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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 a power seating system - tilt only, recline only, or combination tilt and recline - with or without 
power elevating leg rests will be covered if criteria 4, 5, or 6 are met: 
4. The beneficiary is at high risk for development of a pressure ulcer and is unable to perform a 
functional weight shift; or 
5. The beneficiary utilizes intermittent catheterization for bladder management and is unable to 
independently transfer from the wheelchair to bed; or 
6. The power seating system is needed to manage increased tone or spasticity. 
 
If these criteria are not met, the power seating component(s) will be denied as not reasonable and necessary. 
 
You can find this information in the Local Coverage Determination (LCD): Wheelchair Options/Accessories 
(L33792). 
 
The rules say 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. However, if 
individual components of the harness are replaced, code K0108 should be used. 
  
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 
 
You can find this information in the Local Coverage Article (LCA): Wheelchair Options/Accessories 
(A52504). 
 
The rules say Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) suppliers are 
reminded that: 
- Supplier-produced records, even if signed by the treating practitioner, and attestation letters (e.g. 
letters of medical necessity) are deemed not to be part of a medical record for Medicare payment 
purposes. 
- Templates and forms, including Centers for Medicare & Medicaid Services (CMS) Certificate of 
Medical Necessity (CMN) prior to date of service January 1, 2023, are subject to corroboration with 
information in the medical record. 
- A prescription is not considered to be part of the medical record. Medical information intended to 
demonstrate compliance with coverage criteria may be included on the prescription but must be 
corroborated by information contained in the medical record. 
- The beneficiary's medical record must contain sufficient documentation of the beneficiary's 
medical condition to substantiate the necessity for the type and quantity of items ordered and for the 
frequency of use or replacement (if applicable). The information should include the beneficiary's 
diagnosis and other pertinent information including, but not limited to, duration of the beneficiary's 
condition, clinical course (worsening or improvement), prognosis, nature and extent of functional 
limitations, other therapeutic interventions and results, past experience with related items, etc. 

You can find this information in the Local Coverage Article (LCA): Standard Documentation Requirements for 
All Claims Submitted to DME MACs (A55426). 
 
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.