Diastasis Recti Surgery and Medicare Item 30175: Who Qualifies

Since 1 July 2022, Medicare has had an item for repairing separated tummy muscles after pregnancy: MBS item 30175. It applies only when every criterion is met, including a gap of at least 3 cm on imaging, documented symptoms and physiotherapy that has not helped.

This guide sets out the criteria as a checklist, explains what has to be documented, and describes how specialist plastic surgeon Dr Reema Hadi assesses this at your consultation.

The short answer

• If you meet every item 30175 criterion: Medicare pays a benefit towards the surgeon's fee, and hospital cover may help with the hospital and other costs.
• If you do not: no Medicare benefit and usually no private health insurance benefit. Surgery would be a private cosmetic procedure.

The criteria are set by the Australian Government. No surgeon can change them, and eligibility is decided at consultation, not online.

MBS item 30175: the checklist

According to MBS Online (read 13 October 2026), every one of these must apply:

1. You have an abdominal wall defect as a consequence of pregnancy.
2. You have a diastasis of at least 3 cm, measured by diagnostic imaging before surgery.
3. You have at least moderately severe pain or discomfort at the diastasis during everyday use of your tummy muscles, and/or low back pain or urinary symptoms likely due to the diastasis. Either must be documented in your records by the practitioner providing the service (your surgeon).
4. You have not responded to non-surgical (conservative) treatment, and that treatment included physiotherapy.
5. You have not been pregnant in the last 12 months.
6. The operation is a radical abdominoplasty with repair of the diastasis, removal of skin and tissue, and moving the belly button. It is not a laparoscopic (keyhole) procedure.
7. It is not claimed together with certain other items, including the weight-loss items 30166, 30177 and 30179 and item 30176.

The item is "Applicable once per lifetime".

What has to be documented

The MBS explanatory note TN.8.276 says the imaging report, your symptoms of pain and discomfort, and the failure of conservative treatment must all be recorded in your notes. It adds that:

• Diagnostic imaging means imaging by a radiology provider, not a measurement taken in the clinic.
• Conservative treatment must include physiotherapy, and could also include pain medication, a lower back brace, lifestyle changes or exercise.
• Cosmetic surgery is not covered. Medicare benefits are not available for surgery done for cosmetic reasons.

Medicare claims can be audited, so the records must reflect your real history. Please describe your symptoms accurately.

How to prepare

1. See your GP. Talk about your symptoms and ask for a referral to a physiotherapist and, when you are ready, to Dr Hadi.
2. Do a course of physiotherapy. Keep your physiotherapist's letter or notes showing what you tried and for how long.
3. Keep a symptom record. Note any pain at the gap, back pain or bladder symptoms, what triggers them and how they affect daily life.
4. Get imaging. An ultrasound or other scan from a radiology provider measures the gap. Dr Hadi will tell you which scan and who arranges it.
5. Bring everything to your consultation: the referral, imaging report, physiotherapy notes and any GP notes [CHECK 9].

What Medicare pays under item 30175

From 1 July 2026, the MBS schedule fee for item 30175 is $1,161.05. For a private patient in hospital, Medicare pays 75% of the schedule fee, which is $870.80.

That benefit is towards the surgeon's fee only. It is 75% of the schedule fee, not of what the surgeon charges. The anaesthetist bills separately, and the hospital charges its own fee. Any difference between the fee charged and what Medicare and your insurer pay is your out-of-pocket gap. Fees change each year, so check the current figure on MBS Online. Dr Hadi gives you a written, itemised quote after your first consultation.

How Dr Hadi assesses this at your consultation

1. Your history: your pregnancies, when your last baby was born, your symptoms and the physiotherapy you have done.
2. Examination: she examines your tummy, the gap and any hernia, and looks at the skin.
3. Your records: she reviews the imaging report and physiotherapy notes and records your symptoms, as the item requires.
4. Ultrasound: it needs to be 3cm or more.
5. Her honest view: she tells you whether you appear to meet the criteria and how your operation would be billed.
6. If you don't qualify: surgery would be private. You get a written quote and time to decide, with two consultations and at least 7 days between consent and booking.

You need a referral from your GP before your first appointment. A referred specialist consultation may attract a Medicare rebate.

Common questions about the criteria

• A caesarean birth does not rule you out. The item asks whether the defect is a consequence of pregnancy, not how you gave birth.
• Breastfeeding is not mentioned in the item. Dr Hadi will advise on timing.
• A gap under 3 cm on imaging does not meet the item, even with symptoms.
• A previous claim of item 30175 means it cannot be claimed again.
• Loose skin after weight loss falls under different items, such as 30177. See Does Medicare cover an abdominoplasty

Private health insurance

Private health insurance helps only when an MBS item applies. The Government's privatehealth.gov.au explains that services not listed on the MBS, such as elective cosmetic surgery, are covered only to a limited extent or not at all, depending on the policy.

• Use the item number: tell your fund you are asking about MBS item 30175.
• Ask about waiting periods, including for conditions that existed before you took out cover.
• Ask what you will pay: any amount payable on admission and any medical gap.

Results and risks

Whether or not Medicare contributes, the operation and its risks are the same. All surgery carries risks, and results vary. Read Abdominoplasty risks and when something goes wrong, learn more in Diastasis recti: signs, the 3 cm rule and when surgery is considered, or see our diastasis recti surgery page. To book with Dr Hadi, call 02 9526 6885 or use our contact page.

Frequently asked questions

Is diastasis recti surgery covered by Medicare in Australia?

It can be, under MBS item 30175, when every criterion is met: a pregnancy-related gap of at least 3 cm on imaging, documented symptoms, failed physiotherapy and no pregnancy in the last 12 months.

How do you qualify for diastasis recti surgery under Medicare?

You need imaging showing a gap of at least 3 cm, documented pain or back or bladder symptoms, a course of physiotherapy that has not helped, and no pregnancy in the past 12 months.

Does it have to be an ultrasound?

The item says diagnostic imaging by a radiology provider. Ultrasound is common, but Dr Hadi will advise which scan you need.

How much does Medicare pay for item 30175?

From 1 July 2026, $870.80, which is 75% of the $1,161.05 schedule fee, towards the surgeon's fee for a private patient in hospital. Other fees are separate.

Can I claim item 30175 more than once?

No. The item is applicable once per lifetime.

Can I get Medicare for diastasis repair if I want more children?

The item only requires no pregnancy in the last 12 months. A later pregnancy can stretch the repair, so talk about timing with Dr Hadi.

Will private health insurance cover diastasis repair?

Only if item 30175 applies and your hospital policy includes it. Call your fund with the item number.