Manual Table of Contents

TRICARE/CHAMPUS Policy Manual 6010.47-M, December 1998, Change 12 (May 14, 1999)

  1. Collapse to hide TRICARE/CHAMPUS Policy Manual contentsManualTRICARE/CHAMPUS Policy Manual 6010.47-M, December 1998
    1. PDF FilePOL TOC (TRICARE/CHAMPUS Policy Manual)
    2. PDF FilePOL (Tricare/CHAMPUS Policy Manual)
    3. PDF FilePOL (Tricare/CHAMPUS Policy Manual)
    4. PDF FilePOL Foreword (TRICARE/CHAMPUS Policy Manual)
    5. PDF FilePOL Introduction (TRICARE/CHAMPUS Policy Manual)
    6. Expand to show POL Chap 1 TOC contentsPDF FilePOL Chap 1 TOC -- Medical Services (TRICARE/CHAMPUS Policy Manual)
      1. Expand to show POL Chap 2 TOC contentsPDF FilePOL Chap 2 TOC -- Anesthesia (TRICARE/CHAMPUS Policy Manual)
        1. Collapse to hide POL Chap 3 TOC contentsPDF FilePOL Chap 3 TOC -- Surgery And Related Services (TRICARE/CHAMPUS Policy Manual)
          1. PDF FilePOL Chap 3 Sect 1.1 -- Complications (Unfortunate Sequelae) Resulting From Noncovered Surgery Or Treatment (Tricare/CHAMPUS Policy Manual)
          2. PDF FilePOL Chap 3 Sect 1.2 -- Cosmetic, Reconstructive And Plastic Surgery - General Guidelines (Tricare/CHAMPUS Policy Manual)
          3. PDF FilePOL Chap 3 Sect 1.3 -- Laser Surgery (Tricare/CHAMPUS Policy Manual)
          4. PDF FilePOL Chap 3 Sect 1.4 -- Assistant Surgeons (Tricare/CHAMPUS Policy Manual)
          5. PDF FilePOL Chap 3 Sect 1.5 -- Laparoscopic Surgical Procedures (Tricare/CHAMPUS Policy Manual)
          6. PDF FilePOL Chap 3 Sect 1.6B -- Heart-Lung And Lung Transplantation (Tricare/CHAMPUS Policy Manual)
          7. PDF FilePOL Chap 3 Sect 1.6D -- Small Intestine (SI); Combined Small-Intestine-Liver (SI/L); And Multivisceral Transplantation (Tricare/CHAMPUS Policy Manual)
          8. PDF FilePOL Chap 3 Sect 1.6E -- Combined Liver-Kidney Transplantation (Tricare/CHAMPUS Policy Manual)
          9. PDF FilePOL Chap 3 Sect 1.6F -- Kidney Transplantation (Tricare/CHAMPUS Policy Manual)
          10. PDF FilePOL Chap 3 Sect 1.6G -- Simultaneous Pancreas-Kidney Transplantation (Tricare/CHAMPUS Policy Manual)
          11. PDF FilePOL Chap 3 Sect 1.6H -- Pancreas Transplantation (Tricare/CHAMPUS Policy Manual)
          12. PDF FilePOL Chap 3 Sect 1.6J -- Combined Heart-Kidney Transplantation (Tricare/CHAMPUS Policy Manual)
          13. PDF FilePOL Chap 3 Sect 1.6L -- Donor Costs (Tricare/CHAMPUS Policy Manual)
          14. PDF FilePOL Chap 3 Sect 2.1 -- Integumentary System (Tricare/CHAMPUS Policy Manual)
          15. PDF FilePOL Chap 3 Sect 2.2 -- Reconstructive Collagen Implantation (Tricare/CHAMPUS Policy Manual)
          16. PDF FilePOL Chap 3 Sect 2.3 -- Dermabrasion (Tricare/CHAMPUS Policy Manual)
          17. PDF FilePOL Chap 3 Sect 2.4 -- Blepharoplasty (Tricare/CHAMPUS Policy Manual)
          18. PDF FilePOL Chap 3 Sect 2.5 -- Liposuction (Tricare/CHAMPUS Policy Manual)
          19. PDF FilePOL Chap 3 Sect 2.6 -- Postmastectomy Reconstructive Breast Surgery (Tricare/CHAMPUS Policy Manual)
