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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 medically necessary services are those that are reasonable and necessary for the diagnosis or 
treatment of an illness or injury. Medically necessary services include services to improve the functioning of a 
malformed body member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
  
   
The rules say that the covered indications for aortography/angiography are: 
1. Medical Necessity for Abdominal Aortography/Angiography 
- Acute traumatic abdominal injury 
- Aneurysm and other primary vascular abnormalities 
- Occlusive disease, including evaluation for acute or chronic intestinal ischemia 
- Acute GI hemorrhage 
- Congenital anomaly 
- Prior to arterial interventional procedures or open surgical procedures 
2. Medical Necessity for Stand-Alone Renal Angiography 
- Severe or difficult to control renal hypertension 
~ for severe or difficult to control renal hypertension, or 
~ progressive renal insufficiency, or 
~ resistant hypertension 
- Renal neoplasm 
- Hematuria of unknown cause 
- Abnormal kidney imaging involving radioisotopes 
- Renal artery stenosis, aneurysm, trauma, or other intrinsic defects prior to renal arterial 
intervention 
3. Medical Necessity for Lower Extremity or Renal Angiography done at the same time as a different 
interventional procedure (for example, cardiac catheterization with coronary angiography) 
4. Medical necessity for a Stand-Alone Lower Extremity Angiography must be documented by pre-
procedure clinical assessment. This assessment should include the following: 
- Documentation that an invasive intervention is planned, and 
- Documentation that a prior non-invasive study was completed and indicates further study is 
needed by angiography for the planned intervention, and 
- Documentation of one of the following conditions: arterial embolism, acute or chronic ischemia, 
peripheral vascular disease (includes claudication), or aneurysm. 
 
You can find these rules in Local Coverage Determination (LCD) Diagnostic Abdominal Aortography and 
Renal Angiography (L35092). 
 
The rules state that endovenous stents may be placed for patients with severely symptomatic venous 
obstructions due to any of the following: 
1. Iliac vein compression syndrome also known as May-Thurner or Cockett syndrome. 
2. Iliocaval obstruction. 
3. Iliofemoral obstruction for patients with venous leg ulceration(s) not relieved by conservative therapies 
and compression. Progression of symptoms may lead to Phlegmasia Cerulea Dolens (PCD), acute 
inferior vena cava (IVC) thrombosis, and rapid thrombus extension despite anticoagulation as well as 
anatomically extensive DVT affecting the common femoral and/or iliac vein, or post-thrombotic 
stenosis with ankle edema of venous origin. 
4. Superior or Inferior Vena Caval Thrombosis including Superior Vena Cava syndrome. 
5. Post-thrombotic syndrome (PTS). 
6. As an adjunct to catheter-directed thrombolysis for acute femoroiliocaval deep vein thrombosis when 
post thrombolysis imaging identifies symptomatic residual stenosis. 
7. Post radiation venous stenosis. 
8. Symptomatic post-traumatic venous stenosis including those resulting from central venous catheters or 
transvenous device (e.g., pacemakers, defibrillators,) pacemaker leads or a history of abdominal and/or 
pelvic surgery. 9. Salvage of thrombosed or stenotic symptomatic or limited function arteriovenous dialysis access 
fistulae or grafts with compromised venous outflow, failed angioplasty rapid restenosis, or vessel 
perforation. This may include treatment of trapping a life threatening thrombus, an aneurysm or 
pseudoaneurysm that threatens the viability of the AV fistula or graft, or the treatment of a hemodialysis 
vascular access rupture that cannot be controlled through balloon tamponade. 
10. Thrombotic obstruction of major hepatic veins (Budd-Chiari syndrome). 
11. Transvenous decompression of portosystemic shunts. 
12. Post-operative stenosis or venous narrowing due to repair of congenital cardiac disease, e.g. sinus 
venosus Atrial Septal Defect (ASD), discordant atrioventricular connection status post Mustard or 
Senning repair of Transposition of the Great Arteries (TGA). 
13. Pulmonary vein stenosis resulting from congenital malformation, extrinsic compression, sequelae of 
radiofrequency ablation (RFA), lung transplantation, or status post repair of Total Anomalous 
Pulmonary Vein Return (TAPVR). 
 
You can find these rules in Local Coverage Determination (LCD) Endovenous Stenting (L37893). 
 
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.