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 a Market/MTF,
when the noncovered initial surgery or treatment is authorized by
the Market/MTF Director and
the Market/MTF 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 a Market/MTF and
authorized by the Market/MTF Director;
and
1.2.2 Market/MTF 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.