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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 according to the 2017 American College of Cardiology (ACC)/American Heart Association 
(AHA) High Blood Pressure Clinical Practice Guideline, a blood pressure is considered normal for adults with 
a systolic blood pressure of less than 120 mm Hg and a diastolic blood pressure of less than 80 mm Hg. 
Hypertension Stage 2, also known as severe hypertension, is noted to be a systolic blood pressure of greater 
than or equal to 140 mm Hg or a diastolic blood pressure of greater than or equal to 90 mm Hg. Resistant 
hypertension is uncontrolled high blood pressure despite the use of at least three different antihypertensive 
medication classes. 
 
Diagnostic arteriography is an invasive procedure for the purpose of evaluating vascular disease. The process 
involves passing a needle or catheter through the skin under fluoroscopic guidance into an artery followed by 
injection of contrast material and imaging of the vascular area in question using digital imaging or serial film 
imaging. The procedures for abdominal aortography or renal arteriography are most commonly done under 
conscious sedation. 
 
Angiography or arteriography is a medical imaging technique used to visualize the inside, or lumen, or blood 
vessels and organs of the body, particularly in arteries, veins, and chambers of the heart. This LCD applies the 
term angiography when referring to abdominal angiography or renal arteriography. 
 
Covered Indications 
 
Medical Necessity for Abdominal Aortography/Angiography 
Acute traumatic abdominal injury 
Aneurysm and other primary vascular abnormalities 
Occlusive disease, including evaluation for acute or chronic intestinal ischemia 
Acute GI hemorrhage 
Congenital anomaly 
Prior to arterial interventional procedures or open surgical procedures 
Medical Necessity for Stand-Alone Renal Angiography 
Severe or difficult to control renal hypertension 
for severe or difficult to control renal hypertension, OR 
progressive renal insufficiency, OR 
resistant hypertension 
Renal neoplasm 
Hematuria of unknown cause 
Abnormal kidney imaging involving radioisotopes 
Renal artery stenosis, aneurysm, trauma, or other intrinsic defects prior to renal arterial intervention 
Medical Necessity for Lower Extremity or Renal Angiography done at the same time as a different 
interventional procedure (for example, cardiac catheterization with coronary angiography) 
 
Diagnostic renal angiography or lower extremity angiography performed at the time of an interventional 
procedure is separately reportable if at least one indication for medical necessity for a stand-alone lower 
extremity or renal angiography is met AND one of the following are also met: 
No prior catheter-based angiographic study is available and a full diagnostic study is performed, and the 
decision to intervene is based on the diagnostic study, OR 
A prior study is available, but as documented in the medical record: 
The patients condition with respect to the clinical indication has changed since the prior study; OR 
There is inadequate visualization of the anatomy or pathology; OR 
There is a clinical change during the interventional procedure that requires new evaluation outside the target 
area of intervention. 
Medical necessity for a Stand-Alone Lower Extremity Angiography must be documented by pre-procedure 
clinical assessment. This assessment should include the following: 
Documentation that an invasive intervention is planned, AND Documentation that a prior non-invasive study was completed and indicates further study is needed by 
angiography for the planned intervention, AND 
Documentation of one of the following conditions: arterial embolism, acute or chronic ischemia, peripheral 
vascular disease (includes claudication), or aneurysm. 
 
Limitations 
 
LIMITATIONS FOR ABDOMINAL OR RENAL AORTOGRAPHY/ANGIOGRAPHY OR LOWER 
EXTREMITY ANGIOGRAPHY: 
 
There are no absolute contraindications to diagnostic aortography/angiography. Relative contraindications 
include but are not limited to: 
Severe hypertension 
Uncorrectable coagulopathy or thrombocytopenia 
Clinically significant sensitivity to iodinated contrast material 
Renal insufficiency based on the estimated glomerular filtration rate (eGFR) 
Congestive heart failure 
Certain connective tissue disorders which may indicate increased risk for complications at the puncture site 
Diagnostic angiography performed at a separate session from an interventional procedure may be separately 
reportable. If a diagnostic angiogram was performed prior to an interventional procedure, a second diagnostic 
angiogram performed at the time of an interventional procedure is separately reportable when documentation 
supports it is medically reasonable and necessary to repeat the study to further define the anatomy and 
pathology. If the prior diagnostic angiogram was performed, a second angiogram (e.g., for the dye injections 
necessary to perform the interventional procedure) is not separately reportable. 
The localization or guidance is integral to an interventional procedure and is not separately reportable unless 
CPT instructions specify otherwise. 
In addition to the initial procedure, an appropriate frequency of repeat procedures can be allowed as long as 
medical necessity is clearly established and documented. It is expected that important diagnostic information 
will be obtained from the angiography, which will assist in patient management and treatment. Repeat 
angiography may be medically reasonable and necessary if there is documentation of new and incapacitating 
symptoms. 
Medicare would not expect to see a high percentage of femoral or iliac angiography done at the same time of 
coronary studies and such billing could be subject to review. 
Renal angiography performed at the time of cardiac catheterization in the absence of accepted clinical 
indication that support medical necessity will be denied as such services are generally not indicated, as 
mentioned in this LCD. 
Appropriate non-invasive tests should be performed prior to a repeat angiography. A trial of or a change in 
medical management would be expected prior to repeat angiography unless the patient is deemed unstable and 
in need of some type of surgical intervention. 
 
You can find these rules in the Local Coverage Determination (LCD) Diagnostic Abdominal Aortography and 
Renal Angiography L35092. 
 
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.