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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 Multislice or Multidetector Computed Tomography (MDCT) angiography with its advanced 
spatial and temporal resolution has opened up new possibilities in the imaging of the major vessels of the chest, 
including aorta, pulmonary arteries, and coronary arteries. 
 
MDCT angiography of the chest for non-cardiac assessment will be considered medically reasonable and 
necessary for the following signs or symptoms of disease: 
 
 Assessment of a symptomatic patient when presentation is suspicious for pulmonary emboli; 
 Abnormalities of the thoracic vasculature such as aortic dissection, aortic aneurysm, pulmonary arterio-
venous malformation (AVM) and other abnormalities of the systemic circulation, excluding the heart; 
 Assessment of suspected congenital anomalies of the heart or great vessels; and 
 Assessment of cardiac, mediastinal or lung parenchymal lesions, the vascularity of which is unknown or ill 
defined, but is critical to the diagnosis. 
 
Covered Indications 
 
MDCT angiography of the chest for cardiac assessment will be considered medically reasonable and necessary 
for the following signs or symptoms of disease: 
 
 Cardiac evaluation of a patient with chest pain syndrome (e.g., anginal equivalent, angina), who is at a low to 
moderate risk for coronary artery disease (CAD), if use of MDCT is expected to avoid performing diagnostic 
cardiac catheterization. MDCT and coronary angiography are not expected to be performed on the same patient 
for diagnostic purposes prior to the application of anticipated therapy. (If a high pre-test probability of disease 
exists, as if the patient has known CAD, it is assumed the patient would go to coronary angiography as the 
definitive test, where possible angioplasty and/or stenting could be performed at the same time). 
 Assessment of suspected congenital anomalies of coronary circulation. 
 Assessment of symptomatic patients with equivocal stress test results, with or without cardiac imaging, if 
MDCT is expected to avoid performing diagnostic coronary angiography. (Again, if a high pre-test probability 
of disease exists, as if the patient has known CAD, it is not expected that CT coronary angiography would be 
done in addition to a subsequent coronary catheterization and angiogram). 
 Evaluation of pulmonary veins prior to arrhythmia ablation procedures 
 Evaluation of cardiac veins prior to insertion of biventricular pacemaker 
 Limitations 
 
 The test is never covered for screening, i.e., in the absence of signs, symptoms or disease. 
 The test is never covered for patients with stable coronary artery disease without any significant change in 
signs or symptoms. 
 The selection of the test should be made within the context of other testing modalities so that the resulting 
information facilitates the management decision and does not merely add an additional layer of testing. The test 
may be denied, on post-pay review, as not medically necessary when used for cardiac evaluation of a patient 
with extensive disease where there is a pre-test knowledge of extensive calcification that would diminish the 
interpretive value. 
 
You can find this rule in the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 
100-03, Medicare Local Coverage Determination (LCD): Computed Tomographic Angiography of the Chest, 
Heart and Coronary Arteries (L33282). 
 
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.