TRICARE Policy Manual 6010.60-M, April 2015Chap 4SurgeryRevision: C-122, Dec 20, 2023Section/Addendum Subject/Addendum Title1.1Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment1.2Treatment Of Unfortunate Sequelae And/Or Medically Necessary Follow-On Care Subsequent To Authorized Noncovered Initial Surgery Or Treatment In A Market/Military Medical Treatment Facility (MTF)2.1Cosmetic, Reconstructive, And Plastic Surgery - General Guidelines2.2General Surgery3.1Laser Surgery3.2Robotic Surgery4.1Assistant Surgeons5.1Integumentary System5.2Post-Mastectomy Reconstructive Breast Surgery and Breast Prostheses5.3Prophylactic Mastectomy, Prophylactic Oophorectomy, And Prophylactic Hysterectomy5.4Reduction Mammaplasty For Macromastia5.5Silicone Or Saline Breast Implant Removal5.6Breast Reconstruction As A Result Of A Congenital Anomaly5.7Gynecomastia 5.8Negative Pressure Wound Therapy (NPWT)6.1Musculoskeletal System6.2Bone Growth Stimulation7.1Oral Surgery8.1Respiratory System8.2Lung Volume Reduction Surgery (LVRS)9.1Cardiovascular System9.2Photopheresis9.3Intracoronary Stents9.4Therapeutic Apheresis10.1Transjugular Intrahepatic Portosystemic Shunt (TIPS)11.1Hemic And Lymphatic Systems12.1Mediastinum And Diaphragm13.1Digestive System13.2Surgery For Morbid Obesity14.1Urinary System15.1Male Genital System16.1Intersex Surgery17.1Female Genital System18.1Maternity Care18.2Antepartum Services18.3Abortions 18.4Cesarean Sections18.5Fetal Surgery19.1Endocrine System20.1Nervous System20.2Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson’s Disease20.3Stereotactic Radiofrequency Thalamotomy21.1Eye And Ocular Adnexa22.1Auditory System22.2Cochlear Implantation23.1High Dose Chemotherapy (HDC) And Stem Cell Transplantation24.1Heart-Lung And Lung Transplantation24.2Heart Transplantation24.3Combined Heart-Kidney Transplantation (CHKT) 24.4Small Intestine (SI), Combined Small Intestine-Liver (SI/L), And Multivisceral Transplantation24.5Liver Transplantation24.6Combined Liver-Kidney Transplantation (CLKT)24.7Simultaneous Pancreas-Kidney (SPK), Pancreas-After-Kidney (PAK), And Pancreas-Transplant-Alone (PTA), And Pancreatic Islet Cell Transplantation24.8Kidney Transplantation24.9Donor Costs