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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 providers/suppliers must report services correctly. Procedures should be reported with the 
Current Procedural Terminology (CPT) code that describes the services performed. You can find this rule in 
the Centers for Medicare & Medicaid Services, Medicare National Correct Coding Initiative Policy Manual for 
Medicare Services, Chapter I(A). 
 
The rules say that the Correct Coding Initiative was developed to promote correct coding and to control 
improper coding leading to inappropriate payment in Part B claims. The Coding Policy Manual also explains 
what is referred to as Column One/Column Two Correct Coding and Mutually Exclusive Edits. These are code 
pairs that should not be reported together. Medicare Administrative Contractors (MACs) subject all line items 
for the same beneficiary, same National Provider Identifier (NPI), and same date of service to National Correct 
Coding Initiative (NCCI) edits. The National Correct Coding Initiative (NCCI) File Formats continue to 
include a Correct Coding Modifier Indicator (CCMI) for the Column One / Column Two Correct Coding edit 
file. This indicator determines whether an NCCI Procedure to Procedure (PTP)-associated modifier causes the 
code pair to bypass the edit. You can find this rule in the Centers for Medicare & Medicaid Services, Internet 
Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 23, Section 20.9. 
 
The rules say that a peripheral nerve block injection (CPT codes 64XXX) for postoperative pain management 
may be reported separately with an anesthesia 0XXXX code only if the mode of intraoperative anesthesia is 
general anesthesia, subarachnoid injection, or epidural injection, and the adequacy of the intraoperative 
anesthesia is not dependent on the peripheral nerve block injection.  
 
If an epidural or peripheral nerve block injection (62320-62327 or 64400-64530 as identified above) for 
postoperative pain management is reported separately on the same date of service as an anesthesia 0XXXX 
code, modifier 59 or XU may be appended to the epidural or peripheral nerve block injection code to indicate 
that it was administered for postoperative pain management.  
 
An epidural or peripheral nerve block injection for postoperative pain management in patients receiving 
general anesthesia, spinal (subarachnoid injection) anesthesia, or postoperative pain management in patients 
receiving general anesthesia, spinal (subarachnoid injection) anesthesia, or regional anesthesia by epidural 
injection as described above may be administered preoperatively, intraoperatively, or postoperatively. 
 
You can find this rule in the Centers for Medicare and Medicaid Services, Medicare National Correct Coding 
Initiative Policy Manual for Medicare Services, Chapter II.B(4). 
 
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.