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The Managed Care Support (MCS) Manuals (T-3) for contracts prior to 07/21/2016 are now superseded and can be found in the "Superseded" portion (indicated by a red banner) of each T-17 manuals' web page.
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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