive a rebate from Medicare and your health fund. Also, the hospital costs are usually covered by your private health fund. However, it does depend on the level and type of cover. There will be an out-of-pocket fee for Dr Safvat as well as the anaesthetist and this will be discussed further during your initial consultation where a detailed estimate will be provided.

Does this mean Medicare will cover my tummy tuck?

Remember that an abdominoplasty to treat post-partum rectus diastasis is not the same as a tummy tuck. A ‘tummy tuck’ is considered a cosmetic procedure, which Medicare does not cover. To be eligible for Medicare subsidy, the abdominoplasty must be performed with the goal of addressing functional impairments.

As with all new item numbers, Medicare will review the procedure’s usage again in two years. If they find reason to believe it is being misused for cosmetic reasons, they will likely remove it once again and make it inaccessible to women who need it for functional reasons. Dr Safvat cannot use the item number to perform the surgery for cosmetic reasons alone, as doing so is misuse of Medicare funding.

This does not mean that you cannot have a tummy tuck at all. You may be eligible to have a tummy tuck under massive weight loss criteria which again can be determined by Dr Safvat during consultation. If your tummy tuck does not accompany a functional impairment or weight loss criteria, it cannot be performed with a Medicare rebate, however, you can still receive tummy tuck surgery after pregnancy if you agree to the full costs as a cosmetic procedure.

How Ethique Plastic Surgery can help

As Dr Andre Safvat is a fully accredited Specialist Plastic Surgeon, he is permitted to assess your eligibility for abdominoplasty under the new item number and perform it. Tummy Tuck is a specific area of interest for Dr Safvat and he performs this procedure regularly with excellent results.

If you feel that you may be suitable for a subsidised abdominoplasty following your pregnancy under Medicare’s new guidelines, we encourage you to ask your GP for a referral to Ethique Plastic Surgery. Dr Andre Safvat will assess your suitability during the initial consultation. If you are not eligible or if the procedure is not in your best interest, he will advise alternative pathways to getting the results you need.

Patients should discuss with their GP and Plastic Surgeon as to whether surgery is a good option for them. All surgery comes with risks which will be discussed during consultation. Your final results can take up to 12 months or more to be seen. Before proceeding, it is recommended that you seek a second opinion from an appropriately qualified health practitioner.

DR ANDRE SAFVAT  (MED1155201)
Registered Medical Practitioner, Specialist Plastic Surgeon (specialist registration in Surgery – Plastic surgery).