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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  Apheresis (also known as pheresis or therapeutic pheresis) is a medical procedure utilizing 
specialized equipment to remove selected blood constituents (plasma, leukocytes, plataelets, or cells) from 
whole blood. The remainder is retransfused into the person from whom the blood was taken. 
 
For purposes of Medicare coverage, apheresis is defined as an autologous procedure, i.e., blood is taken from 
the patient, processed, and returned to the patient as part of a continuous procedure (as distinguished from the 
procedure in which a patient donates blood preoperatively and is transfused with the donated blood at a later 
date). 
 
Indications and Limitations of Coverage 
 
B. Indications 
 
Apheresis is covered for the following indications: 
 
    Plasma exchange for acquired myasthenia gravis; 
    Leukapheresis in the treatment of leukemia; 
    Plasmapheresis in the treatment of primary macroglobulinemia (Waldenstrom); 
    Treatment of hyperglobulinemias, including (but not limited to) multiple myelomas, cryoglobulinemia and 
hyperviscosity syndromes; 
    Plasmapheresis or plasma exchange as a last resort treatment of thromobotic thrombocytopenic purpura 
(TTP); 
    Plasmapheresis or plasma exchange in the last resort treatment of life threatening rheumatoid vasculitis; 
    Plasma perfusion of charcoal filters for treatment of pruritis of cholestatic liver disease; 
    Plasma exchange in the treatment of Goodpasture's Syndrome; 
    Plasma exchange in the treatment of glomerulonephritis associated with antiglomerular basement membrane 
antibodies and advancing renal failure or pulmonary hemorrhage; 
    Treatment of chronic relapsing polyneuropathy for patients with severe or life threatening symptoms who 
have failed to respond to conventional therapy; 
    Treatment of life threatening scleroderma and polymyositis when the patient is unresponsive to conventional 
therapy; 
    Treatment of Guillain-Barre Syndrome; and 
    Treatment of last resort for life threatening systemic lupus erythematosus (SLE) when conventional therapy 
has failed to prevent clinical deterioration. 
 
C. Settings 
 
Apheresis is covered only when performed in a hospital setting (either inpatient or outpatient) or in a 
nonhospital setting, e.g., a physician directed clinic when the following conditions are met: 
 
    A physician (or a number of physicians) is present to perform medical services and to respond to medical 
emergencies at all times during patient care hours; 
    Each patient is under the care of a physician; and 
    All nonphysician services are furnished under the direct, personal supervision of a physician. 
 
You can find this information in Medicare's National Coverage Determination (NCD) for Apheresis 
(Therapeutic Pheresis) (110.14). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.