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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 PTA and stenting of vessels is covered only when all of the following conditions are met: 
 
     
  
  The patient has undergone prior thorough medical evaluation and management of symptoms. See below under 
specific categories for guidelines on medical evaluation and management recommendations. 
    Surgical intervention would otherwise be considered as an alternative treatment for the patient. 
    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 OR 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), or ostial renal artery stenosis. 
 
Coverage for non-coronary vascular stents depends on the use of an FDA-approved stent. Several different 
stents are currently used in the medical community. Each device has specific indications described by the FDA 
for approved market uses. Stent placement is covered by Medicare only when an FDA-approved stent is: 
 
    Used for the FDA-approved indications, OR 
    Used for the above indications supported by the peer medical literature. 
 
Specific Arterial Indications for PTA and Stenting 
 
    Brachiocephalic arteries: PTA and stenting may be indicated for treatment of flow-limiting stenosis resulting 
in conditions such as subclavian steal syndrome, upper extremity claudication, ischemic rest pain of the arm 
and hand, non-healing tissue ulceration and focal gangrene. Stenting of the inflow arteries, such as the 
innominate or subclavian when they are the inflow vessels of an arteriovenous fistula for chronic hemodialysis 
and are significantly stenotic, is often useful. 
    PTA and stenting for critical limb ischemia is considered appropriate under the following conditions: Limb 
threatening lower extremity ischemia. 
 
    PTA and stenting for claudication may be appropriate under the following conditions: Individuals who have 
failed medical management and home exercise program and continue to have significant activity limiting 
disease, with an anatomically suitable lesion for intervention. Medical management of peripheral artery disease 
(PAD) should include Class I recommendations for antiplatelet therapy, statins, home exercise program, 
smoking cessation including planning, counseling or behavior modification and pharmacotherapy if needed. 
    Mesenteric vessels: This includes acute mesenteric ischemia, chronic mesenteric ischemia, mesenteric 
thrombosis, dissection, or any other vascular insufficiency resulting in gastrointestinal symptoms. Stenting of 
the mesenteric vessels is covered only when angioplasty of the vessels would not suffice and after the patient 
has had a thorough medical evaluation and management of symptoms, and for whom surgical intervention is 
the likely alternative. The eligible patients will be required to have multiple comorbidities documented making 
them poor candidates for open surgical procedures. In these situations, PTA and stent placement should be 
considered an alternative to surgery and not an addition to medical management. 
    Hemodialysis access graft/fistula: This includes stenosis, restenosis, occlusion and pseudoaneurysm. 
 
Specific Venous Stents 
 
    Superior vena cava and subclavian/innominate veins stents: PTA and stenting are covered for superior vena 
cava syndrome, post-radiation venous stenosis, congenital stenosis, and thrombosis and embolism, including 
acute thrombophlebitis. Stenting of the veins, such as the innominate, subclavian, or superior vena cava when 
they are the outflow vessels of an arteriovenous fistula for chronic hemodialysis and are significantly stenotic, 
is often useful. 
    Inferior vena cava and iliofemoral veins: This includes vena caval and iliofemoral venous occlusions and 
stenosis due to the following: post-radiation venous stenosis, congenital stenosis or webs, extrinsic venous 
compression (May-Thurner syndrome), thrombophlebitis, and symptomatic post-traumatic venous stenosis. You can find these rules in Local Coverage Determination (LCD) Non-Coronary Vascular Stents (L35998). 
 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.