Medicare Benefits Schedule - Note TN.8.276

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

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Multiple Operation Rule

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)

(Anaes.) (Assist.)

Fee: $1,067.80 Benefit: 75% = $800.85

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