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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 pamidronate disodium intravenous (IV), and zoledronic acid IV, are covered for the 
following indications: 
1. Hypercalcemia associated with malignancy 
Osteoclastic hyperactivity resulting in excessive bone resorption is the underlying complication with 
metastatic bone disease and hypercalcemia associated with malignancy. Most cases of hypercalcemia, 
associated with malignancy, occurs in patients who have breast cancer, squamous-cell tumors of the 
lung or head and neck, renal-cell carcinoma, and certain hematologic malignancies (multiple myeloma 
and some types of lymphomas). Bisphosphonates, in conjunction with hydration, are indicated for 
moderate or severe hypercalcemia associated with malignancy with or without bone metastases. 
2. Cancer Treatment-Induced Bone Loss (CTIBL) in Breast and Prostate Cancer 
Breast Cancer 
Cytotoxic chemotherapy: There are 2 mechanisms of cytotoxic chemotherapy inducing bone loss. First, 
there is a direct negative effect of the cytotoxic therapy on bone cells, predominantly osteoblasts and, 
second, many women who are premenopausal have cytotoxic therapy effects on ovarian function, which 
results in gonadal loss. In addition, in premenopausal women, surgery (oophorectomy) or radiation 
therapy to the ovary results in bone loss. Hormone therapy, tamoxifen in premenopausal women, and 
the aromatase inhibitors result in bone loss, as well as gonadotropin-releasing hormone (GnRH) 
antagonists/agonists, which shut off ovarian function. All of these result in estrogen depletion. 
 
Prostate Cancer 
In prostate cancer, cytotoxic therapy again has a negative effect not only on testicular function but also 
on bone. Surgical therapy, hormone therapy, including antiandrogens and GnRH agonists/antagonists, 
results in androgen depletion. The final common pathway, estrogen and androgen depletion, results in a 
decrease in bone mineral density. 
3. Bone metastases secondary to solid tumors, breast cancer, and prostate cancer 
4. Multiple Myeloma 
5. Osteolytic lesions due to metastases 
6. Pagets Disease of bone (osteitis deformans) *See additional information for zoledronic acid 
below. 
Intravenous bisphosphonates are indicated for moderate to severe Pagets disease of bone. 
7. Prophylaxis and treatment of heterotopic ossification associated with spinal cord injury, 
traumatic brain injury, hip replacement, and burns It is indicated parenterally when the patient has failed a trial of the oral drug or has insurmountable 
issues related to absorption, compliance or dosing posture. 
 In addition, Zoledronic acid njection is covered for the treatment of moderate to severe Pagets disease of bone 
in men and women:  
1. when there is an elevation in serum alkaline phosphatase two times or higher than the upper 
limit of the age specific normal reference range 
2. there is risk for complications from their disease 
3. to induce remission (normalization of serum alkaline phosphatase) 
You can find more information in Local Coverage Determination (LCD): Bisphosphonate Drug Therapy 
(L34648). 
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.