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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: 

Non-selective renal angiography performed at the time of a different interventional procedure (e.g., cardiac 
catheterization with coronary angiography): 
While withdrawing the catheter during a cardiac catheterization procedure, providers often inject a small 
amount of dye to examine the renal arteries. 
Renal angiography, non-selective, performed at time of cardiac catheterization will be considered medically 
reasonable and necessary when the clinical index of suspicion for atherosclerotic renal artery stenosis (RAS) is 
high, as defined by the criteria listed below, AND there are reasonable anticipated therapeutic implications for 
which the results of this angiogram will be used AND when the results of noninvasive imaging studies cannot 
be obtained or are inconclusive: 
- Onset of severe hypertension before age 30 or severe hypertension after age 55 
- Exacerbation of previously well-controlled hypertension 
- Resistant hypertension (i.e., failure to achieve goal blood pressure in patients who are adhering to full 
doses of an appropriate 3-drug regimen that includes a diuretic) 
- Malignant hypertension (hypertension with coexistent evidence of acute end-organ damage; i.e., acute 
renal failure, acutely decompensated congestive heart failure, new visual or neurological disturbance, 
and/or advanced [grade III to IV] retinopathy) 
- New azotemia or worsening renal function after the administration of an ACE inhibitor or an 
angiotensin receptor- blocking agent 
- Unexplained atrophic kidney (7 to 8 cm) or a discrepancy in size between the two kidneys of greater 
than 1.5 cm. Note: The atrophy should be otherwise unexplained with lack of a prior history of chronic 
pyelonephritis, reflux nephropathy, trauma, etc. When such a history is present, there is usually not an 
indication for additional renal diagnostic tests to define RAS. 
- Sudden, unexplained pulmonary edema (especially in azotemic patients) - Unexplained renal failure, including patients starting renal replacement therapy (dialysis or renal 
transplantation) 
Diagnostic evaluation for renal hypertension is indicated for hypertension that is refractory, of recent onset, or 
requires a sudden increase in antihypertensive medication to control. 
II. Indications for iliac angiography or lower extremity angiography performed at the time of a different 
interventional procedure (for example, cardiac catheterization with coronary angiography). 
Diagnostic 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 is met AND one of 
the following is 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: 
o the patient's condition with respect to the clinical indication has changed since the prior study; 
or 
o there is inadequate visualization of the anatomy or pathology; or 
o there is a clinical change during the interventional procedure that requires new evaluation 
outside the target area of intervention. 
III. Indications for stand-alone iliac or lower extremity angiography must be documented by pre-procedure 
clinical assessment. This assessment should include the following: 
A. Documentation that an invasive intervention is planned, AND 
B. Documentation that a prior non-invasive study was completed and indicates further study is needed by 
angiography for the planned intervention, AND 
C. Documentation of one of the following conditions: arterial embolism, acute or chronic 
ischemia, peripheral vascular disease (includes claudication), or aneurysm. 

You can find this information at the Medicare Local Coverage Determination (LCD) L36767: Aortography and 
peripheral angiography. 
 
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.