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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 state that a group 2 Single Power Option PWC (K0835, K0836, K0837, K0838, K0839, K0840) is 
covered if all of the coverage criteria (a)-(e) for a PWC are met and if: 
 
    Criterion 1 or 2 is met; and 
    Criteria 3 and 4 are met. 
        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). 
        The beneficiary meets coverage criteria for a power tilt or a power recline seating system (see Wheelchair 
Options and Accessories policy for coverage criteria) and the system is being used on the wheelchair. 
        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 (see Documentation Requirements section). The PT, OT, or practitioner 
may have no financial relationship with the supplier. 
        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. 
 
If a Group 2 Single Power Option PWC is provided and if criterion II(A) or II(B) is not met (including but not 
limited to situations in which it is only provided to accommodate a power seat elevation feature, a power 
standing feature, or power elevating legrests), it will be denied as not reasonable and necessary. 
 
For beneficiaries who do not have special skin protection or positioning needs, a power wheelchair with 
Captains Chair provides appropriate support. Therefore, if a general use cushion is provided with a power 
wheelchair with a sling/solid seat/back instead of Captains Chair, the wheelchair and the cushion(s) will be 
covered only if either criterion 1 or criterion 2 is met: 
 
    The cushion is provided with a covered power wheelchair base that is not available in a Captains Chair 
model  i.e., codes K0839, K0840, K0843, K0860, K0861, K0862, K0863, K0864, K0890, K0891; or     A skin protection and/or positioning seat or back cushion that meets coverage criteria is provided. 
 
If one of these criteria is not met, both the power wheelchair with a sling/solid seat and the general use cushion 
will be denied as not reasonable and necessary. 
 
If the PWC base is not covered, then related accessories will be denied. 
 
You can find this information in the Local Coverage Determination (LCD) Power Mobility Devices L33789. 
 
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.