Important abdominoplasty news: update on post pregnancy item number changes

To meet the criteria you must:

1. have an abdominal wall defect (separation) of 3cm or more, measured by diagnostic imaging (eg ultrasound), as well as;
2. have tried conservative treatment, which must have included physiotherapy

Image, right: before and 4 months after abdominoplasty and breast augmentation with Dr Sharp using 300cc anatomical breast implants. 

Plus you must be experiencing at least one of the following:

• pain at site of diastasis during functional use (ie when using your tummy muscles you have moderate or severe pain in the area). This pain must be ‘moderate’ or ‘severe’ or;
• lower back pain or;
• urinary symptoms

Frequently asked questions about post partum or post pregnancy abdominoplasty surgery

Q. How soon after pregnancy can I claim this item number?
A. 12 months or more

Q. Does it matter how long ago my pregnancy was?
A. No

Q. Do I need a GP referral?
A. Yes

Q. If I meet the criteria, am I allowed to claim the rebate even if I am also having a cosmetic procedure at the same time?
A. Yes. You will be able to claim your eligible rebate for the item numbered procedure. You won’t be able to claim any rebate for the cosmetic component of your costs; these will be additional ‘out of pocket’ fees.

Q. What documentation or tests do I need in order to prove that I have seen a physiotherapist or have pain or urinary symptoms?
A. You don’t need any documentation/proof. This is something Dr Sharp will discuss as part of your history-taking during consultation. He will need to document at least one of these symptoms in your file, so please tell him if any apply.

Q. If I meet the criteria, what does that mean?
A. Your abdominoplasty is considered reconstructive, not cosmetic. You can claim rebates. If you have private health insurance that covers the item number #30175, your hospital fee will be covered by your insurer (your excess will be payable upon admission) and you can claim a small portion of the surgeon and anaesthetic fees postoperatively.

If you aren’t insured, your hospital fee will be 100% out of pocket but you will receive a Medicare rebate for a portion of the surgeon and anaesthetic fees.

Q. What do I need to ask my GP for when I go to get a referral and ultrasound request? 
A. Please ask for a GP referral outlining your area of concern, date of last pregnancy and any of the symptoms mentioned above. Please also ask them to refer you for an ultrasound of your rectus wall, to measure the widest point of divarication. Some patients have advised us that their GP was not aware of the new item number or reconstructive status of postpartum abdominoplasty. Please bring this article or the item number 30175 to your GP appointment, to assist them if need be. We are always very happy to receive a phone call from your GP’s office if they have any questions or require clarification I order to provide your referral.