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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 Gastrointestinal (GI) Panels will only be covered when targeted testing is not appropriate 
AND according to the following additional criteria: 
    For immune-competent patients, at least 1 of the following must apply: 
        Testing is ordered by a clinician specialist in Infectious Diseases or Gastroenterology for a patient with 
severe and established underlying GI pathology (i.e., inflammatory bowel disease (IBD), paralytic ileus, 
radiation therapy to the intestine) AND identification of an infectious cause is necessary to determine next 
steps in patient management. 
        The patient is seriously or critically ill or at imminent risk of becoming seriously or critically ill (as 
defined by the American Hospital Associations General Guide for the Release of Information on the 
Condition of Patients)3 as a result of a presumed GI infection AND the patient is being treated in an 
appropriate critical care facility. 
        The patients clinical indication for GI panel testing is diarrhea, and ALL of the following apply: 
            The diarrheal illness MUST be acute or persistent with signs or risk factors for severe disease (i.e., 
fever, bloody diarrhea, dysentery, dehydration, severe abdominal pain) that may warrant hospitalization 
AND/OR 
            The diarrheal illness is not resolving after 7 days AND the patient has NOT taken laxatives within 24 
hours of the test. 
    For immune-suppressed patients: 
        Testing is ordered by a clinician specialist in 1 of the following: Infectious Diseases, Gastroenterology, 
Oncology, Transplant OR the patient is being managed in an appropriate critical care facility. 
    For ALL patients, exceptions to the limitation on medical specialists who can order expanded panel tests are 
provided in the accompanying Billing and Coding Article, such that patient geography and access to care do 
not preclude the receipt of appropriate diagnostic testing when indicated. You can find these rules in the Local 
Coverage Determination (LCD) MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen 
Identification Testing L39003. The rules say that the test panel is a single test with multiple components and is characterized by a single unit 
of service (UOS =1). A panel cannot be unbundled and billed as individual components regardless of the fact 
that the test reports multiple individual pathogens and/or targets. If additional organisms are not included in a 
panel, testing for those organisms separately may be reasonable and necessary when ordered in addition to the 
panel and supported by documentation in the medical record. You can find this rule in the Local Coverage 
Article Billing and Coding: MolDX: Molecular Syndromic Panels for Infectious Disease Pathogen 
Identification Testing A58726. 
 
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.