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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 CFR 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; and4.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 all of the following basic criteria (A-C) must be met for a power mobility device (K0800-K0898) or a push-rim activated power assist device (E0986) to be covered. Additional coverage criteria for specific devices are listed below.A.The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or more mobility-related activities of daily living (MRADLs) such as toileting, feeding, dressing, grooming, and bathing in customary locations in the home. A mobility limitation is one that: oPrevents the beneficiary from accomplishing an MRADL entirely, oroPlaces the beneficiary at reasonably determined heightened risk of morbidity or mortality secondary to the attempts to perform an MRADL; oroPrevents the beneficiary from completing an MRADL within a reasonable time frame.B.The beneficiary's mobility limitation cannot be sufficiently and safely resolved by the use of an appropriately fitted cane or walker.C.The beneficiary does not have sufficient upper extremity function to self-propel an optimally-configured manual wheelchair in the home to perform MRADLs during a typical day. oLimitations of strength, endurance, range of motion, or coordination, presence of pain, or deformity or absence of one or both upper extremities are relevant to the assessment of upper extremity function.oAn optimally-configured manual wheelchair is one with an appropriate wheelbase, device weight, seating options, and other appropriate nonpowered accessories.POWER OPERATED VEHICLES (K0800-K0808, K0812):A POV is covered if all of the basic coverage criteria (A-C) have been met and if criteria D-I are also met.D.The beneficiary is able to: oSafely transfer to and from a POV, andoOperate the tiller steering system, andoMaintain postural stability and position while operating the POV in the home.E.The beneficiary's mental capabilities (e.g., cognition, judgment) and physical capabilities (e.g., vision) are sufficient for safe mobility using a POV in the home.F.The beneficiary's home provides adequate access between rooms, maneuvering space, and surfaces for the operation of the POV that is provided. G.The beneficiary's weight is less than or equal to the weight capacity of the POV that is provided and greater than or equal to 95% of the weight capacity of the next lower weight class POV -i.e., a Heavy Duty POV is covered for a beneficiary weighing 285 -450 pounds; a Very Heavy Duty POV is covered for a beneficiary weighing 428 -600 pounds.H.Use of a POV will significantly improve the beneficiary's ability to participate in MRADLs and the beneficiary will use it in the home.I.The beneficiary has not expressed an unwillingness to use a POV in the home. If a POV will be used inside the home and coverage criteria A-I are not met, it will be denied as not reasonable and necessary. You can find this rule in the Local Coverage Determination (LCD): Power Mobility Devices (L33789) effective January 1, 2020.