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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 non-invasive vascular studies are considered medically necessary only if the outcome will 
potentially impact the clinical course of the patient. For example, if a patient is (or is not) proceeding on to 
other diagnostic and/or therapeutic procedures regardless of the outcome of non-invasive studies, and non-
invasive vascular procedures will not provide any unique diagnostic information that would impact patient 
management, then the non-invasive procedures are not medically necessary. If it is obvious from the findings 
of the history and physical examination that the patient is going to proceed to angiography, then non-invasive 
vascular studies are not medically necessary. 
 
Extracranial Arterial Studies (93880 - 93882) 
 
Covered cerebrovascular arterial study testing methods include (real-time) duplex scans; and Doppler 
ultrasound waveform with spectral analysis. 
 
Non-covered/non-reimbursed methods include testing methods that have not been found to be useful based on 
authoritative technological assessments or that are included as part of the physical examination. 
 
Cerebrovascular arterial studies may be considered medically necessary if one or more of the following signs 
and symptoms are present: 
 
    1. Asymptomatic or symptomatic cervical bruits; 
    2. Amaurosis fugax; 
    3. Focal cerebral or ocular transient ischemic attacks (including but not limited to): 
             a. localizing symptoms, e.g., sensory loss; and/or 
             b. weakness of one side of the face; and/or 
             c. slurred speech; and/or 
             d. weakness of a limb; 
    4. Syncope that is strongly suggestive of vertebrobasilar or bilateral carotid artery disease in etiology, as 
suggested by medical history; 
    5. Recent history of a previous neurologic or cerebrovascular event; 
    6. Before major cardiac and vascular surgery when a bruit is noted or there is a history of previous 
neurologic or cerebrovascular event; 
    7. After carotid endarterectomy (outside the global period), or follow-up of previously documented stenoses; 
    8. Pulsatile neck mass;     9. Evaluation of blunt or penetrating neck trauma; 
    10. Ocular microembolism (optic nerve/retinal arterial-Hollenhorst plaques/ocular); 
 
Limitations: Studies may not be considered medically necessary if performed for the following signs and 
symptoms: 
 
    1. Drop attack or syncope are rare indications usually seen with vertebrobasilar or bilateral carotid artery 
disease. 
    2. Dizziness is not a typical indication unless associated with other localizing signs or symptoms. However, 
episodic dizziness with symptom characteristics typical of transient ischemic attacks may indicate medical 
necessity, especially when other more common sources, e.g., postural hypotension or transiently decreased 
cardiac output as demonstrated by cardiac event monitoring, have been previously excluded; and/or 
    3. Headaches (including migraines). 
 
You can find this rule in the Local Coverage Determination (LCD) Non-Invasive Vascular Studies L34045. 
 
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.