Medicare Australia is designed to provide affordable and accessible healthcare services to all Australian citizens. It covers a wide range of medical procedures, including primary care, specialist consultations, diagnostic tests, and surgeries. However, understanding the ins and outs of Medicare can be challenging, especially when it comes to specific procedures like diastasis recti repair. In this blog, we will discuss diastasis recti repair, its Medicare coverage, eligibility requirements, out-of-pocket costs, and other financial assistance options
Dr Carmen Munteanu is a specialist plastic surgeon based in Melbourne well-known for her experience in body contouring procedures. She offers a range of procedures, including tummy tuck-abdominoplasty, liposuction, and body lift surgeries.
Before discussing the Medicare coverage details, it’s essential to understand what diastasis recti repair is and why it might be necessary. Diastasis recti is a medical condition where the abdominal muscles separate, creating a gap between them. This separation can occur due to pregnancy, obesity, or other factors that put excessive pressure on the abdominal wall.
Diastasis recti repair, also known as abdominoplasty or tummy tuck, is a surgical procedure that aims to restore the normal position and function of the abdominal muscles. This is done by removing excess skin and fat, tightening the abdominal muscles, and suturing them together. The surgery can help improve the appearance of the abdomen, alleviate lower back pain, and enhance overall core stability.
Beginning July 1, 2022, a new Medicare Benefits Schedule (MBS) item, 30175, was introduced, catering to patients requiring radical abdominoplasty combined with the repair of rectus diastasis, which is the separation of large abdominal muscles typically following pregnancy. This addition is specifically designed to help a niche group of patients who, before receiving this service, have been diagnosed with a diastasis of at least 3cm via diagnostic imaging. These patients typically experience moderate levels of discomfort or pain at the site of the diastasis on the abdominal wall during regular use. This discomfort may extend to lower back pain or urinary symptoms, particularly in cases where non-surgical conservative treatment, such as physiotherapy, has not provided effective relief.
Medicare Australia offers coverage for diastasis recti repair under specific circumstances. The procedure is listed under the Medicare Benefits Schedule (MBS) Item Number 30175, which covers “repair of diastasis recti or abdominal hernia (other than incisional).” However, not all cases of diastasis recti repair are covered by Medicare, and certain eligibility criteria must be met.
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 30166, 30169, 30176, 30177, 30179, 30651, 30655, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies
Applicable once per lifetime
To qualify for Medicare coverage under MBS Item Number 30175, you must meet the following eligibility criteria:
Even if your diastasis recti repair is covered by Medicare Australia, you will still have to cover some costs. These can include:
Private Health Insurance and Diastasis Recti Repair
If you have private health insurance, it may provide additional coverage for your diastasis recti repair surgery. Depending on your policy, private health insurance may cover:
Before scheduling your surgery, consult your private health insurance provider to discuss your coverage options and any limitations or exclusions that may apply.
If you’re struggling to afford the out-of-pocket costs associated with diastasis recti repair surgery, there are additional financial assistance options available:
Once you have consulted with and chosen a Plastic and Reconstructive Surgeon and you’ve made arrangements for your out-of-pocket expenses, it’s time to prepare for your diastasis recti repair surgery. This may involve:
Navigating Medicare Australia for diastasis recti repair coverage can be a complex process, but with the right information and guidance, you can make informed decisions about your surgery.
For more information on Medicare Australia and diastasis recti repair coverage, consult the following resources: