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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 cardiac catheterization is the introduction and positioning of a catheter in the heart to assess 
cardiac function and structure, for diagnosis, treatment planning or to assess therapy. This assessment may 
include the measurement of intracardiac and intra- vascular pressures, obtaining blood samples for blood gas or 
other constituent analysis, determination of cardiac output, injection of contrast for angiography, and 
performing endomyocardial biopsy. The conduct and evaluation of these procedures are then documented and 
interpreted by the physician, in a report. 
 
This is the introduction of a catheter(s) into the left ventricle (LV). The catheter may be inserted retrograde 
from the brachial, axillary, or femoral artery; by cutdown or percutaneously; or transeptally via a patent 
foramen ovale or by septal puncture; or transapically. The catheterization also includes catheterization of the 
left atrium and aorta when performed with the LV catheterization. It includes all hemodynamic measurements 
(with and without maneuvers and/or infusions or medication), blood sampling and shunt determinations as part 
of the procedure. Placement of multiple catheters and their repositioning or replacement is included in this 
procedure. Injection procedures for selective opacification of cardiac chambers or structures, arteries and 
conduits and the supervision and interpretation of such services are reimbursable as part of all-inclusive codes 
for these services. 
 
Left heart catheterization is indicated for the diagnosis of, or treatment planning in patients with myocardial 
abnormalities or dysfunction (including ischemic disease, myocarditis, cardiomyopathy, etc.), valvular 
dysfunction, intracardiac shunts, congenital heart abnormalities, cardiac trauma, or pericardial tamponade.  
 
A catheter with an enclosed transseptal puncture needle is positioned into the right atrium, and under 
fluoroscopic and/or ultrasonic guidance is advanced, puncturing an intact intra-atrial septum thereby entering 
the left atrium. The needle is then removed, leaving the catheter through which a guide wire may be advanced 
to facilitate placement of appropriate catheters into the left atrium and left ventricle. This procedure should not 
be billed if the catheter is advanced into the left atrium through a patent foramen ovale or atrial septal defect. 
 
 
 The transseptal catheterization may be indicated in those cases in which access to the left ventricle is required 
for hemodynamic measurements or angiography, when retrograde access is not feasible or appropriate; when 
access to the left atrium and pulmonary veins is necessary for hemodynamic measurements and angiography; 
and when access to the left atrium and ventricle is necessary for the performance of diagnostic and therapeutic 
electrophysiological procedures. You can find these rules in the Local Coverage Determination (LCD) 
Cardiac Catheterization and Coronary Angiography L33557. 
 
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.