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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. 
 
Left heart catheterization is the introduction of a catheter(s) into the left ventricle (LV). The catheter may be 
inserted retrograde from the brachial, axillary or femoral artery; by cutdown or percutaneously; or transseptally 
via a patent foramen ovale or by septal puncture; or transapically. The catheterization also includes 
catheterization of the left atrium and aorta when performed with the LV catheterization. It includes all 
hemodynamic measurements (with and without maneuvers and/or infusions or medication), blood sampling 
and shunt determinations as part of the procedure. Placement of multiple catheters and their repositioning or 
replacement is included in this procedure. Injection procedures for selective opacification of cardiac chambers 
or structures, arteries and conduits and the supervision and interpretation of such services are reimbursable as 
part of all-inclusive codes for these services (see Supplementary Instructions Article). 
 
There is no additional reimbursement for a left heart catheterization done for reasons other than hemodynamic 
evaluation or LV angiography required for patient management (i.e., when routinely performed with 
coronary/bypass angiography, electrophysiologic or pacing studies, or endomyocardial biopsies). 
 
Left heart catheterization is indicated for the diagnosis of, or treatment planning in patients with myocardial 
abnormalities or dysfunction (including ischemic disease, myocarditis, cardiomyopathy, etc), valvular 
dysfunction, intracardiac shunts, congenital heart abnormalities, cardiac trauma, or pericardial tamponade. 
 
Left Heart Catheterization by Transseptal Puncture 
A catheter with an enclosed transseptal puncture needle is positioned into the right atrium, and under 
fluoroscopic and/or ultrasonic guidance is advanced, puncturing an intact intra-atrial septum thereby entering 
the left atrium. The needle is then removed, leaving the catheter through which a guide wire may be advanced 
to facilitate placement of appropriate catheters into the left atrium and left ventricle. This procedure should not 
be billed if the catheter is advanced into the left atrium through a patent foramen ovale or atrial septal defect. 
 
The transseptal catheterization may be indicated in those cases in which access to the left ventricle is required 
for hemodynamic measurements or angiography, when retrograde access is not feasible or appropriate; when 
access to the left atrium and pulmonary veins is necessary for hemodynamic measurements and angiography; 
and when access to the left atrium and ventricle is necessary for the performance of diagnostic and therapeutic 
electrophysiological procedures. 
 
You can find this rule in the Local Coverage Determination (LCD) Cardiac Catheterization and Coronary 
Angiography (L33557).  
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.