Medicare Benefits Schedule - Item 30175

Radical abdominoplasty, with repair of rectus diastasis, excision of skin and subcutaneous tissue, and transposition of umbilicus, not being a laparoscopic procedure, if:
(a) the patient has an abdominal wall defect as a consequence of pregnancy; and
(b) the patient:

(i) has a diastasis of at least 3cm measured by diagnostic imaging prior to this service; and
(ii) has either or both of the following:

(A) at least moderately severe pain or discomfort at the site of the diastasis in the abdominal wall during functional use and the pain or discomfort has been documented in the patient’s records by the practitioner providing the service;
(B) low back pain or urinary symptoms likely due to rectus diastasis and the pain or symptoms have been documented in the patient’s records by the practitioner providing the service; and

(iii) has failed to respond to non-surgical conservative treatment, that must have included physiotherapy; and
(iv) has not been pregnant in the last 12 months; and

(c) the service is not a service associated with a service to which item 30166, 30169, 30176, 30177, 30179, 30651, 30655, 45530, 45531, 45564, 45565, 45567, 46060, 46062, 46064, 46066, 46068, 46070, 46072, 46080, 46082, 46084, 46086, 46088 or 46090 applies
Applicable once per lifetime (H)

Multiple Operation Rule

(Anaes.) (Assist.)

Fee: $1,105.15 Benefit: 75% = $828.90

(See para TN.8.8, TN.8.97, TN.8.276 of explanatory notes to this Category)

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Lipectomy is not intended as a primary bariatric procedure to correct obesity. MBS benefits are not available for surgery performed for cosmetic purposes. 

For the purpose of informing patient eligibility for lipectomy items (30166, 30169, 30177 and 30179) for the management of significant weight loss (SWL), SWL is defined as a weight loss equivalent to at least five body mass index (BMI) units. Weight must have been stable for at least six months prior to lipectomy, following SWL.

For SWL that has occurred following pregnancy, the products of conception must not be included in the calculation of baseline weight to measure weight loss against. 

The lipectomy items cannot be claimed in association with items 45530, 45531, 45564, 45565 and 45567. Where the abdomen requires surgical closure with reconstruction of the umbilicus following free tissue transfer (45564, 45565, 45567) or breast reconstruction (45530, 45531), item 45571 is to be claimed.

Related Items: 30166 30169 30175 30177 30179 45530 45531 45564 45565 45567 45571

When a prosthesis or prostheses are inserted in conjunction with this operation, benefit would be attracted under Item 45527 or 45529. Benefits would also be payable for nipple reconstruction (Item 45545) when performed.

When claiming item 45530 for a pedicled rectus abdominis flap; item 45571 should be claimed for closure of the abdomen and reconstruction of the umbilicus, including repair of the musculoaponeurotic layer of abdomen. When claiming item 45530 for a latissimus dorsi flap, no item for the closure of the musculoaponeurotic layer should be claimed as it is expected that repair will be by direct suture.

Lipectomy items 30166, 30169, 30177 and 30179 and radical abdominoplasty items 30175 and 30176 should not be claimed in association with post-mastectomy breast reconstruction items 45530 and 45531.

Related Items: 30166 30169 30175 30176 30177 30179 45527 45529 45530 45531 45571

In the context of eligibility for item 30175, acceptable examples of conservative non-surgical treatment must include physiotherapy, however could also include symptomatic management with pain medication, lower back braces, lifestyle changes and/or exercise.

MBS benefits are not available for surgery performed for cosmetic purposes.

Diagnostic imaging refers to imaging provided by a radiology provider. Diagnostic imaging reports, symptoms of pain and discomfort, and failure to respond to non-surgical conservative treatment must be documented in patient notes.

Related Items: 30175