Read on to find out what Dr Moncrieff and our patients have done to help ensure women who are injured during pregnancy can access Medicare for muscle repair again in 2022.
APRIL 2022 UPDATE:
The government announced in the Federal Budget that it will allow women after babies to have access to Medicare assistance again if they can demonstrate an ongoing muscle separation (diastasis) causing pain. They allocated over $6 million dollars to make this possible.
This is available from 1 July 2022 with the qualifications below.
2022 NEW MEDICARE ITEM NUMBER
Category 30175 – Category 3 – Therapeutic Procedures
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 30165, 30651, 30655, 30168, 30171, 30172, 30176, 30177, 30179, 45530, 45564 or 45565 applies
Applicable once per lifetime
Fee: $1,025.60 Benefit: 75% = $769.20
TN
In the context of eligibility for item 30175, acceptable examples of conservative non-surgical treatment include symptomatic management with pain medication, lower back braces, lifestyle changes, physiotherapy and/or exercise. Diagnostic imaging, documented symptoms of pain and discomfort, and documented failure to respond to non-surgical conservative treatment must all be documented in patient notes
HISTORY AND BACKGROUND
What some women suffer after kids:
Many women we see need their abdominal wall repaired if it was irreparably damaged during pregnancy.
We are NOT talking about cosmetic ‘tummy tucks’ (which will not attract a taxpayer rebate). Instead, this is the reconstruction of abdominal separation that can’t be fixed no matter how much physio or diet they do. And back pain and incontinence becomes a chronic problem for many of these women.
What we have done to help:
In 2016 the Government ended support for these women by removing access to the relevant Medicare item number for abdominoplasty and restricting it only to mass weight loss patients. So Dr Moncrieff and his colleagues from around Australia commenced research to show just how helpful abdominoplasty can be at reducing the chronic health issues facing women after babies.
That research was published in the Journal of Plastic and Reconstructive Surgery with Dr Moncrieff listed as one of the authors.
In 2020 we supported a petition which called on the government to reinstate the Medicare item number for mum's injured through pregnancy. It was signed by over 13,000 mums, doctors and others before the closing date of 23 September 2020.
And in 2021, we supported a submission to the government by the Australian Society of Plastic Surgeons to allow women after babies have access to Medicare assistance again if they can demonstrate at least a 3cm ongoing muscle separation (diastasis) causing pain.
The research
A copy of the research showing back pain and incontinence improvements after tummy tucks, co-authored by Dr Moncrieff is available here.
A big thank you:
To everyone who signed the petition and all our patients who took the time to complete the regular research surveys throughout their surgical journey with us, a huge thanks and let’s hope it helps some other women have the same health improvements.
Related pages:
Am I able to claim a tummy tuck from Medicare?
How can I tell if I have muscle separation?
