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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 pay for durable medical equipment that is mainly used to serve a medical 
purpose. Items such as hospital beds, respirators, wheelchairs and crutches are examples of equipment that are 
clearly used for medical purposes. Medicare will not pay for: 
 
1. Equipment that is primarily and customarily used for nonmedical purposes. Examples include air 
conditioners, humidifiers, dehumidifiers and electric air cleaners; 
2. Equipment used for a patients comfort or for the convenience of a person caring for the patient. Examples 
include elevators, stairway elevators, physical fitness equipment and self-help devices such a grab bars. You 
can find these rules in the Medicare Benefit Policy Manual, Chapter 15, Section 110.1.  
 
Contract suppliers are not required to furnish a specific brand name item or mode of delivery to a beneficiary 
unless prescribed by a physician or treating practitioner to avoid an adverse medical outcome. A physician or 
treating practitioner (that is a physician assistant, clinical nurse specialist, or nurse practitioner) may prescribe, 
in writing, a particular brand of a competitively bid item or mode of delivery for an item if he or she determines 
that the particular brand or mode of delivery is necessary to avoid an adverse medical outcome for the 
beneficiary. The physician or treating practitioner must document in the beneficiary? medical record the 
reason why the specific brand or mode of delivery is necessary to avoid an adverse medical outcome.  
This documentation should include the following:  
The products brand name or mode of delivery;   The features that this product or mode of delivery has versus other brand name products or modes of delivery; 
and  
An explanation of how these features are necessary to avoid an adverse medical outcome.  
 
If a physician or treating practitioner prescribes a particular brand or mode of delivery to avoid an adverse 
medical outcome, the contract supplier must either:  
(1) Furnish the particular brand or mode of delivery as prescribed by the physician or treating practitioner;  
(2) Consult with the physician or treating practitioner to find another appropriate brand of item or mode of 
delivery for the beneficiary and obtain a revised written prescription from the physician or treating practitioner; 
or 
(3) Assist the beneficiary in locating a contract supplier that can furnish the particular brand of item or mode of 
delivery prescribed by the physician or treating practitioner.  
Any change in the prescription requires a revised written prescription for Medicare payment. A contract 
supplier is prohibited from submitting a claim to Medicare if it furnishes an item different from that specified 
in the written prescription received from the beneficiarys physician or treating practitioner. 
You can find this information in Medicare Claims Processing Manual Chapter 36  Competitive Bidding 30.4 - 
Prescription for Particular Brand, Item, or Mode of Delivery. 
 
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.