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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 persons 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 Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 
100-03, Medicare National Coverage Determinations Manual, Section 280.3(B). 
 
A power seat elevation feature (E2300) and power standing feature (E2301) are non-covered because they are 
not primarily medical in nature. If a wheelchair has an electrical connection device described by code E2310 or 
E2311 and if the sole function of the connection is for a power seat elevation or power standing feature, it will 
be denied as non-covered. E2377 Expandable Controller, E2313 Expandable Controller Harness and E2311 
electronic accessory are requested to control power tilt, recline, and power elevating leg rests through the 
joystick. The notes state that these are needed when 3 or more actuators are being used. The electrical 
connection between the wheelchair controller and two or more motors (E2311), expandable controller (E2377) 
and harness (E2313) cannot be covered. Although there are three requested power options (tilt, recline and 
elevating leg rests), there is not a medical need to control these power options through the joystick. Member is independent with feeding. Member's upper limb strength and function are adequate for the member to be able 
to control the power options using their own switches which are included in the allowance of these power 
options. 
 
Expandable Controller -- An electronic system that is capable of accommodating one or more of 
the following additional functions: 
a.  Proportional input devices (e.g., mini, compact, or short throw joysticks, touchpads, chin control, head 
control, etc.) other than a standard proportional joystick. 
b.  Non-proportional input devices (e.g., sip and puff, head array, etc.) 
c.  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: 
d.  A separate display (i.e., for alternate control devices) 
e. Other electronic devices (e.g., control of an augmentative speech device or computer through the chair's 
drive control) 
f. An attendant control 
 
A harness (E2313) describes all of the wires, fuse boxes, fuses, circuits, switches, etc. that are required for the 
operation of an expandable controller. It also includes all the necessary fasteners, connectors, and mounting 
hardware. Code E2313 is separately billable in addition to an expandable controller both at initial issue and 
with complete replacement of the expandable controller. Code K0108 must not be used for any component or 
feature of an expandable controller at the time of initial issue. The reimbursement for any type of complete 
expandable controller is included in the allowance for codes E2377/E2376 plus E2313. 
 
E0978, Wheelchair Accessory Position Belt/Safety Belt/Pelv Strap is listed under Column II, with approved 
Power Wheelchair Base Group 3 code listed under Column I. Therefore, payment of seat belt and related 
supplies is included with the approved Power Wheelchair Base Group 3. A separate request for seatbelt is 
denied as unbundled. There is no separate payment for mounting hardware for a seat or back cushion.  
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 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.