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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