Separated abdominal muscles after pregnancy — diastasis of the rectus abdominis — have their own Medicare item, and it is one of the most tightly defined in the schedule. Item 30175 is claimable once per lifetime.
The criteria are worth reading before you do anything else, because three of them have to be in place before surgery and cannot be arranged afterwards.
What item 30175 requires
| Requirement | Detail |
|---|---|
| Cause | An abdominal wall defect as a consequence of pregnancy |
| Size | Diastasis of at least 3cm, measured by diagnostic imaging before the operation |
| Symptoms | At least moderately severe pain or discomfort at the site during functional use, or low back pain or urinary symptoms likely due to the diastasis — documented in your records |
| Conservative treatment | Failed to respond to non-surgical treatment, which must have included physiotherapy |
| Timing | Not pregnant in the last 12 months |
| Frequency | Once per lifetime |
The operation the item describes is a radical abdominoplasty with repair of the diastasis, excision of skin and subcutaneous tissue and transposition of the umbilicus.
The three that catch people out
Imaging. The 3cm has to be measured by diagnostic imaging before the service. A surgeon’s measurement with a tape at the consultation does not satisfy the item. Ask your GP for an ultrasound referral early.
Physiotherapy. Conservative treatment must have included it. Months of core work on your own, without a physiotherapist involved, does not document as a failed trial. Get it on the record.
Documented symptoms. The pain, back pain or urinary symptoms have to be in your records. A history first mentioned at a surgical consultation is weaker than one your GP and physiotherapist have been recording.
What diastasis actually is
The two vertical strips of the rectus muscle are joined at the midline by a sheet of connective tissue, the linea alba. Pregnancy stretches it. In most women it recovers; in some it does not, leaving the muscles separated and the midline lax. The result is a lower abdomen that bulges — particularly at the end of the day or when you sit up — and a core that does not hold load.
It is a connective tissue problem, not a fat problem, and that is why it behaves the way it does with exercise.
Why training does not close it
Strengthening the abdominal muscles does not bring the two sides back together, and some exercises — sit-ups, crunches, anything that pushes the midline outward — can make the bulge more obvious. A women’s health physiotherapist can improve how the abdominal wall functions, and that is genuinely worth doing, both because it helps some women and because the item requires it. What it does not do is re-join a stretched linea alba.
The operation
The separated edges are brought together and the midline reinforced with sutures, from the breastbone to the pubis. Because the skin above it has also been stretched, the repair is done as part of an abdominoplasty: excess skin is removed through a low transverse incision, and the umbilicus is repositioned. Dr Kumar uses drains in body contouring surgery, and operates at Westmead Private Hospital.
Recovery is that of a full abdominoplasty (tummy tuck) — about two weeks off work, a gradual return over the following four weeks, and a build-up to full clearance at around twelve weeks. The week-by-week timeline is here.
If a hernia is also present
An umbilical or epigastric hernia often sits within a diastasis, and it is repaired at the same operation. That changes the item numbers and the quote. Abdominoplasty combined with hernia repair.
If the cause was weight loss, not pregnancy
Item 30175 requires the defect to be a consequence of pregnancy. Where redundant skin follows significant weight loss instead, different items apply — 30177 and 30166, each with their own criteria. Abdominoplasty with muscle repair sets out how the two situations differ, and there is useful background on when weight is stable enough at My Weight Loss Journey.
Common questions
Can it be repaired without removing skin? Technically yes, but where skin has been stretched, repairing the muscle alone leaves loose skin over a flatter abdomen, and the item describes the combined operation.
Will it separate again? A further pregnancy can stretch the repair, which is why the item excludes pregnancy in the last 12 months and why most surgeons advise completing your family first.
Does private health cover it? Where a Medicare item applies and your cover and waiting periods allow, your fund generally contributes to the hospital. The hospital quotes after checking.
How long is the scar? Low and transverse, hip to hip, sitting below a bikini line in most patients.
Next step
Start with your GP: an imaging referral and a physiotherapy referral, with your symptoms recorded. Then bring the referral to a consultation — it is required to see Dr Kumar — and he will tell you whether, in his assessment, you meet the item. He consults at Westmead, Penrith and Orange. Call 1300 267 726. More about costs and surgery after pregnancy.
The initial consultation with Dr Kumar is $400, with a Medicare rebate of approximately $88 where you have a GP referral. Surgical fees are quoted individually after your consultation, in a written itemised quote.
All surgery carries risks, and individual results will vary. Read more about the risks of surgery here. A GP referral is required to see Dr Kumar.
Dr Rohit Kumar (MED0001630444) Registered medical practitioner, specialist plastic surgeon (specialist registration in surgery – plastic surgery).
