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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 state that current available body of evidence demonstrates that CCTA can reliably rule out the 
presence of significant coronary artery disease (CAD) in patients with a low to intermediate probability of 
having CAD and can reliably achieve a high degree of diagnostic accuracy and technical performance 
necessary to replace conventional angiography. 
 
Limitations: 
 
    a. These tests are never covered for screening, i.e., in the absence of signs, symptoms or disease. 
 
    b. These tests will be considered not medically necessary if the anticipated results are not expected to 
provide new, additional information to that already previously obtained from other tests (such as stress 
myocardial perfusion images or cardiac ultrasound). New or additional information should facilitate the 
management decision, not merely add a new layer of testing. 
 
    c. These tests will be considered not medically necessary if it is anticipated that the patient would require 
invasive cardiac angiography for further diagnosis or for therapeutic intervention. (e.g., angina decubitus, 
unstable angina, Prinzmetal angina, etc.) 
 
    d. These tests may be denied, on post-pay review, as not medically necessary when used for cardiac 
evaluation if there were pre-test knowledge of sufficiently extensive calcification of the suspect coronary 
segment that would diminish the interpretive value. 
 
    e. The administration of beta blockers and the monitoring of the patient during MDCT/CCTA by a physician 
experienced in the use of cardiovascular drugs is included as part of the test and is not a separately payable 
service. 
 
    f. All studies must be ordered by the physician/qualified non-physician practitioner treating the patient and 
who will use the results of the test in the management of the patient. 
 
    g. CCTA must be performed under the direct supervision of a physician. 
 
    h. This LCD does not address electron beam tomography (EBT) technology or Ultrafast CT for coronary 
artery examination. There is no extension of coverage of EBT based on this policy. 
 
    i. Quantitative calcium scoring is not a covered service and will be denied as not medically necessary. 
Calcium scoring reported in isolation is considered a screening service. When performed in association with 
CT angiography, there is neither separate nor additional included reimbursement for the calcium scoring. 
 
    j. Acceptable Levels of Competence for Performance and Interpretation: Providers submitting claims for 
these tests must demonstrate proficiency and training in performing the tests according to the following 
standards: 
 
 
 
The acceptable levels of competence, as defined by the American College of Cardiology (ACC)/American 
Heart Association (AHA) Clinical Competence Statement on Cardiac Imaging with Computed Tomography 
and Magnetic Resonance (2005) and the American College of Radiology (ACR) Clinical Statement on 
Noninvasive Cardiac Imaging (2005). 
 
You can find this information in the Local Coverage Determination (LCD):  Cardiac Computed Tomography 
(CCT) and Coronary Computed Tomography Angiography (CCTA) (L33559). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.