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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 pay for durable medical equipment that is mainly used to serve a medical 
purpose. Items such as hospital beds, respirators, wheelchairs and crutches are examples of equipment that are 
clearly used for medical purposes. Medicare will not pay for: 
 
1. Equipment that is primarily and customarily used for nonmedical purposes. Examples include air 
conditioners, humidifiers, dehumidifiers and electric air cleaners; 
2. Equipment used for a patients comfort or for the convenience of a person caring for the patient. Examples 
include elevators, stairway elevators, physical fitness equipment and self-help devices such as grab bars. You 
can find these rules in the Centers for Medicare & Medicaid Services, Internet Only Manual, Publication 100-02, Medicare Benefit Policy Manual, Chapter 15, Section 110.1.  
 
The rules say that a nonadjustable skin protection and positioning seat cushion (E2607, E2608) is a 
prefabricated cushion which has the following characteristics: 
 
It has the minimum structural features described in (a) or (b): 
 
The feature must be at least 25 mm in height in the pre-loaded state. It has two or more of the following: 
A pre-ischial bar or ridge which is placed anterior to the ischial tuberosities and prevents forward migration of 
the pelvis, 
 
Two lateral pelvic supports which are placed posterior to the trochanters and are intended to maintain the pelvis 
in a centered position in the seat and/or provide lateral stability to the pelvis, 
 
A medial thigh support which is placed in contact with the adductor region of the thigh and provides the 
prescribed amount of abduction and prevents adduction of the thighs, 
 
Two lateral thigh supports which are placed anterior to the trochanters and provide lateral stability to the lower 
extremities and prevent unwanted abduction of the thighs. 
 
It has two or more air compartments located in areas which address postural asymmetries, each of which must 
have a cell height of at least 50 mm, must allow the user to add or remove air, and must have a valve which 
retains the desired air volume; and 
 
It has the following minimum performance characteristics: 
 
Simulation tests demonstrate a loaded contour depth of at least 40mm with an overload deflection of at least 5 
mm, or 
 
Human subject tests demonstrate an average peak pressure index that is less than 85% of that of a standard 
reference cushion within the area of the ischial tuberosities and sacrum/coccyx; and 
 
Following testing simulating 18 months of use: 
 
Simulation tests demonstrate an overload deflection of at least 5 mm, or 
 
Human subject tests demonstrate an average peak pressure index that is less than 85% of those of a standard 
reference cushion within the area of the ischial tuberosities and sacrum/coccyx; and 
 
It has a removable vapor permeable or waterproof cover or it has a waterproof surface. 
 
You can find this information in Local Coverage Article Wheelchair Seating - Policy Article A52505. 
 
The rules say that 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 PWCs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 PWCs. 
 
You can find this information in the 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.