Nearly 60 percent of mums have abdominal muscle separation after pregnancy. Some of them have a tummy tuck to fix their separated muscles. Until now, postpartum women had to pay out of pocket for the surgery.
Starting July 2022, more than $6 million in funding will be available to eligible mums who have abdominoplasty to fix muscle separation after pregnancy. While it won’t cover a tummy tuck for cosmetic reasons, repairing the muscles can improve uncomfortable symptoms and even reduce the tummy pooch many women have after giving birth.
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What is Diastasis Recti?
Diastasis recti (also known as rectus diastasis or rectus divarication) refers to a widening between the rectus abdominis muscle. The condition is believed to affect up to two-thirds of postpartum women.
Why is it a problem?
Diastasis recti can cause uncomfortable symptoms such as:
- Pelvic pain
- Poor posture
- Low back pain
- Feeling bloated
- Urinary incontinence
- A lower tummy pooch
- Reduced trunk stability
- A visible gap between the abdominal muscles
How is diastasis recti treated?
A small muscle divarication may close on its own after giving birth. Evidence suggests core exercises and physiotherapy can improve separated abdominal muscles. When these treatments fail, some mums have the muscles repaired as part of a tummy tuck.
How does a tummy tuck fix muscle separation?
Some postpartum women find they can’t improve their symptoms with exercise, pain medications, back braces, or physiotherapy. When conservative treatments fail, a specialist surgeon may perform a tummy tuck with muscle repair. This entails suturing the abdominal muscles together at the midline and removing any excess skin if needed.
What is the New Medicare Item Number for Abdominoplasty?
MBS Item 3017X Abdominoplasty with Repair of Rectus Diastasis has been recently added to the Medicare Benefits Schedule. It should go into effect in the summer of 2022.
*Note there are different item numbers for other forms of abdominoplasty. The new item number (3017X) is specifically for postpartum women with abdominal muscle separation.
What does this mean for me?
Tummy tuck surgery can be costly. With the introduction of MBS Item number 3017X, patients who meet the eligibility criteria may be able to reduce the cost of abdominoplasty. This means that some mums can now access public funding for abdominoplasty, but only when it is performed to repair abdominal muscle separation. Not everyone with separated muscles after pregnancy will qualify, but those who do may pay substantially less.
How did the item number happen?
The Australian Society of Plastic Surgeons submitted an official request to the government asking to reinstate the Medicare Benefits Schedule (MBS) listing for abdominoplasty to surgically repair postpartum rectus diastasis.
“After considering the strength of the available evidence in relation to comparative safety, clinical effectiveness and cost-effectiveness, MSAC supported creation of a new Medicare Benefits Schedule (MBS) item to reinstate abdominoplasty with repair of rectus diastasis following pregnancy”. Source
MSAC also noted abdominoplasty has acceptable safety and “superior effectiveness that was sustained over five years” for the treatment of diastasis recti, compared to no treatment.
When does it go into effect?
The MBS item number is slated to go into effect on 1 July 2022.
Why is this good news?
Now, eligible postpartum women can offset some of the cost of a tummy tuck in Australia. Before, they would have paid for the surgery entirely out-of-pocket. Note the item number is not for patients who want a tummy tuck for cosmetic reasons. Because not all patients will qualify, the funding cost per year is predicted to be less than $2 million over the next five years.
Who is Eligible?
While many mums have symptoms of diastasis recti, not all will qualify for the item number.
The MBS Item Number 3017X descriptor states the patient must:
- Have diastasis recti as a result of pregnancy
- Wait at least 12 months after pregnancy to have the procedure
- Have at least a 3 cm separation of the rectus abdominis muscle
- Have failed to respond to conventional, non-surgical treatments for diastasis recti
- Have documentation of moderate-to-severe pain/discomfort and/or lower back pain or urinary incontinence as a result of their muscle separation
What kind of documented proof do I need?
Diagnostic imaging may be needed to confirm a 3 cm or more separation between the abdominal muscles.
A doctor should note whether the patient has physical discomfort or symptoms from the condition.
The physician should also specify whether the muscle separation and related symptoms have not responded to conservative treatments such as:
- Lifestyle changes
- A lower back brace
Who decides if I am eligible?
