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Decision: unknown

 
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 an expandable controller is 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: 
a. A separate display (i.e., for alternate control devices) 
b. Other electronic devices (e.g., control of an augmentative speech device or computer through the chairs 
drive control) 
c. An attendant control 
You can find this rule in Local Coverage Article: Power Mobility Devices - Policy Article (A52498). 
The rules say that a custom fabricated seat cushion (E2609) is covered if criteria (1) and (3) are met. A custom 
fabricated back cushion (E2617) is covered if criteria (2) and (3) are met: 
1. Beneficiary meets all of the criteria for a prefabricated skin protection seat cushion or positioning seat 
cushion; 2. Beneficiary meets all of the criteria for a prefabricated positioning back cushion; 
3. There is a comprehensive written evaluation by a licensed/certified medical professional, such as a 
physical therapist (PT) or occupational therapist (OT), which clearly explains why a prefabricated 
seating system is not sufficient to meet the beneficiarys seating and positioning needs. The PT or OT 
may have no financial relationship with the supplier. 
You can find this rule in Local Coverage Determination (LCD): Wheelchair Seating (L33312). 
 
The rules say that 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. You can find this rule in Local Coverage Article: Wheelchair 
Options/Accessories - Policy Article (A52504). 
 
The rules say that a power tilt seating system (E1002) includes: a solid seat platform and a solid back; any 
frame width and depth; detachable or flip-up fixed height or adjustable height armrests; fixed or swingaway 
detachable legrests; fixed or flip-up footplates; a motor and related electronics with or without variable speed 
programmability; a switch control which is independent of the power wheelchair drive control interface; any 
hardware that is needed to attach the seating system to the wheelchair base. You can find this rule in Local 
Coverage Article: Wheelchair Options/Accessories - Policy Article (A52504) 
 
The rules say that there is no separate payment for mounting hardware for a seat or back cushion. You can find 
this rule in Local Coverage Article: Wheelchair Seating - Policy Article (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.