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TRICARE Policy Manual 6010.60-M, April 1, 2015
Chapter 4
Section 1.2
Treatment Of Unfortunate Sequelae And/Or Medically Necessary Follow-On Care Subsequent To Authorized Noncovered Initial Surgery Or Treatment In A Military Treatment Facility (MTF)/Enhanced Multi-Service Market (eMSM)
Issue Date:  February 28, 2012
Authority:  32 CFR 199.4(e)(9)(ii)
Revision:  
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.
2.0  Effective Date
For treatment of unfortunate sequelae and/or necessary follow-on care subsequent to an authorized noncovered initial surgery or treatment occurring on or after October 17, 2011.
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