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U.S. Marshals Service

Prisoner Health Care Standards

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:

Q. SURGERY - NOT COVERED

CARDIOVASCULAR SYSTEM SURGERY

Donor cardiectomy

Donor cardiectomy-pneumonectomy

Heart transplant

Heart-lung transplant

Varicose vein ligation, division, excision, or stripping

DIGESTIVE SYSTEM SURGERY

Anterior gastropexy for hiatal hernia

Excision tonsil tags

Frenuloplasty

Gastric bypass for morbid obesity

Gastroplasty for morbid obesity

Hemorrhoidal surgery, except when unresponsive to conservative
treatment

Elective Revision of colostomy

Elective Revision of ileostomy

Surgical treatment for morbid obesity

Vermilionectomy, with mucosal advancement

EAR, NOSE AND THROAT SURGERY

Adenoidectomy

Excision of soft tissue lesion of the ear

Excision of exostosis

Excision of tonsil tags

Functional reconstruction of the internal nose

Insertion of nasal septal prosthesis

Lysis of intranasal synechia

Myringotomy with or without Tubes

Orthognathic surgery

Repair of oronasal fistula

Rhinoplasty

Septoplasty or submucous resection

Sleep Apnea surgery

Tonsillectomy

Treatment for temporomandibular joint dysfunction and disorders,
including surgery and appliances

Tympanoplasty

EYE SURGERY

Blepharoptosis repair

Canthoplasty

Cataract surgery

Closure of lacrimal punctum

Conjunctivodacryocystotomy

Conjunctivorhinostomy

Corneal relaxing incision

Corneal wedge resection

Correction of lid retraction

Correction of everted punctum

Epikeratoplasty

Keratomileusis

Keratophakia

Keratoprosthesis

Modification of ocular implant

Photorefractive keratectomy

Plastic repair of canaliculi

Radial keratotomy

Reconstruction of eyelid

Reduction of overcorrection of ptosis

Release of extensive scar tissue

Removal or revision of orbital implant

Strabismus surgery

Transposition extraocular muscle

LASIK (Laser-Assisted in Situ Keratomileusis)

GENERAL SURGERY

Any operative procedure or any portion of a procedure performed
primarily to improve physical appearance and/or treat a mental condition through change in bodily form

Any costs incurred for organ transplantation, whether incurred by recipient or donor, including bone marrow transplants, and tissue typing

Non-emergency Herniorrhaphy

Oral and maxillofacial surgery, unless required as a result of injury incurred while in the custody of the USMS and preauthorized
by the Office of Interagency Medical Services

Plastic surgery

Reconstructive surgery unless required as a result of injury incurred while in the custody of the USMS and preauthorized by the Office of Interagency Medical Services

Removal of implant material

Stand-by surgeons

Surgical treatment for morbid obesity

Surgical correction of congenital anomalies

GENITAL SYSTEM (FEMALE) SURGERY

Construction of artificial vagina

Dilation of vagina under anesthesia

Excision of vaginal septum

Fimbrioplasty

Genitoplasty

Hymenotomy, simple incision

Hysteroplasty to repair uterine anomaly

Intersex surgery, female to male

Intersex surgery, male to female

Ligation or transection of fallopian tubes

Non-emergency hysterectomy

Plastic repair of introitus

Reversal of surgically induced sterility

Salpingostomy

Transcervical introduction of fallopian tube catheter

Transection of fallopian tube, minilaparotomy

Transposition of ovary

Tubotubal anastomosis

Uterine suspension

Voluntary sterilization

GENITAL SYSTEM (MALE) SURGERY

Circumcision

Epididymovasostomy, anastomosis epididymis to vas deferens

Excision, penile plaque

Genitoplasty

Insertion penile prosthesis

Insertion of testicular prosthesis

Intersex surgery, female to male

Intersex surgery, male to female

Ligation of vas deferens

Plastic operation on penis to correct angulation

Removal/repair/replacement of penile prosthesis

Repair of hypospadias complications

Reversal of surgically induced sterility

Surgical correction of abnormality in penile prosthesis

Transurethral balloon dilation, prostatic urethra

Vasectomy

Vasotomy

Vasovasotomy, vasovasorrhaphy

Voluntary sterilization

INTEGUMENTARY SYSTEM SURGERY (SKIN, SUBCUTANEOUS AND AREOLAR TISSUE, BREAST)

