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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 Nationally Covered Indications: Category I - (Clinically effective, usually part of initial patient 
evaluation, may be an adjunct to radiologic and nuclear medicine diagnostic technique) 
 
    Echoencephalography, (Diencephalic Midline) (A-Mode). 
    Echoencephalography, Complete (Diencephalic Midline and Ventricular Size). 
    Ocular and Orbital Echography (A-Mode). 
    Covered procedures include efforts to determine the suitability of aphakic patients for implantation of an 
artificial lens (pseudophakoi) following cataract surgery. 
    Ocular and Orbital Sonography (B-Mode). 
    Echocardiography, Pericardial Effusion (M-Mode). 
    Pericardiocentesis, by Ultrasonic Guidance. 
    Echocardiography, Cardiac Valve(s) (M-Mode). 
    Echocardiography, Complete (M-Mode). 
    Echocardiography, limited (e.g., follow-up or limited study) (M-Mode). 
    Pleural Effusion Echography. 
    Thoracentesis, by Ultrasonic Guidance. 
    Abdominal Sonography, complete survey study (B-Scan). 
    Abdominal Sonography, limited (e.g., follow-up or limited study) (B-Scan). 
    Abdominal Sonography is not synonymous with ultrasound examination of individual organs. 
    Renal Cyst Aspiration, by Ultrasonic Guidance. 
    Renal Biopsy, by Ultrasonic Guidance. 
    Pancreas Sonography (B-Scan). 
    Pancreatic Sonography has proven effective in diagnosing pseudocysts. 
    Spleen Sonography (B-Scan). 
    Abdominal Aorta Echography (A-Mode). 
    Abdominal Aorta Sonography (B-Scan). 
    Retroperitoneal Sonography (B-Scan). 
    Retroperitoneal Sonography does not include planning of fields for radiation therapy. 
    Urinary Bladder Sonography (B-Scan). 
    Urinary bladder Sonography does not include staging of bladder tumors. 
    Pregnancy Diagnosis Sonography (B-Scan). 
    Fetal Age Determination (Biparietal Diameter) Sonography (B-Scan).     Fetal Growth Rate Sonography (B-Scan). 
    Placenta Localization Sonography (B-Scan). 
    Pregnancy Sonography, Complete (B-Scan). 
    Molar Pregnancy Diagnosis Sonography (B-Scan). 
    Ectopic Pregnancy Diagnosis Sonography (B-Scan). 
    Passive Testing (Antepartum Monitoring of Fetal Heart Rate In the Resting Fetus). 
    Intrauterine Contraceptive Device Sonography (B-Scan). 
    Pelvic Mass Diagnosis Sonography (B-Scan). 
    Amniocentesis, by Ultrasonic Guidance. 
    Arterial Flow Study, Peripheral (Doppler). 
    Venous Flow Study, Peripheral (Doppler). 
    Arterial Aneurysm, Peripheral (B-Scan). 
    Radiation Therapy Planning Sonography (B-Scan). 
    Thyroid Echography (A-Mode). 
    Thyroid Sonography (B-Scan). 
    Breast Echography (A-Mode). 
    Breast Sonography (B-Scan). 
    Hepatic Sonography (B-Scan). 
    Gallbladder Sonography. 
    Renal Sonography. 
    Two-Dimensional Echocardiography (B-Mode). 
    Monitoring of cardiac output (Esophageal Doppler) for ventilated patients in the ICU and operative patients 
with a need for intra-operative fluid optimization 
 
C. Nationally Non-Covered Indications 
 
Category II - (Clinical reliability and efficacy not proven): 
 
    B-Scan for atherosclerotic narrowing of peripheral arteries. 
 
D. Other 
 
Uses for ultrasound diagnostic procedures not listed in Category I or II above are left to local MAC discretion. 
In view of the rapid changes in the field of ultrasound diagnosis, uses for ultrasound diagnostic procedures 
other than those listed under Categories I and II should be carefully reviewed before payment. Medical 
justification may be required. You can find this information in Medicare's National Coverage Determination 
(NCD): Ultrasound Diagnostic Procedures (220.5). 
 
The rules say Stress testing without cardiac imaging will be considered medically reasonable and necessary for: 
 
    Patients with low or intermediate pre-test probability for CAD who are exhibiting cardiac symptoms, 
including otherwise unexplained angina equivalent symptoms with normal or minor changes in resting ECG 
and no contraindications to exercise. 
    Patients with diabetes mellitus who are exhibiting cardiac symptoms, including otherwise unexplained 
angina equivalent symptoms, with normal or minor changes in resting ECG and no contraindications to 
exercise. 
    New-onset atrial fibrillation (with no prior cardiac evaluation). 
    Determining functional capacity and response to therapy in patients with hypertrophic cardiomyopathy 
(HCM). 
    Patients with an intermediate or high CHD risk (ATP III risk criteria) who have experienced syncope (an 
abrupt, transient, complete loss of consciousness) and cardiac etiology is suspected based on an initial 
evaluation, including history, physical examination, or ECG and the patient is able to exercise.     Patients without cardiac symptoms who underwent a percutaneous coronary intervention (PCI) (with a stent) 
procedure more than 2 years prior or a coronary artery bypass graft (CABG) more than 5 years prior and have 
not undergone an evaluation for CAD within the past 2 years (stress echocardiogram, SPECT MPI, PET MPI, 
CMR, coronary computed tomography angiography [CCTA], cardiac catheterization) and are able to exercise. 
    Patients with established CAD who experienced an acute coronary syndrome (ACS) event (ST segment 
elevation myocardial infarction [STEMI], a NonST segment elevation myocardial infarction [NSTEMI], or 
unstable angina) within the past 90 days provided that they did not undergo coronary angiography at the time 
of the acute event and are currently clinically stable and able to exercise. 
    Patients with disease conditions associated with CAD (e.g., atherosclerotic abdominal aortic aneurysm, 
peripheral vascular disease, carotid artery disease, chronic renal failure) with no stress testing evaluation 
performed within the preceding 2 years and who are able to exercise. Pre-operative cardiac evaluation in 
patients able to exercise and who will be undergoing noncardiac surgery with one of the following: 
        Intermediate risk for surgery (cardiac risk 1-5%), unknown functional capacity, and the results will affect 
patient management decisions. 
        High risk for surgery (greater than 5% cardiac risk), unknown functional capacity, and the results will 
affect patient management decisions. You can find this information in Medicare's Local Coverage 
Determination (LCD): Cardiology Non-emergent Outpatient Stress Testing (L35083). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.