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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 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: 
 
a. Physical inability to perform a maximum exercise workload, or 
b. New or previously unrecognized uninterpretable electrocardiogram (ECG) 
c. ECG is uninterpretable for ischemia due to any one of the following: 
 
-Complete left bundle branch block (right bundle branch does not render ECG uninterpretable for ischemia), 
-Ventricular paced rhythm, 
-Pre-excitation pattern such as Wolff-Parkinson-White, 
-A more than 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. 
 
d. A history of coronary artery disease (CAD) based on a prior anatomic evaluation of the coronary arteries OR 
a history of coronary artery bypass graft surgery (CABG) or percutaneous coronary intervention (PCI), OR 
e. 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, OR 
f. Evidence or high suspicion of ventricular arrhythmias, OR 
g. 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, OR 
h. Patients with recent equivocal or borderline testing where ischemia remains a concern, OR 
i. 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, OR 
j. 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) 
k. 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 
l. 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 
m. Patients with hypertrophic cardiomyopathy (HCM) 
 
You can find this rule in the Local Coverage Determination (LCD) - Cardiology Non-emergent Outpatient 
Stress Testing (L38396) - Effective April 25, 2021. 
 
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.