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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 medically necessary services are those that are reasonable and necessary for the diagnosis or 
treatment of an illness or injury. Medically necessary services include services to improve the functioning of a 
malformed body member. You can find this rule in the Social Security Act, Section 1862(a)(1)(A). 
 
The rules say that services that are not medically necessary are not covered. The rules also say that 
experimental and investigational devices are not covered. You can find this rule at 42 CFR Sections 411.15 and 
411.15(o). 
 
The rules say that codes E2310 and E2311 describe the electronic components that allow the beneficiary to 
control two or more of the following motors from a single interface (e.g., proportional joystick, touchpad, or 
non-proportional interface): power wheelchair drive, power tilt, power recline, power shear reduction, power 
leg elevation, power seat elevation, power standing. It includes a function selection switch which allows the 
beneficiary to select the motor that is being controlled and an indicator feature to visually show which function 
has been selected. When the wheelchair drive function has been selected, the indicator feature may also show the direction that has been selected (forward, reverse, left, right). This indicator feature may be in a separate 
display box or may be integrated into the wheelchair interface. Payment for the code includes an allowance for 
fixed mounting hardware for the control box and for the display box (if present). 
 
A non-expandable controller has the following features: 
- May have the ability to control up to 2 power seating actuators through the drive control (for example, 
seat elevator and single actuator power elevating leg rests). (Note: Control of the power seating 
actuators though the Control Input Device would require the use of an additional component, E2310 or 
E2311.) 
- Can accommodate only an integral joystick or a standard proportional remote joystick 
- May allow for the incorporation of an attendant control 
 
An expandable controller is capable of accommodating one or more of the following additional functions: 
- Other types of proportional input devices (e.g., mini-proportional or compact joysticks, touchpads, chin 
control, head control, etc.) 
- Non-proportional input devices (e.g., sip and puff, head array, etc.) 
- 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.) 
An expandable controller may also be able to operate one or more of the following: 
- A separate display (i.e., for alternate control devices) 
- Other electronic devices (e.g., control of an augmentative speech device or computer through the chair's 
drive control) 
- An attendant control 
 
Miscellaneous options, accessories, or replacement parts for wheelchairs that do not have a specific Healthcare 
Common Procedure Coding System (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 this information in the Local Coverage Article (LCA): Wheelchair Options/Accessories 
(A52504). 
 
The rules say wheelchair seat and back cushion codes are all-inclusive. Use of HCPCS code K0108 or any 
other HCPCS code to separately bill for added components such as the foam blocks, gel packs, air cells, or 
equivalent material is incorrect coding. 
 
You can find this information in the Local Coverage Article (LCA): Wheelchair Seating (A52505). 
 
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.