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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 vascular stents are used to enhance primary patency in arteries and veins, usually at the site of 
stenotic or occlusive lesions. Stents also may be used as an adjunct to technically inadequate Percutaneous 
Transluminal Angioplasty (PTA) or in cases where PTA alone will not be expected to provide a durable result. 
Peripheral vascular stenting may be indicated for patients with symptomatic arterial and venous disease 
resulting in an occlusive process. This LCD does not address carotid artery stenting, which is subject to 
National Coverage Determination (NCD) 20.7, nor does it address intracranial events or stent placement for 
hemodialysis access. Please see IOM Publication 100-03, Medicare National Coverage Determinations (NCD) 
Manual, Chapter 1, Part 1, Section 20.7, Percutaneous Transluminal Angioplasty (PTA), for details regarding 
carotid artery stenting. Refer to L37893-Endovenous Stenting for information regarding endovenous stents. 
 
Stenting of vessels is covered only when all of the following conditions are met: 
 
    Angioplasty alone would not suffice. 
    The patient has undergone prior thorough medical evaluation and management of symptoms for which PTA 
and stent are therapeutic. 
    Surgical intervention would otherwise be considered as an alternative treatment for the patient. 
    Condition(s) exists for which there is evidence of equal outcomes with renal artery intervention and medical 
therapy when compared with outcome of medical or surgical management. 
 
Vascular stents are utilized either following a suboptimal or failed PTA, or as a planned adjunct to PTA (so-
called primary stenting). When PTA of the vessel without stenting is not expected to or has not been sufficient 
to restore sufficient blood flow in symptomatic patients for whom surgery is the likely alternative, PTA with 
stent placement is indicated as an alternative to surgery. Please see IOM Publication 100-03, Medicare National 
Coverage Determinations (NCD) Manual, Chapter 1, Part 1, Section 20.7, Percutaneous Transluminal 
Angioplasty (PTA), for more information regarding national indications and limitations of PTA. A suboptimal 
or failed PTA is defined as a dilation judged by the physician to be suboptimal or failed due to the presence of 
unfavorable lesion morphology such as:  
 
    An inadequate angiographic and/or hemodynamic result as defined by a 30 percent or greater residual 
stenosis post-PTA, lesion recoil or intimal flaps. 
    Flow-limiting dissections post-PTA. 
    A 5 millimeters-of-mercury (mmHg) or greater mean trans-stenotic pressure gradient post-PTA. 
    Acute occlusion of the vessel post-PTA.     Significant recurrence of a lesion at the prior PTA site within 12 months. 
 
A stent may be placed as a planned adjunct to PTA rather than in response to a suboptimal or failed PTA (so-
called primary stent deployment). Primary stenting is justified for situations where PTA alone is not expected 
to provide a durable result, such as: 
 
    Arterial or venous occlusions that carry a high risk for distal embolization or rapid recurrence. Refer to 
L37893-Endovenous Stenting for information regarding endovenous stents. 
    Occlusive lesions known to be unfavorable for PTA alone, such as significantly calcified lesions, eccentric 
lesions, lesions related to external compression (e.g., May-Thurner syndrome and malignant compression of the 
superior vena cava), ostial renal artery stenoses or restenosis of prior stented areas. 
 
You can find this information in Medicare's Local Coverage Determination (LCD): Non-Coronary Vascular 
Stents (L35084). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.