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TRICARE Reimbursement Manual 6010.64-M, April 2021
Chapter 1
Section 36
Forensic Examinations Following Sexual Assault or Domestic Violence
Issue Date:  October 29, 2009
Authority:  32 CFR 199.4(e)(27)
This policy is mandatory for reimbursement of services provided by either network or non-network providers. However, alternative network reimbursement methodologies are permitted when approved by Defense Health Agency (DHA) and specifically included in the network provider agreement.
2.0  ISSUE
How are forensic examinations following sexual assault or domestic violence to be reimbursed?
3.1  Forensic examinations, including evidence collection kits, are covered when provided in Civilian Health Care (CHC) facilities following a sexual assault or domestic violence.
3.2  Claims must contain one or more diagnosis codes that indicate the purpose of the visit or inpatient admission is directly related to services for an examination or treatment resulting from sexual assault or domestic violence.
3.3  Reimbursement for forensic examinations and evidence collection kits shall be made according to the appropriate type of provider, type of service, and place of service in effect at the time services are rendered.
4.0  Effective Date
October 17, 2006.
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