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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.

Medicare may cover the use of an FDA-approved drug or biological if it is safe and effective and otherwise reasonable and necessary for the patient. FDA approved drugs used for indications other than what is indicated on the official label may be covered if the use is determined to be medically accepted, taking into consideration the major drug compendia, authoritative medical literature and/or accepted standards of medical practice. You can find this rule in the Medicare Benefit Policy Manual, Chapter 15, Sections 50.4.1 and 50.4.2.

The rules say that:
The treatment of primary immunodeficiency syndromes associated with defects in humoral immunity to replace or boost immunoglobulin G (IgG)
The treatment of idiopathic thrombocytopenic purpura (ITP) when a rapid rise in the platelet count is required such as prior to surgery, to control excessive bleeding, or to defer or avoid splenectomy
Treatment of Kawasaki disease, in conjunction with aspirin
Prevention of recurrent bacterial infections in patients with hypogammaglobulinemia associated with B-cell chronic lymphocytic leukemia (CLL)
Decreasing risk of acute graft-vs.-host disease, associated interstitial pneumonia, and infections after bone marrow transplant in the first 100 days after transplantation
Reducing the risk of severe bacterial infections in human immunodeficiency virus (HIV) infected children with a CD4 count of greater than 200 to 400
Second-line treatment of dermatomyositis
The treatment of adults with Guillain-Barr syndrome diagnosed within the first 2 weeks of illness
Treatment of hyperimmunoglobulinemia E syndrome and Lambert-Eaton myasthenic syndrome (LEMS)
Treatment of multifocal motor neuropathy (MMN)
Treatment of relapsing-remitting multiple sclerosis
Treatment of chronic parvovirus B19 infection and severe anemia associated with bone marrow suppression and pure red cell aplasia
Treatment of progressive pemphigus vulgaris, pemphigus foliaceus, bullous pemphigoid, mucous membrane pemphigoid, and epidermolysis bullosa acquisita in patients that have failed conventional treatment and patients in whom conventional therapy is otherwise contraindicated
For coverage criteria of Autoimmune Mucocutaneous Blistering Diseases, please see CMS Internet-Only Manual, Pub. 100-03, Medicare National Coverage Determinations Manual, Chapter 1, Part 4, 250.3
Treatment of stiff person syndrome
Treatment of Myasthenia Gravis (MG) in patients who have profound, rapidly progressive and/or potentially life-threatening muscular weakness and are refractory to, or intolerant of cholinesterase inhibitors, corticosteroids and azathioprine
The prevention and/or treatment of organ rejection in patients sensitized to living or cadaveric organ donors Schonlein-Henoch
Treatment of Paraneoplastic Visual Loss
Treatment of Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in patients meeting the necessary criteria
Treatment of Multiple Myeloma for the prevention of life-threatening infections due to reduced gamma globulins

You can find this information in Medicare's Local Coverage Determination (LCD): Intravenous Immunoglobulin (IVIG) (L34580).

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.