Medicare will pay for anything you need if your Dr contacts Medicare ahead of time and explains the situation regarding what you think is medically necessary and your dr wil back it up. I spoke with a Medicare Supervisor who called me at the requaet of President Bush, and this is what she told me. Your Dr has to caontact them and explain why you need thhis procedure done. If you just go do it without prior contact, you are taking the risk of denial.
She also told me that what the general "rules" are for payment of procedures, testing, etc, set by Congress, are merely general rules for what they wil ordinarily pay for, but each patient is different. Thus the necessity of prior contact with Medicare to discuss YOUR particular situation. Mostly they will not deny the service or procedure.
Hope this helps you - it really helped me. I had thousands of dollars worth of procedures and tests they did not want to pay for. It was prior to Pain Management being coded and Congress had not acted on it yet. However, they paid for every single penny of those bills after my Dr called them.
I thinnk it is now referred to as a "Prior Authorization". They also use trhis phrase for any Medications in Part D billing. Certain meds require Prior Authorization, or you willl have to shell out for these meds. If your dr fills out a form that your insurance company has, and faxes it in or gets it to your pharmacy and they fax it in, it will be approved in either 24 hours or 72 hours, depending on the form Dr uses. They have their rules and each insurance carrier is a little different, so check your book of rules they send you in January of each year - things change also..so be sure to read the darned booklets! LOL