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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 services that are not medically necessary are not covered. The rules also say that 
experimental and investigational devices are not covered. You can find this rule at 42 CFR Sections 411.15 and 
411.15(o). 
 
The rules state that serum iron studies are useful in the evaluation of disorders of iron metabolism, particularly 
iron deficiency and iron excess. 
 
Indications 
1. Ferritin, iron and either iron binding capacity or transferrin are useful in the differential diagnosis of 
iron deficiency, anemia, and for iron overload conditions. 
a. The following presentations are examples that may support the use of these studies for 
evaluating iron deficiency: certain abnormal blood count values (i.e., decreased mean 
corpuscular volume (MCV), decreased hemoglobin/hematocrit when the MCV is low or normal, 
or increased red cell distribution width (RDW) and low or normal MCV); abnormal appetite 
(pica); acute or chronic gastrointestinal blood loss; hematuria; menorrhagia; malabsorption; 
status post-gastrectomy; status post-gastrojejunostomy; malnutrition; preoperative autologous 
blood collection(s); malignant, chronic inflammatory and infectious conditions associated with 
anemia which may present in a similar manner to iron deficiency anemia; following a significant surgical procedure where blood loss had occurred and had not been repaired with adequate iron 
replacement. 
b. The following presentations are examples that may support the use of these studies for 
evaluating iron overload: chronic hepatitis; diabetes; 
hyperpigmentation of skin; arthropathy; cirrhosis; hypogonadism; hypopituitarism; impaired 
porphyrin metabolism; heart failure; multiple transfusions; sideroblastic anemia; thalassemia 
major; cardiomyopathy, cardiac dysrhythmias and conduction disturbances. 
2. Follow-up testing may be appropriate to monitor response to therapy, e.g., oral or parenteral iron, 
ascorbic acid, and erythropoietin. 
3. Iron studies may be appropriate in patients after treatment for other nutritional deficiency anemias, such 
as folate and vitamin B12, because iron deficiency may not be revealed until such a nutritional 
deficiency is treated. 
4. Serum ferritin may be appropriate for monitoring iron status in patients with chronic renal disease with 
or without dialysis. 
5. Serum iron may also be indicated for evaluation of toxic effects of iron and other metals (e.g., nickel, 
cadmium, aluminum, lead) whether due to accidental, intentional exposure or metabolic causes. 
You can find this information in the centers for Medicare and Medicaid Services, Internet Only Manual, 
Publication 100-03, Medicare National Coverage Determinations (NCD) Manual, Serum Iron Studies, NCD 
190.18. 
 
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.