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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 Multislice or Multidetector Computed Tomography (MDCT) angiography of the chest for 
non-cardiac assessment will be considered medically reasonable and necessary for the following signs or 
symptoms of disease: 
 
    Assessment of a symptomatic patient when presentation is suspicious for pulmonary emboli; 
    Abnormalities of the thoracic vasculature such as aortic dissection, aortic aneurysm, pulmonary arterio-
venous malformation (AVM) and other abnormalities of the systemic circulation, excluding the heart; 
    Assessment of suspected congenital anomalies of the heart or great vessels; and 
    Assessment of cardiac, mediastinal or lung parenchymal lesions, the vascularity of which is unknown or ill 
defined, but is critical to the diagnosis. 
 
MDCT angiography of the chest for cardiac assessment will be considered medically reasonable and necessary 
for the following signs or symptoms of disease: 
 
    Cardiac evaluation of a patient with chest pain syndrome (e.g. anginal equivalent, angina), who is at a low to 
moderate risk for coronary artery disease (CAD), if use of MDCT is expected to avoid performing diagnostic 
cardiac catheterization. MDCT and coronary angiography are not expected to be performed on the same patient 
for diagnostic purposes prior to the application of anticipated therapy. (If a high pre-test probability of disease 
exists, as if the patient has known CAD, it is assumed the patient would go to coronary angiography as the 
definitive test, where possible angioplasty and/or stenting could be performed at the same time). 
    Assessment of suspected congenital anomalies of coronary circulation. 
    Assessment of symptomatic patients with equivocal stress test results, with or without cardiac imaging, if 
MDCT is expected to avoid performing diagnostic coronary angiography. (Again, if a high pre-test probability 
of disease exists, as if the patient has known CAD, it is not expected that CT coronary angiography would be 
done in addition to a subsequent coronary catheterization and angiogram). 
    Evaluation of pulmonary veins prior to arrhythmia ablation procedures 
    Evaluation of cardiac veins prior to insertion of biventricular pacemaker 
 
 
 
 
 
 The limitations for coverage include: 
 
    The test is never covered for screening, i.e., in the absence of signs, symptoms or disease. 
    The test is never covered for patients with stable coronary artery disease without any significant change in 
signs or symptoms. 
    The selection of the test should be made within the context of other testing modalities so that the resulting 
information facilitates the management decision, and does not merely add an additional layer of testing. The 
test may be denied, on post-pay review, as not medically necessary when used for cardiac evaluation of a 
patient with extensive disease where there is a pre-test knowledge of extensive calcification that would 
diminish the interpretive value. 
    Coverage of this modality for coronary artery assessment is limited to devices that process thin, high-
resolution slices (0.75 mm or less) A multidetector scanner must have a row of at least 32 detectors. For non-
cardiac thoracic assessment, the multidetector scanner may have a capability of less than 16 slices or less. The 
rotational gantry speeds for cardiac evaluation must be 420 milliseconds or less. 
    The administration of beta-blockers and/or other medications and the monitoring of the patient by a 
physician during the MDCT are not separately payable services. 
    All studies must be ordered by a physician or a qualified non-physician practitioner. A physician or qualified 
non-physician provider must be present during testing whenever cardioactive agents or contrast agents are 
administered (direct physician supervision). Ideally, this supervising physician will be experienced in this 
procedure and ACLS-certified. 
    Electron Beam Technology provides high temporal resolution and enables quantitative assessment of the 
coronary artery calcium, but because of limited spatial resolution as a result of the limited z axis resolution 
(slice thickness=3.0 mm), it does not permit direct visualization in multi-reformation of the whole coronary 
system. Therefore, CT angiography of the heart is not considered medically necessary when performed with an 
EBT scanner. 
 
You can find this information in the Local Coverage Determination (LCD) for Computed Tomographic 
Angiography of the Chest, Heart and Coronary Arteries (L33282). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.