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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 IV. A Group 3 PWC with no power options (K0848-K0855) is covered if: A. All of the
coverage criteria (a)-(e) for a PWC are met; and B. The beneficiary's mobility limitation is due to a
neurological condition, myopathy, or congenital skeletal deformity; and C. The beneficiary has had a specialty
evaluation that was performed by a licensed/certified medical professional, such as a PT or OT, or practitioner
who has specific training and experience in rehabilitation wheelchair evaluations and that documents the
medical necessity for the wheelchair and its special features (see Documentation Requirements section). The
PT, OT, or practitioner may have no financial relationship with the supplier; and D. The wheelchair is provided
by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP) who specializes in
wheelchairs and who has direct, in-person involvement in the wheelchair selection for the beneficiary. You can
find this information in Medicare's Local Coverage Determination (LCD) Power Mobility Devices (L33789).

The rules say that POWER TILT AND/OR RECLINE SEATING SYSTEMS (E1002, E1003, E1004, E1005,
E1006, E1007, E1008, E1009, E1010, E1012): A power seating system -- tilt only, recline only, or combination
tilt and recline -- with or without power elevating leg rests will be covered if criteria 1, 2, and 3 are met and if
criterion 4, 5, or 6 is met: 1. The beneficiary meets all the coverage criteria for a power wheelchair described in
the Power Mobility Devices LCD; and 2. A specialty evaluation that was performed by a licensed/certified
medical professional, such as a physical therapist (PT) or occupational therapist (OT) or practitioner who has
specific training and experience in rehabilitation wheelchair evaluations of the beneficiary's seating and
positioning needs. The PT, OT, or practitioner may have no financial relationship with the supplier; and 3. The
wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional (ATP)
who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the
beneficiary. 4. The beneficiary is at high risk for development of a pressure ulcer and is unable to perform a
functional weight shift; or 5. The beneficiary utilizes intermittent catheterization for bladder management and
is unable to independently transfer from the wheelchair to bed; or 6. The power seating system is needed to
manage increased tone or spasticity.

You can find this information in Medicare's Local Coverage Determination (LCD): Wheelchair
Options/Accessories (L33792).

The rules say that A headrest (E0955) is also covered when the beneficiary has a covered manual tilt-in-space,
manual semi or fully reclining back on a manual wheelchair, a manual fully reclining back on a power
wheelchair, or power tilt and/or recline power seating system. E2377 Expandable Controller and E2313
Expandable Controller Harness are requested to control multiple power options through the joystick. The notes
state that these are needed when 2 or more actuators are being used. The expandable controller (E2377) and
harness (E2313) cannot be covered. As noted above, the multiple power options (power tilt and power recline)
are not medically necessary. As three power features cannot be approved, E2377 Expandable Controller and
E2313 Expandable Controller Harness cannot be covered. One Power Option: When one power seating
function/actuator/motor is provided on a power wheelchair, one unit of E2310 (electronic connection between
wheelchair controller and one power seating system motor) is allowed. An expandable controller (E2377) and
harness (E2313) are not allowed in this situation unless a specialty interface is used. Example: E1002 (power
seating system, tilt only) is added to a power wheelchair. A power tilt system uses one power seating
motor/actuator. Two Power Option: when two power seating functions/actuators/motors are provided, one unit
of E2311 (electronic connection between wheelchair controller and two or more power seating system motors)
is allowed. An expandable controller (E2377) and harness (E2313) are not allowed in this situation unless a
specialty interface is used. Example: E1006 (Wheelchair accessory, power seating system, combination tilt and
recline, without shear reduction) is added to a power wheelchair. The tilt and recline functions each have one
actuator or power seating system motor, for a total of two. Three Power Option: When three or more power
seating functions/actuators/motors are provided, one unit of E2311. (electronic connection between wheelchair
controller and two or more power seating system motors), one unit of E2377 (expandable controller), and one
unit of E2313 (harness for upgrade to expandable controller) are allowed. Example: E1008 (Wheelchair
accessory, power seating system, combination tilt and recline, with power shear reduction) is added to a power
wheelchair. The tilt, recline, and power shear reduction features each have one actuator or power seating
system motor, for a total of three. You can find this information in Medicare's Local Coverage Determination
(LCD): Wheelchair Seating (L33312).

If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.