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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 a group three power wheelchair with a single power option is covered if: 
 
A. The Group 3 criteria are met; and 
B. The Group 2 single power option criteria is met 
 
You can find this rule in Local Coverage Determination (LCD): Power Mobility Devices (L33789) - Effective 
January 1, 2020. 
 
The rules say that a group 2 single power option wheelchair is covered if all of the coverage criteria for a basic 
power wheelchair are met, and if: 
 
A. Criterion 1 or 2 is met, and 
B. Criteria 3 and 4 are met 
 
1. The beneficiary requires a drive control interface other than a hand or chin-operated standard proportional 
joystick (examples include but are not limited to head control, sip and puff, switch control). 
2. The beneficiary meets coverage criteria for a power tilt or a power recline seating system and the system is 
being used on the wheelchair. 
3. The beneficiary has had 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 and that documents the medical necessity for 
the wheelchair and its special features. The PT, OT, or practitioner may have no financial relationship with the 
supplier. 
4. 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 rule in Local Coverage Determination (LCD): Power Mobility Devices (L33789) - Effective 
January 1, 2020. 
 
The rules say that a group 3 power wheelchair is covered if: 
 
A. Al of the coverage criteria for a basic power wheelchair is met 
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 physical therapist (PT) or occupational therapist (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. The PT, OT, or practitioner may have no financial relationship with the 
supplier. 
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 rule in Local Coverage Determination (LCD): Power Mobility Devices (L33789) - Effective 
January 1, 2020. 
 
The rules say that a power tilt seating system (E1002) 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; a motor and related electronics with or without variable speed 
programmability; a switch control which is independent of the power wheelchair drive control interface; any 
hardware that is needed to attach the seating system to the wheelchair base. It does not include a headrest. It 
must have the following features: ability to tilt to greater than or equal to 20 degrees from horizontal; back 
height of at least 20 inches; ability for the supplier to adjust the seat to back angle; ability to support 
beneficiary weight of at least 250 pounds. 
 
You can find this rule in Local Coverage Article:Wheelchair Options/Accessories - Policy Article (A52504) - 
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.