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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 state that covered indications for flow cytometry include: 
 
    HIV Infection 
 
    The status of a Human Immunodeficiency Virus- (HIV) infected patient can be monitored by the analysis of 
the surface antigen CD4 (a T-cell receptor for HIV). This information can contribute to a prognosis as well as 
medical management for that individual (e.g., the need for AZT therapy or prophylaxis). Monitoring would be 
considered appropriate no greater in frequency than every 3 months. (When a patient is stable, especially 
during the long period of clinical latency, assays would be appropriate at a frequency less often. When the 
patient has an acute problem or therapy change, it may be necessary to perform the test at an increased 
frequency.) 
 
    Leukemia or Lymphoma 
 
    Leukemias and lymphomas may be analyzed in tissue, blood or marrow. Sometimes, flow cytometry may be 
performed on peripheral blood and fine needle aspirate material, thus, avoiding more invasive procedures for 
diagnosis. The presence or absence of antigens is determined using an antibody panel for appropriate diagnosis 
and classification. In the great majority of cases, 20 antibody determinations are sufficient to address diagnostic 
and prognostic concerns. This process is usually necessary at the initial diagnostic phase, for separate 
hematologic malignancies or when tumor is present in several anatomic sites. After this initial diagnostic phase, 
flow cytometry may be indicated to determine response to therapy. 
 
    Organ Transplants 
 
    Postoperative monitoring of organ transplants may be necessary to determine early rejection, 
immunosuppressive therapy toxicity or differentiation of infection from allograft rejection. The cells surface 
marker examined is CD3. This may require repeated analysis when symptoms are expressed for the above 
conditions by the transplant patient. 
 
    Carcinomas 
 
    DNA analysis of tumor for ploidy and percent-S-phase cells may be necessary for a few selective patients 
with carcinomas. Information obtained from flow cytometry is useful when the obtained prognostic information will affect treatment decisions in patients with low stage (localized disease). This is usually 
performed only one time after a diagnosis has been made and before treatment is initiated. 
 
    Primary Immunodeficiencies 
 
    Primary immunodeficiencies (e.g., Lymphocyte disorders, Phagocyte disorders, Monocyte/macrophage 
disorder) are immune disorders that are present at birth. These conditions are quite rare. Diagnosis typically 
occurs at an early age due to recurrent infections with frequent failures. Initial evaluation for suspected primary 
immunodeficiencies includes physical exam, laboratory evaluation (e.g., CBC, platelet, WBC with differential, 
ESR) and may include skin testing. Flow cytometry is indicated for diagnostic purposes in the presence of 
established disease or when abnormal results are found in the initial evaluation. 
 
    It is expected that the initial evaluation will contain a higher number of antibody examinations than a 
subsequent antibody examination. 
 
You can find this information in the Local Coverage Determination (LCD) Flow Cytometry L35032. 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.