Chapter 4
Section 1.2
Treatment Of Unfortunate
Sequelae And/Or Medically Necessary Follow-On Care Subsequent To
Authorized Noncovered Initial Surgery Or Treatment In A Military Treatment
Facility (MTF)/Enhanced Multi-Service Market (eMSM)
Issue Date: February 28, 2012
Revision:
1.0 POLICY
1.1 Benefits
are available for otherwise covered drugs, services and supplies
required in the treatment of unfortunate sequelae and/or medically
necessary follow-on care subsequent to an authorized noncovered
initial surgery or treatment provided in an MTF/eMSM, when the noncovered initial
surgery or treatment is authorized by the MTF Commander/eMSM Manager
and the MTF/eMSM is unable to provide the treatment of unfortunate
sequelae and/or medically necessary follow-on care.
1.2 Documentation
must be submitted by the provider or the beneficiary with the claim
to provide evidence that:
1.2.1 The noncovered initial surgery
or treatment was provided in an MTF/eMSM and authorized by the MTF
Commander/eMSM Manager; and
1.2.2 MTF/eMSM was unable to provide
the subsequent treatment of unfortunate sequelae and or medically
necessary follow-on care related to the non-covered initial surgery
or treatment.
1.3 Treatment of unfortunate sequelae
and medically necessary follow-on care includes otherwise covered
services such as drugs, supplies, Physical Therapy (PT) and office
visits.
Note: Coverage for treatment of unfortunate
sequelae includes expected and unexpected complications.
2.0 Effective
Date
For treatment of unfortunate sequelae
and/or necessary follow-on care subsequent to an authorized noncovered
initial surgery or treatment occurring on or after October 17, 2011.
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