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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 Cardiovascular nuclear imaging is indicated for the following: 
Assessment of the functional and prognostic importance of angina; 
 
Diagnostic evaluation of patients with chest pain and uninterpretable or equivocal ECG changes caused by 
drugs, bundle branch block, or left ventricular hypertrophy; 
 
Assessment of congenital anomalies of coronary arteries; 
 
Risk assessment or re-evaluation of disease in patients who are asymptomatic or have stable symptoms, with 
known atherosclerotic heart disease on catheterization or SPECT perfusion imaging, who have not had a 
revascularization procedure within the past two years; 
 
Detection of coronary artery disease in patients, without chest pain syndrome, with new-onset of diagnosed 
heart failure or left ventricular systolic dysfunction; 
 
Evaluation of ischemic versus non-ischemic cardiomyopathy when cardiac catheterization / coronary 
angiography are not planned; 
 
Evaluation of myocardial perfusion and/or function before and after coronary artery bypass surgery or other re-
perfusion procedures; 
 
Quantification and surveillance of myocardial infarction and prognostication in patients with infarction; 
Assessment of congenital anomalies of coronary arteries; Preoperative assessment for non-cardiac surgery, 
when used to determine risk for surgery and/or perioperative management in: 
?patients with minor or intermediate clinical risk predictors and poor functional capacity; 
?patients with intermediate or high likelihood of coronary heart disease, or 
?patients with poor functional capacity undergoing high risk non-cardiac surgery; 
 
Evaluation of ventricular function in patients with non-ischemic myocardial disease; 
 
Evaluation of patients in whom an accurate measure of the ejection fraction is needed to make a determination 
of whether to implant a defibrillator or biventricular pacemaker;  
 
Evaluation of a patient receiving chemotherapeutic drugs which are potentially cardiotoxic (e.g., adriamycin).  
 
First pass studies will be considered medically necessary only when information sought is immediately relevant 
to the management of the patient?s clinical condition, and has not been previously obtained or likely to be 
obtained from other planned tests such as echocardiography or equilibrium gated blood pool studies. First pass 
studies may be indicated for the assessment and identification of shunts. 
 
Infarct avid scintigraphy is indicated in patients in whom it is not possible to make a definitive diagnosis of 
myocardial infarction by EKG or enzyme testing. 
 
You can find these rules in the Local Coverage Determination (LCD) for Cardiovascular Nuclear Medicine, 
L33560. 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.