Abdominoplasty – New Medicare Criteria

Many patients who have lost weight or have had their abdominal muscles stretched by previous pregnancies will be left with loose tissues surrounding the muscles in the abdomen. The lining of the rectus abdominus muscles (six pack muscles) are most commonly affected by this problem. Frequently patients present with symptoms such as bloating after meals, a visible abdominal bulge in their clothes despite often being a healthy body weight and chronic low back pain resistant to treatment by physiotherapy or chiropractors.

In the past, the Federal Government has recognised the functional nature of these issues by supporting patients seeking correction of the problem with a Medicare item number that did not restrict these patients to fulfil specific criteria in order to access surgical correction. It is well recognised by surgeons who perform abdominoplasty surgery and patients who have received this surgery in the past that corrective surgery to tighten the rectus abdominus muscle fascia helps alleviate the symptoms associated with laxity and stretching of these tissues.

In January 2016 the Medicare item number pertaining to abdominoplasty surgery was modified to include new qualifying criteria which limits the item number to patients who have lost enough weight to drop 5 BMI points (around 15-20kg) and who have maintained that weight for at least six months. This unfortunately excludes patients who have had very significant stretching of their tissues due to previous pregnancies including multiple births and large babies where the functional issues associated with stretching of the muscles and the overlying tissues are not insignificant.

Whilst it is recognised that weight loss patients are indeed worthy of such surgery, it should not be overlooked that patients who have had significant stretching of their tissues by other means are equally worthy candidates. The Australian Society of Plastic Surgeons is lobbying the Government to try and reverse the changes above to at least make it possible for appropriate patients seeking corrective surgery to access the number and thereby obtain support from Medicare and their private insurance companies.

Hopefully, in the long term, common sense will prevail and the decision made in January of this year will at least partially be reversed. I will keep you posted as the situation unfolds.