          20. PDF FilePOL Chap 3 Sect 2.7 -- Prophylactic Mastectomy (Tricare/CHAMPUS Policy Manual)
          21. PDF FilePOL Chap 3 Sect 2.8 -- Reduction Mammoplasty (Tricare/CHAMPUS Policy Manual)
          22. PDF FilePOL Chap 3 Sect 2.9 -- Silicone Or Saline Breast Implant Removal (Tricare/CHAMPUS Policy Manual)
          23. PDF FilePOL Chap 3 Sect 2.10 -- Breast Construction As A Result Of A Congenital Anomaly (Tricare/CHAMPUS Policy Manual)
          24. PDF FilePOL Chap 3 Sect 2.11 -- Stereotaxic (Stereotactic) Breast Biopsy (Tricare/CHAMPUS Policy Manual)
          25. PDF FilePOL Chap 3 Sect 3.1 -- Mandibular Staple Implant (Tricare/CHAMPUS Policy Manual)
          26. PDF FilePOL Chap 3 Sect 3.2 -- Musculoskeletal System (Tricare/CHAMPUS Policy Manual)
          27. PDF FilePOL Chap 3 Sect 3.3 -- Oral Surgery Of The Temporomandibular Joint (Tricare/CHAMPUS Policy Manual)
          28. PDF FilePOL Chap 3 Sect 3.4 -- Ilizarov Bone Lengthening Technique (Tricare/CHAMPUS Policy Manual)
          29. PDF FilePOL Chap 3 Sect 3.5 -- Electrical Stimulation Of Bone (Tricare/CHAMPUS Policy Manual)
          30. PDF FilePOL Chap 3 Sect 3.6 -- Mandibular Bone Grafts (Tricare/CHAMPUS Policy Manual)
          31. PDF FilePOL Chap 3 Sect 3.7 -- Pectus Excavatum (Tricare/CHAMPUS Policy Manual)
          32. PDF FilePOL Chap 3 Sect 3.9 -- Denis-Browne Splint (Tricare/CHAMPUS Policy Manual)
          33. PDF FilePOL Chap 3 Sect 4.1 -- Respiratory System (Tricare/CHAMPUS Policy Manual)
          34. PDF FilePOL Chap 3 Sect 4.2 -- Rhinoplasty (Tricare/CHAMPUS Policy Manual)
          35. PDF FilePOL Chap 3 Sect 4.3 -- Transtracheal Oxygen Therapy (Tricare/CHAMPUS Policy Manual)
          36. PDF FilePOL Chap 3 Sect 5.1 -- Cardiovascular System (Tricare/CHAMPUS Policy Manual)
          37. PDF FilePOL Chap 3 Sect 5.2 -- Automatic Implantable Cardioverter-Defibrillator (AICD) (Tricare/CHAMPUS Policy Manual)
          38. PDF FilePOL Chap 3 Sect 5.3 -- Heart Transplantation (Tricare/CHAMPUS Policy Manual)
          39. PDF FilePOL Chap 3 Sect 5.4 -- Extracorporeal Membrane Oxygenation (ECMO) (Tricare/CHAMPUS Policy Manual)
          40. PDF FilePOL Chap 3 Sect 5.5 -- Implantable Infusion Pump (Tricare/CHAMPUS Policy Manual)
          41. PDF FilePOL Chap 3 Sect 5.6 -- Therapeutic Apheresis (Tricare/CHAMPUS Policy Manual)
          42. PDF FilePOL Chap 3 Sect 5.7 -- Photopheresis (Tricare/CHAMPUS Policy Manual)
          43. PDF FilePOL Chap 3 Sect 5.8 -- Extracorporeal Immunoadsorption (ECI) With Protein A Columns (Tricare/CHAMPUS Policy Manual)
          44. PDF FilePOL Chap 3 Sect 5.9 -- Percutaneous Transluminal Balloon Valvuloplasty (Tricare/CHAMPUS Policy Manual)
          45. PDF FilePOL Chap 3 Sect 5.10 -- Intracoronary Stents (Tricare/CHAMPUS Policy Manual)
          46. PDF FilePOL Chap 3 Sect 6.1 -- High Dose Chemotherapy And Stem Cell Transplantation (Tricare/CHAMPUS Policy Manual)
          47. PDF FilePOL Chap 3 Sect 6.2 -- Hemic And Lymphatic Systems (Tricare/CHAMPUS Policy Manual)
          48. PDF FilePOL Chap 3 Sect 7.1 -- Mediastinum And Diaphragm (Tricare/CHAMPUS Policy Manual)
