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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 providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that procedures and examinations which are not covered under the portable x-ray provision 
include the following:  
-Procedures involving fluoroscopy; 
-Procedures involving the use of contrast media; 
-Procedures requiring the administration of a substance to the patient or injection of a substance into the patient 
and/or special manipulation of the patient;  
-Procedures which require special medical skill or knowledge possessed by a doctor of medicine or doctor of 
osteopathy or which require that medical judgment be exercised;  
-Procedures requiring special technical competency and/or special equipment or materials;  
-Routine screening procedures; and  Procedures which are not of a diagnostic nature. 
You can find this rule in the Centers for Medicare & Medicaid Services, Medicare Claims Processing Manual, 
Chapter 15, Section 80.4.4. 
 
The rules say that when services are furnished in a mobile unit, they are often provided to serve an entity for 
which another POS code exists. For example, a mobile unit may be sent to a physicians office or a skilled 
nursing facility. If the mobile unit is serving an entity for which another POS code already exists, providers 
should use the POS code for that entity. However, if the mobile unit is not serving an entity which could be 
described by an existing POS code, the providers are to use the Mobile Unit POS code 15. Apply the 
nonfacility rate to payments for services designated as being furnished in POS code 15; apply the appropriate facility or nonfacility rate for the POS code designated when a code other than the mobile unit code is 
indicated. 
 
A physician or practitioner's office, even if mobile, qualifies to serve as a telehealth originating site. Assuming 
such an office also fulfills the requirement that it be located in either a rural health professional shortage area as 
defined under section 332(a)(1)(A) of the Public Health Service Act (42 U.S.C. 254e(a)(1)(A)) or in a county 
that is not included in a Metropolitan Statistical Area as defined in section 1886(d)(2)(D) of the Act, the 
originating physician's office should use POS code 11 (Office) in order to ensure appropriate payment for 
services on the list of Medicare Telehealth Services. 
 
You can find these rules in the Centers for Medicare & Medicaid Services, Medicare Claims Processing 
Manual, Chapter 26, Section 10.5. 
 
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.