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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 Cardiovascular Stress Testing: 
 
A cardiovascular stress test is covered for a patient who: 
 
Has signs or symptoms consistent with coronary artery disease (CAD): 
Angina pectoris or anginal equivalent symptoms, 
Cardiac rhythm disturbances, 
Unexplained syncope, 
Heart failure, or 
Significant atherosclerotic vascular disease elsewhere in the body (e.g., carotid obstructive disease, peripheral 
vascular disease involving the lower extremities, or abdominal aortic aneurysm. 
 Has a metabolic disorder known to cause CAD: 
Diabetes mellitus, 
Syndrome X, or 
Atherogenic hypercholesterolemia. 
Has an abnormal electrocardiogram (ECG) consistent with CAD. 
Needs an evaluation for progression of CAD with the potential for a change in treatment: 
Following coronary artery bypass graft (CABG) surgery; 
Following a myocardial infarction (MI); 
Following a percutaneous transluminal coronary angioplasty (PTCA), atherectomy, intracoronary 
thrombolysis, or other coronary revascularization procedure; 
Following medical treatment to reverse or stabilize CAD; or 
For a history of a coronary artery ischemic event without symptoms (e.g., a prior silent MI). 
Needs an evaluation as part of a preoperative assessment when intermediate- or high-risk for CAD is present 
and surgery is likely to induce significant cardiac stress. 
Needs an evaluation when information from the clinical assessment does not adequately assess functional 
capacity when such information is needed to manage the patient (e.g., for a patient with angina to assess the 
level of exercise tolerance for treatment planning). 
Cardiovascular stress testing would not be considered Reasonable and Necessary when:  
The incremental information obtained from a repeat test or from the addition of an echocardiogram to an 
electrical stress test is of no clinical relevance. The results of the test have no potential to affect the treatment of 
the patient, such as when the patient has a severe comorbidity that is likely to limit life expectancy and/or likely 
to limit his/her candidacy for revascularization. Secondary conditions will potentially decrease both the 
sensitivity and specificity of testing (e.g., immediate postoperative period, anemia, or infection). 
A stress test is performed too frequently (See the Utilization Guidelines section). 
 Medicare will not cover cardiovascular stress testing: 
 
For Screening CAD (e.g., in a patient without signs or symptoms of CAD), such as for the presence of risk 
factors smoking, obesity, family history of CAD, but no personal history of vascular disease or related 
metabolic disorder. When used solely to motivate changes in lifestyle. To qualify a patient for a noncovered 
service, such as fitness training, a weight loss program, or an occupational fitness evaluation. For a 
preoperative assessment prior to either a noncovered surgery or a covered surgery if the reasonable and 
necessary criteria for the testing is not documented. You can find this information in the Local Coverage 
Determination (LCD) for Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and 
Stress Echocardiography (L34324). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.