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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 providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare and Medicaid Services, Medicare National Correct Coding Initiative Policy Manual 
for Medicare Services, Chapter I(A). 
 
The rules say that independent laboratories can bill Medicare through their MAC for the specimen collection 
fee. The specimen collection fee applies if the specimen is collected by trained laboratory personnel from a 
homebound or non-hospital inpatient and the specimen is a type that would not require only the services of a 
messenger pick up service. To identify specimen collection, codes G2023 and G2024 were established. 
Medicare beneficiaries are considered "confined to the home" (that is, "homebound") if it is medically 
contraindicated for the patient to leave the home. When it is medically contraindicated for a patient to leave the 
home, there exists a normal inability for an individual to leave home and leaving home safely would require a 
considerable and taxing effort. A patient who is exercising "self-quarantine" for his or her own safety during a 
pandemic outbreak of an infectious disease, such as COVID-19, would not be considered "confined to the 
home" or "homebound" unless it is also medically contraindicated for the patient to leave the home. You can 
find this rule in the Centers for Medicare and Medicaid Services, Covid-19 Medicare Fee-For-Service Billing. 
 
The rules say that the Correct Coding Initiative was developed to promote correct coding and to control 
improper coding leading to inappropriate payment in Part B claims. An add-on code is eligible for payment 
only if it is reported with an appropriate primary procedure performed by the same practitioner. An add-on 
code is not eligible for payment if it is the only procedure reported by a practitioner. You can find this rule in 
the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 100-04, Medicare Claims 
Processing Manual, Chapter 23, Section 20.9. 
 
The rules say that the Food and Drug Administration approves Clinical Laboratory Improvements Amendments 
of 1988 (CLIA) waived tests on a flow basis. The CMS identifies CLIA waived tests by providing an updated 
list of waived tests to the A/B MACs (A) and (B) on a quarterly basis via a Recurring Update Notification. To 
be recognized as a waived test, some CLIA waived tests have unique HCPCS procedure codes and some must 
have a QW modifier included with the HCPCS code. You can find this rule in the Centers for Medicare and 
Medicaid Services, Internet Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 
16, Section 70.8. 
 
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.