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
Director/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
Director/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.