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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. 
 
The rules say that CT scans are covered if there is literature to support its use for the patient?s condition and the 
scan is reasonable and necessary for the patient. You can find this rule in the Medicare National Coverage 
Determinations Manual, Section 220.1(A). 
 
The following clinical indications apply to the Computerized Axial Tomography (CT or CAT) of the thorax: 
 
    Evaluation of pulmonary, mediastinal, pleural and chest wall infections and their complications 
    Detection and characterization of mediastinal neoplasms and other processes 
    Assessment of cardiopulmonary failure or insufficiency 
    Diagnosis and/or staging of neoplastic and hematologic processes arising in the thorax or with potential 
involvement of the thorax 
    Detection and determination of nature and extent of cardiovascular abnormalities such as, but not limited to 
aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications and sequelae 
of atherosclerotic disease 
    For assessing and/or guiding drainage of pulmonary or pleural fluid collections such as abscess, empyema, 
effusion or pneumothorax 
    For characterizing and follow-up evaluation of interstitial and alveolar lung disease due to idiopathic, 
allergic, collagen-vascular, environmental or other causes 
    For evaluating thoracic sequelae of remote processes including, but not limited to, pancreatitis, 
gastrointestinal perforation and other processes 
    For assessing injury, potential injury or thoracic sequelae after trauma, burn, surgery, transplantation, 
radiation therapy, chemotherapy or invasive procedure such as pacemaker placement, chest tube placement or 
mechanical ventilation 
    Evaluation of the patient with symptoms that may be arising from the chest, or be referred to the chest 
including but not limited to cough, hemoptysis, chest pain, abdominal pain and others 
    To further characterize a suspected abnormality detected by another imaging test 
    Evaluation of a patient with myasthenia gravis to rule out thymic tumors 
    Performance of CT-guided biopsies and drainage procedures when fluoroscopy is inadequate 
    The most common symptom of an aortic dissection (occurring in approximately 90% of the cases) is sudden, 
excruciating pain most commonly located in the anterior chest. Patients may describe the pain as "cutting," 
"ripping," or "tearing". A sudden neurologic episode usually accompanies the onset of most instances of 
"painless" aortic dissection. 
 
NOTE: Radiologic examinations of the chest represent the basic diagnostic tests used to identify abnormalities 
of the thorax. The chest x-ray and/or physical examination should be used to evaluate patients who present with 
signs and/or symptoms suggestive of chest pathology prior to proceeding to a CT scan. 
 
You can find these rules in Local Coverage Determination (LCD): Computerized Axial Tomography (CT), 
Thorax (L33459). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com. 
 
The Plan contract says that the Plan covers items and services in accordance with Medicare rules.