Acne surgery

Arthoscopy of the temporomandibular joint

Augmentation of the mandibular body or angle

Blepharoplasty

Bone graft, nasal maxillary and malar areas

Breast reconstruction

Cartilage graft

Cervicoplasty

Condylectomy of the temporomandibular joint

Coronoidectomy

Correction of inverted nipples

Excision of excessive skin

Fascia lata graft

Genitoplasty

Graft for facial nerve paralysis

Hair transplant

Immediate insertion of breast prosthesis after mastectomy

Insertion of tissue expander

Insertion of contraceptive capsules

Ligament Release of Tarsal Tunnel

Mammoplasty

Mastectomy for gynecomastia

Mastopexy

Meniscectomy of the temporomandibular joint

Muscle Resection

Nipple/areola reconstruction

Nipple exploration

Non-emergency Herniorrhaphy

Periprosthetic capsulectomy, breast

Reconstruction of nail bed

Reconstructive surgery

Reduction of the forehead

Removal by contouring of a benign tumor of the facial bone

Removal of tissue expander

Removal of sutures under anesthesia

Removal of intact mammary implant

Removal of contraceptive capsules

Replacement of tissue expander

Revision reconstructed breast

Rhytidectomy

Skin graft

Submucosal Resection

Subperiosteal implant

Suction assisted lipectomy

Tissue graft

Treatment for temporomandibular joint dysfunction and disorders,
including surgery and appliances

NERVOUS SYSTEM SURGERY

Burr holes, implantation neurostimulator electrodes

Craniectomy, implantation neurostimulator electrodes

Incision/subcutaneous placement neurostimulator generator/receiver

Incision and subcutaneous placement/cranial neurostimulator

Incision/subcutaneous placement neurostimulator generator/receiver

Laminectomy, implantation neurostimulator electrodes

Percutaneous implantation neurostimulator electrodes

Revision/removal spinal neurostimulator generator/receiver

Revision or removal/cranial neurostimulator

Revision/removal peripheral neurostimulator electrodes

Revision/removal intracranial neurostimulator electrodes

Revision/removal peripheral neurostimulator generator/receiver

ORTHOPEDIC SURGERY

Arthrocentesis, unless acute

Arthroplasty

Arthroscopy-surgical

Arthrotomy

Bone graft

Carpal Tunnel Decompression, unless serious enough to result in nerve damage or unremitting pain

Condylectomy

Diagnostic arthroscopy, with or without biopsy

Disc repair, or discectomy, unless due to severe pain that is unresponsive to conservative treatment or with clear evidence of motor impairment

Foot Surgery, including Bunionectomy

Hammertoe operation, for cock-up fifth toe

Joint Reconstruction

Ligament Release of Tarsal Tunnel

Myotomy

Non-emergency back (disc) surgery

Non-emergency limb amputation

Non-emergency Reconstruction of the mandible

Orthognathic surgery

Osteoplasty for orthognathic deformities

Osteotomy of the facial bones

Osteotomy of the mandible

Osteoplasty of ramus, with or without bone graft

Osteotomy of the body of the mandible

Osteotomy-segmented or subapical-per sextant or quadrant

Partial ostectomy

Radical resection of mandible with bone graft

Reconstruction of cleft foot

Reconstruction of the toe

Skin grafts

Synovectomy

Transosseous implant

Transseptal fiberotomy

URINARY SYSTEM SURGERY

Donor nephrectomy

Recipient nephrectomy

Renal autotransplantation, reimplantation

Renal homotransplantation

Renal transplantation with recipient nephrectomy

 
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