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The rules say that plans must pay for a medical service or item if regular Medicare would pay for it in this case. 
You can find this rule at 42 Code of Federal Regulations (CFR) Section 422.101. 
 
Medicare guidance says CPT code 64490-RT*1 and 64490-LT-59*1 has a bilateral surgery indicator of "1". 
You can find this guidance in the 2020 National Physician Fee Schedule Relative Value July Release. 
 
Medicare guidance says If the bilateral surgery indicator is "1", it states:1 = 150 percent payment adjustment 
for bilateral procedures applies. If code is billed with the bilateral modifier base payment for these codes when 
reported as bilateral procedures on the lower of: (a) the total actual charge for both sides, or (b) 150 percent of 
the fee schedule amount for a single code. If code is reported as a bilateral procedure and is reported with other 
procedure codes on the same day, apply the bilateral adjustment before applying any applicable multiple 
procedure rules. You can find this guidance in the Medicare Claims Processing Manual Chapter 23 - Fee 
Schedule Administration and Coding Requirements Section 50.6 Physician Fee Schedule Payment Policy 
Indicator File Record Layout. 
 
Medicare guidance says MUEs for HCPCS codes with an MAI of 2 are absolute date of service edits. These 
are per day edits based on policy. HCPCS codes with an MAI of 2 have been rigorously reviewed and 
vetted within CMS and obtain this MAI designation because UOS on the same date of service (DOS) in excess 
of the MUE value would be considered impossible because it was contrary to statute, regulation, or 
subregulatory guidance. This subregulatory guidance includes clear correct coding policy that is binding on 
both providers and CMS claims processing contractors. Limitations created by anatomical or coding limitations 
are incorporated in correct coding policy, both in the HIPAA mandated coding descriptors and CMS approved 
coding guidance as well as specific guidance in CMS and NCCI manuals. For example, it would be contrary to 
correct coding policy to report more than one unit of service for CPT 94002 (Ventilation assist and 
management . . . initial day) because such use could not accurately describe two initial days of management 
occurring on the same date of service as would be required by the code descriptor. As a result, claims 
processing contractors are instructed that an MAI of 2 denotes a claims processing restriction for which 
override during processing, reopening, or redetermination would be contrary to CMS policy.If the bilateral 
surgery indicator is 1, a bilateral surgical procedure must be reported with 1 UOS and modifier 50 
(bilateral modifier).CPT 64490-RT*1 and 64490-LT-59*1 was not billed in accordance with Medicare 
National Correct Coding Initiative Policy - Medically Unlikely Edits (MUE). This is not a medical necessity 
denial. You can find this guidance in the National Correct Coding Initiative Policy Chapter 1 - General Correct 
Coding Policies,Sec-V - Medically Unlikely Edits. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.