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.