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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 Power Wheelchair Basic Equipment Package - Each power wheelchair code is required to 
include all these items on initial issue (i.e., no separate billing/payment at the time of initial issue, unless 
otherwise noted). The statement that an item may be separately billed does not necessarily indicate coverage. 
 
Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately. 
 
Battery charger, single mode 
 
Complete set of tires and casters, any type 
 
Legrests. There is no separate billing/payment if fixed, swingaway, or detachable non-elevating legrests with or 
without calf pad are provided. Elevating legrests may be billed separately. 
 
Footrests/foot platform. There is no separate billing/payment if fixed, swingaway, or detachable footrests or a 
foot platform without angle adjustment are provided. There is no separate billing for angle adjustable footplates 
with Group 1 or 2 power wheelchairs (PWCs). Angle adjustable footplates may be billed separately with Group 
3, 4 and 5 PWCs. 
 
Armrests. There is no separate billing/ payment if fixed, swingaway, or detachable non-adjustable height 
armrests with arm pad are provided (K0015). Adjustable height armrests (E0973, K0020) may be billed 
separately. 
 
Any weight specific components (braces, bars, upholstery, brackets, motors, gears, etc.) as required by 
beneficiary weight capacity. 
 Any seat width and depth. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may 
be billed separately: 
 
For Standard Duty, seat width and/or depth greater than 20 inches; 
 
For Heavy Duty, seat width and/or depth greater than 22 inches; 
 
For Very Heavy Duty, seat width and/or depth greater than 24 inches; 
 
For Extra Heavy Duty, no separate billing 
 
Any back width. Exception: For Group 3 and 4 PWCs with a sling/solid seat/back, the following may be billed 
separately: 
 
For Standard Duty, back width greater than 20 inches; 
 
For Heavy Duty, back width greater than 22 inches; 
 
For Very Heavy Duty, back width greater than 24 inches; 
 
For Extra Heavy Duty, no separate billing 
 
Controller and Input Device. There is no separate billing/payment if a non-expandable controller and a standard 
proportional joystick (integrated or remote) is provided. An expandable controller, a nonstandard joystick (i.e., 
non-proportional or mini, compact or short throw proportional), or other alternative control device may be 
billed separately. 
 
Power Operated Vehicle (POV) Basic Equipment Package - Each POV is to include all these items on initial 
issue (i.e., no separate billing/payment at time of initial issue): 
 
Lap belt or safety belt. Shoulder harness/straps or chest straps/vest may be billed separately 
 
Battery or batteries required for operation 
 
Battery charger, single mode 
 
Weight appropriate upholstery and seating system 
 
Tiller steering 
 
Non-expandable controller with proportional response to input 
 
Complete set of tires 
 
All accessories needed for safe operation 
 
A table at the end of this section defines the bundling guidelines for wheelchair bases and options/accessories. 
Codes listed in Column II are not separately payable from the wheelchair base and must not be billed 
separately at the time of initial purchase or rental of the wheelchair. 
 
A replacement option/accessory for POV is billed using a wheelchair option/accessory code. All options and 
accessories provided at the time of initial issue of a POV are not separately billable. Accessories provided at the time of initial issue of a rollabout chair are not separately billable. Accessories 
provided with the initial issue of a transport chair are not separately billable with the exception of elevating 
legrests (E0990, K0195). A replacement accessory for a rollabout or transport chair is billed using code E1399. 
 
Miscellaneous options, accessories, or replacement parts for wheelchairs that do not have a specific HCPCS 
code and are not included in another code should be coded K0108. If multiple miscellaneous accessories are 
provided, each should be billed on a separate claim line using code K0108. When billing more than one line 
item with code K0108, ensure that the additional information can be matched to the appropriate line item on the 
claim. It is also helpful to reference the line item to the submitted charge. If a supplier chooses to bill separately 
for a component that is included in another code, code A9900 must be used. 
 
You can find these rules in the 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.