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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 duplex scanning of the lower extremity arteries performed to establish the level and/or 
degree of arterial occlusive disease, will be considered medically necessary if a) significant signs and/or 
symptoms indicate a high likelihood of limb ischemia, and b) the patient is a candidate for invasive therapeutic 
procedures under any of the following circumstances: 
 
    The patient has symptoms of peripheral vascular ischemia and is found on physical examination to have 
absence or marked diminution of pulses (suspected to be secondary to obstruction of lower extremity arteries) 
of one or both lower extremities.  
    The patient has developed sudden pallor, numbness, and coolness of an extremity and vascular obstruction 
(embolism or thrombosis) is suspected.  
    Claudication of less than one block or of such severity that it interferes significantly with the patient's 
occupation or lifestyle. 
    The patient has an aneurysm or arteriovenous malformation of a lower extremity artery. 
    The patient has sustained lower extremity trauma with possible vascular injury or the patient has sustained 
iatrogenic vascular injury. 
    Rest pain of ischemic origin (typically including the forefoot), associated with absent pulses, which becomes 
increasingly severe with elevation and diminishes with placement of the leg in a dependent position. 
    Tissue loss defined as gangrene or pre-gangrenous changes of the extremity, or ischemic ulceration of the 
extremity occurring in the absence of pulses. 
    Follow-up studies post-operative conditions: 
        In the immediate post-operative period if re-established pulses are lost, become equivocal, or if the patient 
develops related signs and/or symptoms of ischemia with impending repeat intervention. 
        Following bypass surgery or post-angioplasty with or without stent placement at three months, six months 
and one year when clinically indicated. 
    Subsequent studies may be allowed if there is clinical evidence of recurrent vascular disease evidenced by 
signs (i.e. decreased ABI from previous exam) or symptoms (i.e., recurrence of claudication symptoms that 
interfere significantly with the patients occupation or lifestyle). For postoperative surveillance, either a limited 
Duplex or multi-level Doppler with pressures is usually sufficient, but it is not considered necessary to do both. 
 
 
 
 
 Examples of additional signs and symptoms that do not indicate medical necessity include: 
 
    Continuous burning of the feet is considered to be a neurologic symptom. 
    "Leg pain, nonspecific" or "Pain in limb" as single diagnoses are too general to warrant further investigation 
unless they can be related to other signs and symptoms. 
    Edema rarely occurs with arterial occlusive disease unless it is in the immediate postoperative period, in 
association with another inflammatory process or in association with rest pain.  
    Absence of relatively minor pulses (eg, dorsalis pedis or posterior tibial) in the absence of ischemic 
symptoms. The absence of pulses is not an indication to proceed beyond the physical examination unless 
related signs and/or symptoms are present which are severe enough to require possible invasive intervention. 
    Screening of an asymptomatic patient is not covered. 
 
You can find this information in the Local Coverage Determination (LCD) for Duplex Scan of Lower 
Extremity Arteries (L33667). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.