          49. PDF FilePOL Chap 3 Sect 8.1 -- Digestive System (Tricare/CHAMPUS Policy Manual)
          50. PDF FilePOL Chap 3 Sect 8.2 -- Surgery For Tongue-Tie (Ankyloglossia) (Tricare/CHAMPUS Policy Manual)
          51. PDF FilePOL Chap 3 Sect 8.3 -- Vestibuloplasty Procedures (Surgery On Gums And Jaws) (Tricare/CHAMPUS Policy Manual)
          52. PDF FilePOL Chap 3 Sect 8.4 -- Surgery For Morbid Obesity (Tricare/CHAMPUS Policy Manual)
          53. PDF FilePOL Chap 3 Sect 8.5 -- Liver Transplantation (Tricare/CHAMPUS Policy Manual)
          54. PDF FilePOL Chap 3 Sect 8.6 -- Cryotherapy (Cryosurgery) For Liver Metastases (Tricare/CHAMPUS Policy Manual)
          55. PDF FilePOL Chap 3 Sect 8.7 -- Transjugular Intrahepatic Portosystemic Shunt (TIPS) (Tricare/CHAMPUS Policy Manual)
          56. PDF FilePOL Chap 3 Sect 9.1 -- Urinary System (Tricare/CHAMPUS Policy Manual)
          57. PDF FilePOL Chap 3 Sect 9.2 -- Lithotripsy (Tricare/CHAMPUS Policy Manual)
          58. PDF FilePOL Chap 3 Sect 9.3 -- Bladder Stimulators (Tricare/CHAMPUS Policy Manual)
          59. PDF FilePOL Chap 3 Sect 9.4 -- Collagen Implantation For Incontinence (Tricare/CHAMPUS Policy Manual)
          60. PDF FilePOL Chap 3 Sect 10.1 -- Male Genital System (Tricare/CHAMPUS Policy Manual)
          61. PDF FilePOL Chap 3 Sect 11.1 -- Intersex Surgery (Tricare/CHAMPUS Policy Manual)
          62. PDF FilePOL Chap 3 Sect 12.1 -- Transcervical Balloon Tuboplasty (Tricare/CHAMPUS Policy Manual)
          63. PDF FilePOL Chap 3 Sect 12.2 -- Female Genital System (Tricare/CHAMPUS Policy Manual)
          64. PDF FilePOL Chap 3 Sect 13.1 -- Hemolytic Disease Of The Fetus And Newborn (Tricare/CHAMPUS Policy Manual)
          65. PDF FilePOL Chap 3 Sect 13.2 -- Maternity Care (Tricare/CHAMPUS Policy Manual)
          66. PDF FilePOL Chap 3 Sect 13.3 -- Amniocentesis (Tricare/CHAMPUS Policy Manual)
          67. PDF FilePOL Chap 3 Sect 13.4 -- Chorionic Villus Sampling (Tricare/CHAMPUS Policy Manual)
          68. PDF FilePOL Chap 3 Sect 13.5 -- Electronic Fetal Monitoring (Tricare/CHAMPUS Policy Manual)
          69. PDF FilePOL Chap 3 Sect 13.6 -- Abortions (Tricare/CHAMPUS Policy Manual)
          70. PDF FilePOL Chap 3 Sect 13.7 -- Cesarean Sections (Tricare/CHAMPUS Policy Manual)
          71. PDF FilePOL Chap 3 Sect 14.1 -- Endocrine System (Tricare/CHAMPUS Policy Manual)
          72. PDF FilePOL Chap 3 Sect 15.1 -- Nervous System (Tricare/CHAMPUS Policy Manual)
          73. PDF FilePOL Chap 3 Sect 15.2 -- Temporal Lobectomy (Tricare/CHAMPUS Policy Manual)
          74. PDF FilePOL Chap 3 Sect 15.3 -- Stereotactic Implantation Of Depth Electrodes (Tricare/CHAMPUS Policy Manual)
          75. PDF FilePOL Chap 3 Sect 15.4 -- Stereotactic Radiosurgery/Radiotherapy (Tricare/CHAMPUS Policy Manual)
          76. PDF FilePOL Chap 3 Sect 15.5 -- Central Nervous System Stimulation (Tricare/CHAMPUS Policy Manual)
          77. PDF FilePOL Chap 3 Sect 15.6 -- Facet Blocks (Tricare/CHAMPUS Policy Manual)
