III. NON-AUTHORIZED MEDICAL
INTERVENTIONS/PROCEDURES
The following medical
interventions and procedures are not authorized for
payment by the USMS, unless ordered by the court:
Amniocentesis, unless
justified in writing by a physician or mid-level provider because of
clinical findings indicating possible complications
Any medical care
whatsoever for the infant after delivery, including the first
newborn exam and routine screening, as per Federal Statute
Artificial insemination
Construction of
artificial vagina
Culture of oocyte
Diaphragm fitting
Dilation of vagina under
anesthesia
Elective abortions,
except where the life of the mother would be endangered if the fetus
were carried to term, or where the pregnancy is the result of rape
Embryo transfer
Excision of vaginal
septum
Fimbrioplasty
Gamete or zygote
transfer
Home uterine monitoring
devices, unless justified in writing by a physician or mid-level
provider because of clinical findings indicating possible
complications
Hydrotubation of oviduct
Hymenotomy, simple
incision
Hysteroplasty to repair
uterine anomaly
Infertility workup or
treatment, including Assisted Reproductive Technology (ART)
Injection procedure,
hysterosalpingography
Insertion of
intrauterine device
Intersex surgery, female
to male
Intersex surgery, male
to female
Ligation or transection
of fallopian tubes
Lysis of labial
adhesions
Mammography, unless
ordered in writing by a physician or mid-level provider because of
documented clinical findings indicating suspicion of malignancy and
preauthorized by the Office of Interagency Medical Services, or
unless the detainee is 40 years of age and has been in the
uninterrupted custody of the USMS for greater than 12 months
Non-emergency
Hysterectomy
Oocyte retrieval
Plastic repair of
introitus
Procedures, services and
supplies related to sex transformations
Reversal of surgically
induced sterility
Routine physical
examinations, including PAP smear, unless ordered in writing by a
physician or mid-level provider because of documented clinical
findings and preauthorized by the Office of Interagency Medical
Services, or unless the detainee has been in the uninterrupted
custody of the USMS for greater than 12 months
Subsequent routine
sonogram(s) to determine fetal age and/or size, unless justified in
writing by a physician or mid-level provider because of clinical
findings indicating possible complications. (The initial ultrasound
is covered.)
Salpingostomy
Transcervical
introduction of fallopian tube catheter
Transection of fallopian
tube, minilaparotomy
Transposition of ovary
Tubotubal anastomosis
Tubouterine implantation
Uterine suspension
Voluntary sterilization
or other family planning services, including
contraceptive drugs, devices, or surgery
