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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 CT scans are covered if there is literature to support its use for the patients condition and the 
scan is reasonable and necessary for the patient. You can find this rule in the Centers for Medicare and 
Medicaid Services, Internet Only Manual, Publication 100-03, Medicare National Coverage Determinations 
Manual, Section 220.1(A). 
 
The rules say the following clinical indications apply to the Computerized Axial Tomography (CT or CAT) of 
the thorax: 
- Evaluation of pulmonary, mediastinal, pleural and chest wall infections and their complications 
- Detection and characterization of mediastinal neoplasms and other processes 
- Assessment of cardiopulmonary failure or insufficiency 
- Diagnosis and/or staging of neoplastic and hematologic processes arising in the thorax or with potential 
involvement of the thorax 
- Detection and determination of nature and extent of cardiovascular abnormalities such as, but not limited to 
aneurysm, dissection, embolism, thrombosis, congenital anomalies, postoperative complications and sequelae 
of atherosclerotic disease 
- For assessing and/or guiding drainage of pulmonary or pleural fluid collections such as abscess, empyema, 
effusion or pneumothorax 
- For characterizing and follow-up evaluation of interstitial and alveolar lung disease due to idiopathic, allergic, 
collagen-vascular, environmental or other causes 
- For evaluating thoracic sequelae of remote processes including, but not limited to, pancreatitis, 
gastrointestinal perforation and other processes 
- For assessing injury, potential injury or thoracic sequelae after trauma, burn, surgery, transplantation, 
radiation therapy, chemotherapy or invasive procedure such as pacemaker placement, chest tube placement or 
mechanical ventilation 
- Evaluation of the patient with symptoms that may be arising from the chest, or be referred to the chest 
including but not limited to cough, hemoptysis, chest pain, abdominal pain and others  
- To further characterize a suspected abnormality detected by another imaging test 
- Evaluation of a patient with myasthenia gravis to rule out thymic tumors 
- Performance of CT-guided biopsies and drainage procedures when fluoroscopy is inadequate 
- The most common symptom of an aortic dissection (occurring in approximately 90% of the cases) is sudden, 
excruciating pain most commonly located in the anterior chest. Patients may describe the pain as "cutting," 
"ripping," or "tearing". A sudden neurologic episode usually accompanies the onset of most instances of 
"painless" aortic dissection 
 
You can find this information in the Local Coverage Determination (LCD): Computerized Axial Tomography 
(CT), Thorax (L33459). 
 
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.