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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 Criteria for Testing: 
 
    Individual with breast, ovarian1, pancreatic, or prostate cancer from a family with a known deleterious 
BRCA1 or BRCA2 gene mutation. 
    Individual with a personal history of ovarian cancer 
    Individual with a breast cancer diagnosis meeting any of the following criteria: 
        Diagnosed less than or equal to 45 y 
        Triple negative breast cancer (estrogen receptor (ER) negative, progesterone receptor (PR) negative, and 
human epidermal growth factor receptor 2 (HER2) negative) breast cancer diagnosed less than or equal to 60 y 
        Diagnosed at 46-50 with: 
            An additional breast cancer primary 
            Greater than or equal to 1 first, second, or third degree relative5 with breast cancer at any age, or 
              Greater than or equal to 1 first, second, or third degree relative5 with prostate cancer (Gleason score 
greater than or equal to 7) or 
            An unknown or limited family history 
        Breast cancer diagnosed at any age, and 
              Greater than or equal to 1 first, second, or third degree relative5 with breast cancer less than or equal 
to 50 y, or 
              Greater than or equal to 1 first, second, or third degree relative with ovarian cancer at any age, or 
              Greater than or equal to 1 first, second, or third degree relative with metastatic prostate cancer or 
pancreatic cancer at any age, or 
              Greater than or equal to 2 additional diagnoses of breast cancer at any age in patient and /or in close 
blood relatives, or 
            A first, second, or third degree male relative with breast cancer 
            For an individual of ethnicity associated with higher mutation frequency (e.g., Ashkenazi Jewish) no 
additional family history may be required 
        Male breast cancer 
    Personal history of prostate cancer (Gleason score greater than or equal to 7) at any age with: 
          Greater than or equal to 1 first, second, or third degree relative with ovarian cancer at any age, or 
          Greater than or equal to 1 first, second, or third degree relative with breast cancer less than or equal to 50 
y, or 
          Greater than or equal to 1 first, second, or third degree relative with pancreatic cancer at any age, or          Greater than or equal to 1 first, second, or third degree relative with metastatic prostate cancer pancreatic 
cancer at any age, or 
          Greater than or equal to 2 first, second, or third degree relatives with breast cancer and/or pancreatic 
cancer and/or prostate cancer (any grade) at any age, or 
        Ashkenazi Jewish ancestry 
    Personal history of pancreatic cancer at any age 
    Personal history of metastatic prostate cancer (radiographic evidence of or biopsy-proven disease) 
    BRCA1/2 pathogenic mutation detected by tumor profiling on any tumor type in the absence of germline 
mutation analysis 
 
You can find this information in Medicare's Local Coverage Determination (LCD): MolDX: BRCA1 and 
BRCA2 Genetic Testing (L36813). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.