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A/Prof Mark Magnusson, Specialist Plastic Surgeon, Gold Coast and Toowoomba blog feature image

Abdominoplasty for Split Stomach Muscles (Diastasis Recti): Medicare Item 30175, Eligibility and the Evidence

Diastasis recti is the separation of the two long abdominal muscles that run down the front of your stomach. Medicare may contribute to the cost of repairing it through item 30175, though only when strict medical criteria are met. The condition also goes by the name rectus divarication. It develops when pregnancy stretches the connective tissue that holds the “six-pack” muscles together until those muscles no longer sit side by side. In plenty of women, the gap narrows on its own. In others, it stays open, and core strength, comfort and confidence tend to go with it. Below, we cover what the condition is, the symptoms surgery is meant to address, how the Medicare pathway actually works, and the research behind the item number. This is general information. It is not a diagnosis and not a promise of eligibility. A/Prof Mark Magnusson assesses every patient individually at consultation in Southport and Toowoomba.

What is diastasis recti (rectus divarication)?

Put simply, the gap between the left and right rectus abdominis muscles widens along the midline of the abdomen. A band of connective tissue, the linea alba, joins those two muscles. Pregnancy stretches that band as the uterus grows, and after birth it does not always recover its original tension.

It is common. Sperstad and colleagues followed 300 first-time mothers and published their findings in the British Journal of Sports Medicine in 2016. They recorded diastasis recti in 60 percent of the women at six weeks postpartum, 45.4 percent at six months and 32.6 percent at twelve months. So most new mothers have some separation early on, and roughly a third still have a gap a year down the track.

Two separate problems tend to get muddled together here. Loose skin and stubborn fat are contour issues, and on their own they count as cosmetic. Muscle separation is structural. The abdominal wall has lost its tension and no longer supports the trunk the way it used to. Item 30175 exists for that second problem only.

The symptoms functional muscle repair can address

Functional abdominoplasty targets the physical symptoms that can follow muscle separation. Lower back pain, stress urinary incontinence and a weak core are the main three. When the abdominal wall cannot generate normal tension, the lower back and pelvis end up carrying more of the load, and posture and continence can suffer as a result.

Stress urinary incontinence is the leaking that happens when pressure lands on the bladder. A cough will do it. So will a sneeze, a laugh, or picking up a toddler. It is common after childbirth, and most women never mention it unless someone asks.

Repairing the diastasis restores tension across the abdominal wall, and that can improve how well the lumbar spine and pelvis are supported. The research set out below points to improvement in back pain and incontinence when patients are looked at as a group. Individual results still vary, and surgery is not presented here as a guaranteed cure for anyone.

Medicare item 30175: what it is and who qualifies

Item 30175 is a rebate for radical abdominoplasty with repair of rectus diastasis after pregnancy. Every criterion in the item descriptor has to be met before it applies. The MBS Online factsheet published by the Australian Government Department of Health records a commencement date of 1 July 2022, and the item was written for a small group of patients with a functional problem rather than to fund cosmetic tummy tuck surgery.

To qualify, the current criteria require that the patient:

  • has an abdominal wall defect as a consequence of pregnancy;
  • has a diastasis of at least 3cm measured by diagnostic imaging (such as ultrasound) before surgery;
  • has at least moderately severe pain or discomfort at the site of the separation during functional use, and/or low back pain or urinary symptoms likely due to the diastasis, documented in their records;
  • has failed to respond to non-surgical conservative treatment, which must have included physiotherapy; and
  • has not been pregnant in the last 12 months.

You need a GP referral to see a specialist, and both the symptoms and the failed conservative treatment have to be documented. Clearing the imaging threshold on its own is not enough, because the clinical picture has to fit too. One more thing worth knowing: the item can be claimed only once in a lifetime.

Rebate amounts and criteria change, so please confirm current eligibility at your consultation. As a guide only, the Medicare Schedule Fee rebate for item 30175 has been reported at $828.90. That figure shifts with annual indexation and should not be relied on without checking. Our practice manager checks the current MBS wording and the applicable rebate before any figure is quoted to a patient. Everything in this section is general information, not a guarantee that you will be eligible.

The evidence behind the Medicare pathway

A large Australian study underpinned the case for bringing back a Medicare item for muscle repair. It found that abdominoplasty with rectus repair improved back pain and urinary incontinence. The paper ran in Plastic and Reconstructive Surgery in 2018 (volume 141, issue 3, pages 637 to 645), authored by Taylor, Merten, Sandercoe, Gahankari, Ingram, Moncrieff, Ho, Sellars and Magnusson. It followed 214 patients treated by nine surgeons at nine centres along the east coast of Australia.

Two validated tools were used. Back pain was scored with the Oswestry Disability Index, urinary symptoms with the International Consultation on Incontinence Questionnaire. Patients completed both before surgery, then again at six weeks and at six months. All of them had their rectus muscles repaired. Mean back-pain disability fell from around 21.6 percent before surgery to about 8 percent at six weeks and 3.2 percent at six months. The mean incontinence score dropped from roughly 6.5 to about 1.6. The authors reported statistically significant improvement in back pain and in urinary incontinence at both time points. Six different surgical techniques featured in the series, and by six months no one method had proved better than the rest.

