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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 Medicare will cover a Power Mobility Device (PMD) (i.e., power wheelchair or scooter) for 
a person who meets the following criteria:  
 
1. The person must have a personal mobility deficit;  
2. The deficit must impair their participation in mobility related activities of daily living (MRADLs) such 
as toileting, feeding, grooming and bathing in customary locations within the home;  
3. The person's condition must not be able to be ameliorated by a walker, cane or manual wheelchair; and 
4. The person must be capable of safely operating the PMD.  
You can find this rule in the Medicare National Coverage Determinations Manual, Section 280.3(B). 
 
The rules say that an expandable controller is capable of accommodating one or more of the following 
additional functions: 
  
-Other types of proportional input devices (e.g., mini-proportional or compact joysticks, touchpads, chin 
control, head control, etc.) 
-Non-proportional input devices (e.g., sip and puff, head array, etc.) 
-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.) 
  
An expandable controller may also be able to operate one or more of the following: 
  
-A separate display (i.e., for alternate control devices) 
-Other electronic devices (e.g., control of an augmentative speech device or computer through the chair's drive 
control) 
-An attendant control 
  
You can find this rule in Local Coverage Article: Wheelchair Options/Accessories - Policy Article (A52504) - 
Effective January 1, 2020. 
 
The rules say that one example (not all-inclusive) of a covered indication for swingaway, retractable, or 
removable hardware (E1028) would be to move the component out of the way so that a beneficiary can 
perform a slide transfer to a chair or bed. You can find this rule in Local Coverage Determination (LCD): 
Wheelchair Options/Accessories (L33792) - Effective January 1, 2020. 
 
The rules say that a positioning cushion (E2620) and a positioning accessory (E0953 and E0955) is covered for 
a beneficiary who meets both of the following criteria: 
 
1. The beneficiary has a manual wheelchair or a power wheelchair with a sling/solid seat/back and the 
beneficiary meets Medicare coverage criteria for it; and,  
2. The beneficiary has any significant postural asymmetries 
 
You can find this rule in Local Coverage Determination (LCD): Wheelchair Seating (L33312) - Effective 
January 1, 2020. 
 
The rules say that a combination skin protection and positioning seat cushion (E2607) is covered for a 
beneficiary who meets the criteria for both a skin protection seat cushion and a positioning seat cushion. You 
can find this rule in Local Coverage Determination (LCD): Wheelchair Seating (L33312) - Effective January 1, 
2020. 
 
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.