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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 currently covered indications include using MRA for specific conditions to evaluate flow in 
internal carotid vessels of the head and neck, peripheral arteries of lower extremities, abdomen and pelvis, and 
the chest. Coverage is limited to MRA units that have received FDA premarket approval, and such units must 
be operated within the parameters specified by the approval. In addition, the services must be reasonable and 
necessary for the diagnosis or treatment of the specific patient involved. 
 
The following are indications for MRAs: 
Head and Neck 
All of the following criteria must apply in order for Medicare to provide coverage for MRA of the head and 
neck: 
&#61623; MRA is used to evaluate the carotid arteries, the circle of Willis, the anterior, middle or posterior cerebral 
arteries, the vertebral or basilar arteries or the venous sinuses; 
&#61623; MRA is performed on patients with conditions of the head and neck for which surgery is anticipated and 
may be found to be appropriate based on the MRA. These conditions include, but are not limited to, tumor, 
aneurysms, vascular malformations, vascular occlusion or thrombosis. Within this broad category of 
disorders, medical necessity is the underlying determinant of the need for an MRA in specific diseases. The 
medical records should clearly justify and demonstrate the existence of medical necessity; and, 
&#61623; MRA and CA are not expected to be performed on the same patient for diagnostic purposes prior to the 
application of anticipated therapy. Only one of these tests will be covered routinely unless the physician can 
demonstrate the medical need to perform both tests. 
 
MRA is appropriately used to verify the presence of a condition, suspected because of findings from another 
test (usually an imaging study). For example, a patient who presents with a transient ischemic attack (TIA) 
should not undergo MRA simply because he might have a lesion which is amenable to surgery. However, if 
that patient has a carotid bruit and is found by Doppler study to have carotid stenosis, an MRA may be 
appropriate to evaluate the stenotic section of artery for surgical intervention. Please note that the anticipated 
surgery may be a percutaneous procedure such as carotid angioplasty with stent insertion. 
 
Another patient may present with a headache; it is not appropriate to proceed directly to MRA to rule out the 
possibility of an intracranial aneurysm. However, if that patient was found to have a clinically significant 
amount of blood in the cerebrospinal fluid, or the patient demonstrated signs and symptoms strongly suggesting 
an unruptured intracranial aneurysm, an MRA (or cerebral angiogram) may be appropriate. An MRA is not 
considered medically necessary for screening asymptomatic patients for intracranial aneurysms. 
 
Please note that the anticipated surgery may be a percutaneous procedure such as carotid angioplasty with stent 
insertion. 
 
Peripheral Arteries of Lower Extremities 
&#61623; Both MRA and CA may be useful in some cases, such as: 
A patient has had CA and this test was unable to identify a viable run-off vessel for bypass. When exploratory 
surgery is not believed to be a reasonable medical course of action for this patient, MRA may be performed to 
identify the viable runoff vessel; or, 
A patient has had MRA, but the results are inconclusive. 
 
Abdomen and Pelvis 
 
An MRA of the abdomen for evaluation of possible renal artery stenosis would not be considered medically 
necessary without some evidence consistent with renovascular hypertension. Such evidence might include: 
&#61623; a history of early or late onset of hypertension, hypertension refractory to medication, or worsening renal 
function; 
&#61623; the presence of a renal artery bruit; 
&#61623; laboratory tests (elevated serum renins, increasing creatinine); or 
&#61623; other radiologic tests (ultrasound, captopril scintigraphy, or other imaging showing small kidney or unequal 
kidney sizes). 
 
You can find these rules in the Local Coverage Determination (LCD) for Magnetic Resonance Angiography 
(MRA) (L33633. This LCD is effective for services provided on or after October 1, 2019. 
 
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.