          78. PDF FilePOL Chap 3 Sect 15.7 -- Epidural Narcotics/Steroids (Tricare/CHAMPUS Policy Manual)
          79. PDF FilePOL Chap 3 Sect 15.8 -- Percutaneous Lumbar Discectomy (PLD) (Tricare/CHAMPUS Policy Manual)
          80. PDF FilePOL Chap 3 Sect 15.9 -- Chemonucleolysis (Tricare/CHAMPUS Policy Manual)
          81. PDF FilePOL Chap 3 Sect 15.10 -- Selective Posterior Rhizotomy For Spasticity In Cerebral Palsy (Tricare/CHAMPUS Policy Manual)
          82. PDF FilePOL Chap 3 Sect 15.11 -- Electrical Stimulation Of The Peripheral Nerve (Tricare/CHAMPUS Policy Manual)
          83. PDF FilePOL Chap 3 Sect 15.12 -- Destruction Of Nerve By Radiofrequency Thermoneurolysis (Tricare/CHAMPUS Policy Manual)
          84. PDF FilePOL Chap 3 Sect 15.13 -- Radiofrequency Facet Rhizolysis (Tricare/CHAMPUS Policy Manual)
          85. PDF FilePOL Chap 3 Sect 15.14 -- Psychosurgery (Tricare/CHAMPUS Policy Manual)
          86. PDF FilePOL Chap 3 Sect 15.15 -- Pediatric Microsurgery Repair For Obstetric Brachial Plexus Palsy (Tricare/CHAMPUS Policy Manual)
          87. PDF FilePOL Chap 3 Sect 15.16 -- Stereotactic Radiofrequency Pallidotomy With Microelectrode Mapping For Treatment Of Parkinson’s Disease (Tricare/CHAMPUS Policy Manual)
          88. PDF FilePOL Chap 3 Sect 15.17 -- Stereotactic Radiofrequency Thalamotomy (Tricare/CHAMPUS Policy Manual)
          89. PDF FilePOL Chap 3 Sect 16.1 -- Eye And Ocular Adnexa (Tricare/CHAMPUS Policy Manual)
          90. PDF FilePOL Chap 3 Sect 16.2 -- Corneal Transplants (Tricare/CHAMPUS Policy Manual)
          91. PDF FilePOL Chap 3 Sect 16.3 -- Refractive Keratoplasty (Tricare/CHAMPUS Policy Manual)
          92. PDF FilePOL Chap 3 Sect 16.4 -- Radial Keratotomy (Tricare/CHAMPUS Policy Manual)
          93. PDF FilePOL Chap 3 Sect 16.5 -- Intraocular Lens Implantation (Tricare/CHAMPUS Policy Manual)
          94. PDF FilePOL Chap 3 Sect 16.6 -- Strabismus Surgery (Tricare/CHAMPUS Policy Manual)
          95. PDF FilePOL Chap 3 Sect 16.7 -- Scleral Shell Prothesis (Tricare/CHAMPUS Policy Manual)
          96. PDF FilePOL Chap 3 Sect 16.8 -- Nasolacrimal Duct (Tricare/CHAMPUS Policy Manual)
          97. PDF FilePOL Chap 3 Sect 16.9 -- Excimer Laser Phototherapeutic Keratectomy For Corneal Dystrophies (Tricare/CHAMPUS Policy Manual)
          98. PDF FilePOL Chap 3 Sect 17.1 -- Auditory System (Tricare/CHAMPUS Policy Manual)
          99. PDF FilePOL Chap 3 Sect 17.2 -- Otoplasty (Tricare/CHAMPUS Policy Manual)
          100. PDF FilePOL Chap 3 Sect 17.3 -- Cochlear Implantation (Tricare/CHAMPUS Policy Manual)
        2. Expand to show POL Chap 4 TOC contentsPDF FilePOL Chap 4 TOC -- Radiology (TRICARE/CHAMPUS Policy Manual)
          1. Expand to show POL Chap 5 TOC contentsPDF FilePOL Chap 5 TOC -- Pathology And Laboratory Services (TRICARE/CHAMPUS Policy Manual)
            1. Expand to show POL Chap 6 TOC contentsPDF FilePOL Chap 6 TOC -- Institutional Services (TRICARE/CHAMPUS Policy Manual)
