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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 Centers for Medicare and Medicaid Services, Internet Only Manual, Medicare National Coverage Determinations Manual, Section 280.3(B).

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.

A power seat elevation feature (E2300) and power standing feature (E2301) are non-covered because they are not primarily medical in nature. If a wheelchair has an electrical connection device described by code E2310 or E2311 and if the sole function of the connection is for a power seat elevation or power standing feature, it will be denied as non-covered.

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.)

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 swingaway detachable legrests; 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 legrest 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.