Typically, a specialist surgeon makes the final call. The patient would receive a referral to a specialist surgeon from their GP. It is wise to keep records of any services provided by a physiotherapist, exercise physiologist or radiologist.
What else Should I Know?
Here is what postpartum women should know about the new abdominoplasty MBS item.
You can’t use the new item number for cosmetic surgery
Medicare does not cover aesthetic procedures. While abdominoplasty (with or without muscle repair) can improve the abdomen’s appearance, the new MBS item only applies to mums who have a functional impairment caused by diastasis recti. Patients must meet the eligibility criteria in the item descriptor. Those who don’t meet the criteria will not be covered.
Just because it’s covered, doesn’t mean it’s free
Australia’s Medicare system provides rebates for citizens (and permanent residents) who see registered health providers for certain medical conditions. Those who qualify for the Medicare rebate for abdominoplasty will pay some out-of-pocket costs, although their overall expenses will typically be much less.
The out-of-pocket costs vary based on factors such as:
- Medicare eligibility
- Type of health insurance and level of cover
- Where the surgery takes place (public vs private hospital)
- The surgeon fee, hospital stay, anaesthesia and facility costs
- Aftercare (i.e. prescription medication, compression garments, etc.)
It’s a once in a lifetime opportunity
For mums with moderate-to-severe muscle separation, the new MBS item could be a golden opportunity. However, patients can only take advantage of the rebate once in their lifetime.
This rule change may not last forever
If you are considering a tummy tuck to repair separated muscles after pregnancy, are healthy, and do not plan to have more children, this may be a good time to consider abdominoplasty. The future is unpredictable, as history goes to show.
In the past, the MBS covered abdominoplasty for postpartum diastasis recti. They removed the item number in 2016. At the time, there was concern that the item number had been misused by patients wanting a tummy tuck for cosmetic reasons rather than to treat diastasis recti as intended.
The Australian Society of Plastic Surgeons (ASPS) submitted an application to bring back the item number in 2018, but their attempt was unsuccessful—until now.
With the MBS item reinstated, some mums with diastasis recti can now access public funding to help pay for their abdominoplasty procedure.
The governing agency will conduct a review in two years to ensure the item number is only being used for abdominoplasty to repair diastasis recti rather than cosmetic reasons. If they detect fraud or misuse, they could remove the item number again.
It was a long road to get this approval
An outpouring of public support, campaigning, research and unwavering determination from the medical community led to getting the item number approved. Dr Bernard Beldholm wants to extend a ‘Thank you’ to everyone who worked hard to bring the item number back to the MBS. Without their help, this momentous achievement may not have happened.
Don’t Wait to Treat Your Diastasis Recti
Muscle separation can cause physical discomfort and unpleasant side effects for some women. If you have tried to fix separated muscles with exercise or physical therapy to no avail, abdominoplasty surgery is a treatment that is worth considering.
What steps do I take next?
Take action and get the help you need to treat diastasis recti.
Talk to your doctor
If you think you have diastasis recti, speak to your general practitioner. You should mention if you have symptoms such as urine leaking, pelvic or lower back pain, etc. that may be linked to your muscle separation. Let your GP know if you have tried conventional treatments to relieve your symptoms, such as a back brace, physiotherapy, exercise or pain medications.
Try non-surgical treatments first
Your healthcare provider may suggest conventional treatments such as core exercises for muscle separation or physiotherapy. If those fail and you have more than 3 cm of muscle separation, you may be eligible for the Medicare rebate. Your provider may refer you to a specialist general surgeon who can help you determine if you’re eligible and assist you in submitting the appropriate forms.
Review your health insurance coverage
Check if your insurance plan covers medically necessary plastic and reconstructive surgery. Mums will most likely need Silver level Private Health Insurance cover to take full advantage of the new item number for abdominoplasty. Patients without insurance are likely to pay substantially more. If you lack private health insurance, you may consider taking out a policy during the 12-month waiting period.
What if my doctor says I’m not eligible?
Not all mums with diastasis recti will qualify for the Medicare rebate. If you don’t qualify, you can have abdominoplasty and fund the costs yourself. Some patients may be able to access their super early to pay for abdominoplasty.
The new item number is a big win for mums who need a tummy tuck with muscle repair after pregnancy. While not everyone qualifies, those who do will be able to save money on their abdominoplasty procedure. The new MBS item number is expected to go into effect on 1 July 2022.