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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 Transthoracic Echocardiography is the ultrasonic examination of the heart through the chest 
wall. Two-dimensional (2D) TTE may allow visualization of the cardiac chambers, cyclic variation in 
myocardial wall thickness, valvular structure and function, the proximal great vessels and the pericardium. 
 
Doppler flow evaluation uses the changes in frequency when a transmitted ultrasound wave is reflected from 
moving surfaces (e.g., heart valves, red blood cells) and allows measurement of blood flow velocity which can 
be used to identify valvular stenosis or regurgitation, estimate cardiac output and intracardiac pressures, or 
identify the presence of intracardiac shunts. 
 
In order to qualify as a valid echocardiographic service, the study must be done for an accepted clinical 
indication by a properly trained examiner and must include a permanent record of the findings, data sufficient 
to support the conclusions and an appropriate interpretation and written report. Such a study would meet the 
standards required for a complete echocardiographic examination, regardless of the size or portability of the 
instrument used to perform the study. 
 
This policy addresses the medically necessary and appropriate application of TTE, including stress 
echocardiography. Transesophageal echocardiography (TEE) is the subject of a separate policy statement. 
 
Indications: 
 
Echocardiography is indicated in the evaluation of derangements of valvular, myocardial and pericardial 
structure and function. The general applications for coverage include: 
Transthoracic Echocardiogram 
 
INDICATIONS: 
 
Ventricular Function, Cardiomyopathies and Heart Failure 1. "When the etiology is in doubt, echocardiography can document or rule out the common cardiac causes 
of pulmonary congestion: left-sided valvular disease, depressed systolic or diastolic function, and 
cardiomyopathy. In this regard, echocardiography is the preferred initial diagnostic test when the 
history, physical examination, and routine laboratory tests suggest (or cannot eliminate) cardiac 
disease." (ACC/AHA/ASE 2003 Guideline Update, pg. 35) 
2. "Echocardiography is recommended for patients with edema with clinical signs of elevated central 
venous pressure when a potential cardiac etiology is suspected or when central venous pressure cannot 
be estimated with confidence and clinical suspicion of heart disease is high." TTE is also recommended 
for patients experiencing "dyspnea with clinical signs of heart disease."(ACC/AHA/ASE 2003 
Guideline Update, pg. 37) 
3. "Echocardiography is not recommended in patients with edema when the jugular venous pressure does 
not appear to be elevated." (ACC/AHA/ASE 2003 Guideline Update, pg. 35). 
You can find this rule at Centers for Medicare and Medicaid Services, Local Coverage Determination (LCD) 
L33577, Transthoracic Echocardiography (TTE). 
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.