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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 that cardiac computed tomographic angiography (CCTA), also known as computed tomography 
of the heart and coronary arteries or multidetector computed cardiac tomography (MDCT) is considered 
reasonable and necessary for the evaluation of suspected symptomatic coronary artery disease (CAD) and for 
the detection of structural and morphologic intra- and extra-cardiac conditions. 
  
To establish cardiac computed tomography & angiography (CCTA) medical necessity, your case must meet at 
least one indication in the following two categories: 
 
Symptomatic Coronary Artery Disease (CAD) 
 
1. Evaluation of Acute Chest Pain, unexplained dyspnea or symptoms suggesting angina pectoris (such as jaw 
pain) when there is: 
 
   Intermediate pre-test probability of CAD* and 
   No electrocardiogram (EKG) changes to suggest acute myocardial injury or ischemia and 
   Normal initial cardiac markers. 
   Patients with intermediate risk and a discordant clinical situation (e.g., ongoing ischemic symptoms, 
   normal stress test). 
  
2. Evaluation of Chest Pain Syndrome when there is: 
 
   Intermediate pre-test probability of CAD* and 
   Uninterpretable EKG** or patient is unable to exercise or 
   Uninterpretable or equivocal stress test (exercise, perfusion or stress echo). 
 
**Intermediate pretest probability of CAD by age, gender and symptoms is between 10% and 90% as 
referenced in the American College of Coronary Foundation/American College of Radiology (ACCF/ACR) 
2006 appropriateness criteria for cardiac computed tomography and cardiac magnetic resonance imaging. 
 
** Uninterpretable EKG refers to EKGs with resting ST segment depression greater than or equal to 0.10mV, 
complete left bundle branch block, pre-excitation or paced rhythm. 
 
3. Evaluation of intracardiac structures for suspected coronary anomalies.  
Suspected Cardiac Structural/Morphologic Anomalies 
 
1. Detection of intracardiac and extracardiac structures in: 
 
    Evaluation of cardiac mass (suspected tumor or thrombus) or 
    Evaluation of pericardial conditions (mass, constrictive pericarditis or complications of cardiac surgery) or 
    Patients with technically limited images from echocardiogram, magnetic resonance imaging (MRI) or 
     transesophageal echocardiography (TEE). 
 
 2. Detection of morphologic intracardiac and extracardiac structures for: 
 
    Evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation.  
     While data is limited for three dimensional (3D) reconstruction of the left atrium for ablations, there is  
     broad consensus among cardiologists that these images, which are integrated and used in real-time in  
     the procedure room to shorten procedure time, improve therapeutic success and enhance patient safety or 
    Non-invasive coronary vein mapping prior to placement of biventricular pacemaker or 
    Non-invasive coronary arterial mapping, including internal mammary artery, prior to repeat cardiac surgical 
     revascularization or 
    Detection of complex congenital heart disease including anomalies of coronary circulation, great vessels 
     and cardiac chamber and valves or       
    Evaluation of coronary arteries in patients with new onset heart failure to assess etiology. 
 
You can find this information at Local Coverage Determination (LCD)- Cardiac Computed Tomography & 
Angiography (CCTA) (L33423). 
 
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.