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TRICARE Policy Manual 6010.60-M, April 2015
Chap 4
Surgery
Revision: C-104, Nov 4, 2022
Section/Addendum  Subject/Addendum Title
1.1
Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment
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 (e-MSM)
2.1
Cosmetic, Reconstructive, And Plastic Surgery - General Guidelines
2.2
General Surgery
3.1
Laser Surgery
3.2
Robotic Surgery
4.1
Assistant Surgeons
5.1
Integumentary System
5.2
Post-Mastectomy Reconstructive Breast Surgery and Breast Prostheses
5.3
Prophylactic Mastectomy, Prophylactic Oophorectomy, And Prophylactic Hysterectomy
5.4
Reduction Mammaplasty For Macromastia
5.5
Silicone Or Saline Breast Implant Removal
5.6
Breast Reconstruction As A Result Of A Congenital Anomaly
5.7
Gynecomastia
5.8
Negative Pressure Wound Therapy (NPWT)
6.1
Musculoskeletal System
6.2
Bone Growth Stimulation
7.1
Oral Surgery
8.1
Respiratory System
8.2
Lung Volume Reduction Surgery (LVRS)
9.1
Cardiovascular System
9.2
Photopheresis
9.3
Intracoronary Stents
9.4
Therapeutic Apheresis
10.1
Transjugular Intrahepatic Portosystemic Shunt (TIPS)
11.1
Hemic And Lymphatic Systems
12.1
Mediastinum And Diaphragm
13.1
Digestive System
13.2
Surgery For Morbid Obesity
14.1
Urinary System
15.1
Male Genital System
16.1
Intersex Surgery
17.1
Female Genital System
18.1
Maternity Care
18.2
Antepartum Services
18.3
Abortions
18.4
Cesarean Sections
18.5
Fetal Surgery
19.1
Endocrine System
20.1
Nervous System
20.2
Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson’s Disease
20.3
Stereotactic Radiofrequency Thalamotomy
21.1
Eye And Ocular Adnexa
22.1
Auditory System
22.2
Cochlear Implantation
23.1
High Dose Chemotherapy (HDC) And Stem Cell Transplantation
24.1
Heart-Lung And Lung Transplantation
24.2
Heart Transplantation
24.3
Combined Heart-Kidney Transplantation (CHKT)
24.4
Small Intestine (SI), Combined Small Intestine-Liver (SI/L), And Multivisceral Transplantation
24.5
Liver Transplantation
24.6
Combined Liver-Kidney Transplantation (CLKT)
24.7
Simultaneous Pancreas-Kidney (SPK), Pancreas-After-Kidney (PAK), And Pancreas-Transplant-Alone (PTA), And Pancreatic Islet Cell Transplantation
24.8
Kidney Transplantation
24.9
Donor Costs
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