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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 state that Stress testing with cardiac imaging will be considered medically reasonable and necessary 
for: 
 
    Patients experiencing new, recurrent, or worsening cardiac symptoms, including otherwise unexplained 
angina equivalent symptoms, AND any of the following: 
 
    Physical inability to perform a maximum exercise workload2,5,6,8-10,15,20; OR 
 
    New or previously unrecognized uninterpretable ECG2,5,6,8-10 OR; 
 
                ECG is uninterpretable for ischemia due to any one of the following2,5,8,9,15,21: 
 
                    Complete left bundle branch block (right bundle branch does not render ECG uninterpretable for 
ischemia),21 
 
                    Ventricular paced rhythm, 
 
                    Pre-excitation pattern such as Wolff-Parkinson-White, 
 
                    A > 1 mm ST segment depression (NOT nonspecific ST/T wave changes), 
 
                    Left ventricular hypertrophy (LVH) with repolarization abnormalities, also called LVH with strain 
(NOT without repolarization abnormalities or by voltage criteria), or 
 
                    Patient on digoxin therapy. 
 
            A history of CAD based on a prior anatomic evaluation of the coronary arteries OR a history of CABG 
or PCI;6,8,15 OR 
 
            Syncope and collapse (an abrupt, transient, complete loss of consciousness) for patients with an 
intermediate or high CHD risk (ATP III risk criteria) and where cardiac etiology is suspected based on an 
initial evaluation, including history, physical examination, or ECG and patient is unable to exercise;6,8,10,15,16 OR 
 
            Evidence or high suspicion of ventricular arrhythmias:6,7,8,10 OR 
 
            Worsening or continuing symptoms in a patient who had a normal or submaximal exercise stress test 
and there is suspicion of a false negative result;20,22 OR 
 
            Patients with recent equivocal or borderline testing where ischemia remains a concern;8,15,20 OR 
 
            Patients on beta blocker, calcium channel blocker, and/or antiarrhythmic medication when the 
documentation supports that an adequate workload may not be attainable to enable a fully diagnostic exercise 
study;2,5 OR 
 
            History of false positive exercise stress test (e.g., one that is abnormal, but the abnormality does not 
appear to be due to macrovascular CAD);8,22 OR 
 
            Evaluation of chest pain syndrome after revascularization or in patients with intermediate to high pre-
test probability for CAD regardless of ECG interpretability or ability to exercise;7,8 OR 
 
            High pre-test probability for CAD regardless of ECG interpretability or the ability to exercise, and a 
decision to perform cardiac catheterization or other angiography has not already been made;7,8,10,15 OR 
 
            Patients with HCM;14 OR 
 
You can find this information in the Local Coverage Determination (LCD): Cardiology Non-emergent 
Outpatient Stress Testing (L35083). 
 
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.