Post pregnancy abdominoplasty: can I claim a rebate for my tummy tuck?

Patients who experience muscle separation (or divarication/rectus diastasis) following pregnancy may now be eligible for rebates on abdominoplasty surgery.

After many years of industry and patient advocacy, the government has  allocated funding for post pregnancy abdominoplasty surgery, The item number comes into effect on the Medicare Benefits Schedule from the 1st of July 2022.

Right: before and after abdominoplasty and breast augmentation surgery with Dr Sharp. View full gallery here.

BAM abdo 300cc anatomical high profile implants 1

What is the MBS criteria for abdominoplasty surgery after pregnancy?

Operations listed on the MBS are given an item number, description and criteria. This enables specialist surgeons to determine if a patient’s procedure or consultation can be billed under an item number, and therefore involves a rebate. The MBS post pregnancy item number description and criteria is:

Radical (separation) 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 the patient has: 

  • diastasis of at least 3cm measured by diagnostic imaging
  • has failed to respond to non-surgical conservative treatment including physiotherapy; and (iv) Has not been pregnant in the last 12 months
  • has symptoms of any of the following:
    • at least moderate severity of pain or discomfort at the site of the diastasis in the abdominal wall during functional use
    • low back pain
    • urinary symptoms likely due to rectus diastasis that have been documented in the patient’s records by the practitioner providing this service

 

The item number cannot be used at the same time as these other item numbers: 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565

It is applicable once per lifetime. 

The item number for post pregnancy abdominoplasty is 30175. You can check whether your insurance policy covers you for this item number by contacting your health fund after the 1st of July and asking them to do an ‘eligibility check’.  We also perform these checks for all privately insured patients seeing Dr Sharp for abdominoplasty surgery, as it enables us to provide an accurate quote – read more about this below. 

When will the item become available?

It will be available for use from 1st of July 2022.

mummy makeover real patients Dr SharpDoes a radiologist need to measure the diastasis or can a physiotherapist do the scan?

The separation must be formally scanned and reported by a diagnostic imaging practice only. 

Image, left: Dr Sharp’s tummy tuck patients 

Does my GP also need to document the symptoms of pain and discomfort or can it just be documented by the specialist plastic surgeon?

Although GPs are usually the first port of call and they may well document the history, it is imperative that the treating specialist plastic surgeon who will perform the abdominoplasty procedure, documents all symptoms of pain and discomfort.

What is the minimum timeframe for a patient to be undergoing ‘non-surgical conservative treatment’ before qualifying for abdominoplasty?

The item descriptor does not dictate a minimum timeframe, however the patient must have been at least 12 months postpartum, and have undergone (and failed to respond to) non-surgical conservative treatment – including physiotherapy – before qualifying for abdominoplasty.

Does this mean the tummy tuck costs will be completely covered by rebates?

Not if you have your surgery performed by a private plastic surgeon. There will still be gap fees for your surgeon, assistant and anaesthetist. If you have private health insurance, your hospital fee might be covered – see below for hospital fee information.

How will I be able to tell if I can get a rebate?

This will be assessed by your plastic surgeon upon consultation. If you meet the MBS criteria for this procedure, yes you will receive a Medicare rebate on your surgeon and anaesthetist fees. If you also have eligible private health insurance, you will receive a rebate from your health fund.

How can I check if post pregnancy abdominoplasty is covered by my health insurance policy?

Call your fund and ask for an ‘eligibility check’. Quote the item number and ask if your policy includes this number. We also perform these eligibility checks as a courtesy for patients, when they book in a consultation with Dr Sharp. This provides more certainty regarding the known, total out of pocket costs, inclusive of rebates, which we can provide on the day of consult.

Will the hospital fee for my post pregnancy tummy tuck be covered?

If you have an item number assigned to your procedure and your health insurance provider confirms you are eligible under your current policy, your hospital fee will be covered in the facilities we operate at. Your nominated excess may be payable upon admission.

How much will a post pregnancy abdominoplasty now cost?

It’s impossible to provide an accurate one-size-fits-all answer to this without knowing some important information, including whether a patient has an eligible private health insurance policy and has served their waiting period. If you already know some of the above variables and would like to price range indication, please submit an enquiry via the enquiry form or call 3202 4744.

Remember when comparing quotes from other people’s surgery, which you might see online in forums etc; their procedure costs might not be exactly reflective of your own, because so many variables impact the total cost of surgery. These  factors can vary from patient to patient, especially with larger procedures such as tummy tuck surgery.  In Australia it is not illegal for any doctor to call themselves a ‘surgeon’ so also ensure you are comparing apples with apples. Use the Australian Society of Plastic Surgeon’s website to ensure you are seeing a qualified, specialist plastic surgeon.   

I have a consult coming up; what should I do to get ready beforehand?

If you haven’t already had a scan to assess your diastasis, talk to your GP about getting one. If it is possible that you have diasasis, having the scan prior to your consultation with your plastic surgeon will help ascertain whether the item number applies, at the time of your consult.

Also ask your GP for a referral to see the plastic surgeon, and ask them to list the date of your last pregnancy, any related pain and the non surgical (eg physiotherapy) measures you have undertaken to try and address the diastasis. We recommend seeking at least two opinions before undergoing any surgery. It is possible to use the same referral to see multiple plastic surgeons – the letter does not need to be written out to separate plastic surgeons. 

I am already booked for abdominoplasty surgery due to rectus divarication; how can I find out if my surgery can now be eligible for rebates?

Contact your surgeon; they will be able to assist. 

I have been advised I am already eligible for the 30177 abdominoplasty item number following massive weightloss. Will the new item number impact me?

Only one type of tummy tuck item number can be claimed for your procedure, so there won’t be the option to try use both for your surgery. In other words, if you already qualify for the 30177 item number for abdominoplasty after massive weightloss, even if you also qualify for the new post partum item number as well, it will not impact your rebates.

Is tummy tuck surgery performed as a day procedure or with an inpatient stay?

Both; your length of hospital stay is discussed with your surgeon, and the right hospital stay for your particular circumstances is chosen in consultation with them. It can range from day surgery to a full week in hospital. In most cases where patients are otherwise healthy and well-supported at home, their outcomes are the same irrespective of hospital stay length; some patients just find they are more comfortable recovering at home, while others prefer to be in hospital.

Will I still be able to combine my breast augmentation surgery with tummy tuck surgery if I am claiming an item number?

Yes; if you have a cosmetic breast augmentation and item numbered abdominoplasty procedure planned in the same procedure, you will only claim the anaesthetic, hospital and surgeon’s fees associated with the abdominoplasty component of your procedure. The component of costs associated with the cosmetic breast procedure will not be rebated.

What does tummy tuck recovery involve?

Most patients are back at work about 2 weeks after surgery but must only perform light/desk duties for 6 weeks. At home, they cannot lift or carry more than 2kg for 6 weeks either – think just one 2L carton of milk – so it is important to think about a contingency for grocery shopping, household tasks, lifting children or walking the dog! Returning to exercise can happen gradually after 6 weeks but it is important to do this in very small increments; patients who return too quickly to stretching and weight bearing usually experience poor scarring and stubborn swelling. Read more here.

…and finally, a big thank you!

The restoration of an item number for post pregnancy abdominoplasty would not have been possible without the hard work and perseverance of the Australian Society of Plastic Surgeons, GPs, obstetricians, plastic surgeons and perseverant patients who lobbied the government for many years so that patients could access this important surgery to address muscle diastasis. Thank you to everyone involved. 

To find out more about post pregnancy abdominoplasty surgery book a consultation with Dr Sharp by calling (07) 3202 4744.

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