Appeal type: unknown
Decision: unknown

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 services that are not medically necessary are not covered. The rules also say that 
experimental and investigational devices are not covered. You can find this rule at 42 CFR Sections 411.15 and 
411.15(o). 
 
Options and accessories for wheelchairs are covered if the beneficiary has a wheelchair that meets Medicare 
coverage criteria and the option/accessory itself is medically necessary.  
You can find this information in Local Coverage Determination (LCD): Wheelchair Options/Accessories 
(L33792). 
 
Codes E2310 and E2311 describe the electronic components that allow the beneficiary to control two or more 
of the following motors from a single interface (e.g., proportional joystick, touchpad, or non-proportional 
interface): power wheelchair drive, power tilt, power recline, power shear reduction, power leg elevation, 
power seat elevation, power standing. It includes a function selection switch which allows the beneficiary to 
select the motor that is being controlled and an indicator feature to visually show which function has been 
selected. 
 
A harness (E2313) describes all of the wires, fuse boxes, fuses, circuits, switches, etc. that are required for the 
operation of an expandable controller.

An expandable controller is capable of accommodating one or more of the following additional functions: 
a. Other types of proportional input devices (e.g., mini-proportional or compact joysticks, touchpads, chin 
control, head control, etc.) 
b. Non-proportional input devices (e.g., sip and puff, head array, etc.) 
c. Operate 3 or more powered seating actuators through the drive control. (Note: Control of the power seating 
actuators though the Control Input Device would require the use of an additional component, E2310 or E2311.) 
E2377 is used if an expandable controller is provided at the time of initial issue. 
You can find this information in Local Coverage Article: Wheelchair Options/Accessories - Policy Article 
(A52504). 
 
A power tilt and recline seating system (E1006-E1008) includes: a solid seat platform and a solid 
back; any frame width and depth; detachable or flip-up fixed height or adjustable height 
armrests; fixed or swing away detachable leg rests; fixed or flip-up footplates; two motors and 
related electronics with or without variable speed programmability; a switch control which is 
independent of the power wheelchair drive control interface. 
 
A power leg elevation feature (E1010, E1012) involves dedicated motor(s) and related 
electronics with or without variable speed programmability which allows the leg rest to be raised 
and lowered independently of the recline and/or tilt of the seating system. It includes a switch 
control which may or may not be integrated with the power tilt and/or recline control(s). 
You can find this information in Local Coverage Article: Wheelchair Options/Accessories - Policy Article 
(A52504). 
 
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.