A/Prof Magnusson was one of the contributing surgeons and added 77 of the 214 patients to the dataset. Those were ordinary presenting patients rather than a hand-picked group, so the numbers reflect what tends to happen in everyday surgical practice. The study still describes group outcomes, and it cannot predict what will happen for any one reader.

How the assessment and consultation process works

Your GP is the place to start. In Australia a referral from them is a legal requirement before any cosmetic surgery consultation, so that appointment has to happen regardless. They can also order the ultrasound that measures how wide the separation is. Imaging and a documented trial of physiotherapy come first, well before surgery is on the table.

Why does supervised physiotherapy matter so much? Partly because it often helps. A good number of women improve enough that they no longer want or need surgery. Partly because the item descriptor insists on it: conservative treatment, physiotherapy included, has to have been tried and to have fallen short of resolving the symptoms.

Bring your GP referral to the consultation, along with the ultrasound report, a summary of the physiotherapy you have done, and some notes on your symptoms and how they affect ordinary daily life. A/Prof Magnusson will examine you, work through whether the item 30175 criteria are met, and talk you through the surgical plan, the risks involved and what recovery usually looks like. Consultations run at Southport on the Gold Coast and in Toowoomba. Surgery is carried out at accredited hospitals in both cities.

What if I don’t meet the Medicare criteria?

Abdominoplasty is still available as a self-funded cosmetic procedure if you do not meet the item 30175 criteria. Missing out on the rebate does not rule surgery out. It means Medicare will not contribute, and the costs are met privately.

This happens often. A separation might measure under 3cm. Physiotherapy might have settled things well. Or a pregnancy might be less than 12 months ago, in which case it is a matter of waiting. None of that changes how much loose skin, altered contour or a persistent gap can bother you.

False hope helps nobody. A/Prof Magnusson will say plainly whether he thinks the criteria are met. Where they are not, he will lay out the cosmetic options that are realistic for you and what each would cost, then leave the decision with you. All surgery carries risk. Results differ from one person to the next. A formal consultation is where all of that gets weighed up properly.

Why choose A/Prof Magnusson for abdominoplasty in Gold Coast & Toowoomba

A/Prof Mark Magnusson is a Specialist Plastic Surgeon (FRACS). His practice has long centred on breast and body surgery, functional abdominoplasty included. He has worked in Toowoomba since 2000 and on the Gold Coast since 2016, and he holds an Associate Professor appointment in the School of Medicine and Dentistry at Griffith University.

His involvement in the evidence base is direct. Of the 214 patients in that 2018 multi-centre study of functional outcomes after abdominoplasty, published in Plastic and Reconstructive Surgery, 77 were his. That is the research that supported the Medicare pathway for muscle repair. He is also a past President of the Australasian Society of Aesthetic Plastic Surgeons (ASAPS), a member of the TGA Advisory Board, and sits on the editorial board of the Aesthetic Surgery Journal.

Consulting rooms are at Suite 6, Level 5, 123 Nerang Street, Southport QLD 4215, and in Toowoomba. Surgery is performed at accredited hospitals on the Gold Coast and in Toowoomba. You can check his credentials yourself through these profiles:

Frequently Asked Questions

Does Medicare cover a tummy tuck in Australia?

Not for a cosmetic tummy tuck, no. Where the abdominoplasty is repairing pregnancy-related muscle separation and every clinical criterion is met, item 30175 can contribute. Surgery done for appearance alone attracts no rebate.

What is Medicare item number 30175 and who qualifies?

It is the rebate for radical abdominoplasty with repair of rectus diastasis after pregnancy. To qualify you need a separation of at least 3cm on imaging, documented symptoms such as functional pain, low back pain or urinary symptoms, a failed trial of conservative treatment that included physiotherapy, and no pregnancy in the previous 12 months.

Can a tummy tuck fix abdominal muscle separation after pregnancy?

Yes. Sutures bring the rectus muscles back together along the midline, which restores tension to the abdominal wall, and excess skin comes away in the same operation. Exercise cannot do that. Training builds strength in the muscles around the gap, but it will not close a gap that has stayed open.

Does abdominoplasty help with back pain and urinary incontinence?

The research suggests it often does. In the 2018 multi-centre study of 214 patients, improvements in low back pain and in urinary incontinence after abdominoplasty with muscle repair were both statistically significant. Those are group findings, so individual outcomes vary and cannot be guaranteed.

How large does the muscle separation (diastasis) need to be to qualify, is 3cm the cut-off?

Yes, 3cm is the cut-off for item 30175, measured by diagnostic imaging before surgery. A gap under that does not meet the Medicare criterion, even when symptoms are clearly present. And imaging on its own is not enough, since the symptom and physiotherapy criteria have to be satisfied as well.

Individual results vary, and all surgery carries risks. The right next step is a formal consultation, where your circumstances, imaging and history can be assessed properly and current Medicare eligibility confirmed.

Further reading

Medical references

A/Prof Mark Magnusson, AHPRA number: MED0001382689, Medical Practitioner, Specialist Plastic Surgeon, Nominals: FRACS (Plast)