              1. Expand to show POL Chap 7 TOC contentsPDF FilePOL Chap 7 TOC -- Other Services (TRICARE/CHAMPUS Policy Manual)
                1. Expand to show POL Chap 8 TOC contentsPDF FilePOL Chap 8 TOC -- Special Benefit Information (TRICARE/CHAMPUS Policy Manual)
                  1. Expand to show POL Chap 9 TOC contentsPDF FilePOL Chap 9 TOC -- Eligibility Policy (TRICARE/CHAMPUS Policy Manual)
                    1. Expand to show POL Chap 10 TOC contentsPDF FilePOL Chap 10 TOC -- Provider Policy (TRICARE/CHAMPUS Policy Manual)
                      1. Expand to show POL Chap 11 TOC contentsPDF FilePOL Chap 11 TOC -- Administrative Policy (TRICARE/CHAMPUS Policy Manual)
                        1. Expand to show POL Chap 12 TOC contentsPDF FilePOL Chap 12 TOC -- TRICARE (TRICARE/CHAMPUS Policy Manual)
                          1. Expand to show POL Chap 13 TOC contentsPDF FilePOL Chap 13 TOC -- Payments Policy (TRICARE/CHAMPUS Policy Manual)
                            1. PDF FilePOL Chap A Appendix A-1 -- TRICARE-Authorized Residential Treatment Centers (TRICARE/CHAMPUS Policy Manual)
                            2. PDF FilePOL -- For payment of services provided on or after October 1, 1994 Appendix A-1 -- TRICARE-Authorized Residential Treatment Centers (TRICARE/CHAMPUS Policy Manual)
                            3. PDF FilePOL -- For payment of services provided on or after April 6, 1995 Appendix A-2 -- TRICARE-Authorized Residential Treatment Centers (TRICARE/CHAMPUS Policy Manual)
                            4. PDF FilePOL -- Following are the rate adjustments for those RTCs whose 1995 per diems were below the 30th percentile of all established fiscal year 1995 rates. The rates were adjusted by the lesser of the Consumer Price Index - Urban Wage Earners (CPI-U) for medi
                            5. PDF FilePOL -- Following are the rate adjustments for those RTCs whose 1995 per diems were below the 30th percentile of all established fiscal year 1995 rates. The rates were adjusted by the lesser of the Consumer Price Index - Urban Wage Earners (CPI-U) for medi
                            6. PDF FilePOL -- For payment of services provided on or after October 1, 1997. Appendix A-5 -- TRICARE-Authorized Residential Treatment Centers (TRICARE/CHAMPUS Policy Manual)
                            7. PDF FilePOL -- For payment of services provided on or after October 1, 1998. Appendix A-6 -- TRICARE-Authorized Residential Treatment Centers (TRICARE/CHAMPUS Policy Manual)
                            8. PDF FilePOL Chap B (TRICARE/CHAMPUS Policy Manual)
                            9. PDF FilePOL Appendix B -- Participation Agreement For Freestanding Or Institution-Affiliated Birthing Center Maternity Care Services For TRICARE/CHAMPUS Beneficiaries (TRICARE/CHAMPUS Policy Manual)
                            10. PDF FilePOL (TRICARE/CHAMPUS Policy Manual)
                            11. PDF FilePOL Appendix C -- TRICARE/CHAMPUS Standards For Residential Treatment Centers Serving Children And Adolescents (RTCs) (TRICARE/CHAMPUS Policy Manual)