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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 shower and bath chairs are not covered because they are considered hygienic equipment that 
is not primarily medical in nature. 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 
280.1. 
The rules say a group 2 support surface is covered if the beneficiary meets at least one of the following three 
Criteria (1, 2 or 3): 
1. The beneficiary has multiple stage 2 pressure ulcers located on the trunk or pelvis have failed to 
improve over the past month, during which time the beneficiary has been on a comprehensive ulcer 
treatment program including each of the following:  
a. Use of an appropriate group 1 support surface, and 
b. Regular assessment by a nurse, practitioner, or other licensed healthcare practitioner, and 
c. Appropriate turning and positioning, and 
d. Appropriate wound care, and 
e. Appropriate management of moisture/incontinence, and 
f. Nutritional assessment and intervention consistent with the overall plan of care 
2. The beneficiary has large or multiple stage 3 or 4 pressure ulcer(s) on the trunk or pelvis, 
3. The beneficiary had a myocutaneous flap or skin graft for a pressure ulcer on the trunk or pelvis within 
the past 60 days, and has been on a group 2 or 3 support surface immediately prior to discharge from a 
hospital or nursing facility within the past 30 days 
When the stated coverage criteria for a group 2 mattress or bed are not met, a claim will be denied as not 
reasonable and necessary. 
 
You can find this information in the Local Coverage Determination (LCD): Pressure Reducing Support 
Surfaces  Group 2 (L33642). 
 The rules say for Medicare to consider coverage and payment for any item or service, the information 
submitted by the supplier or provider must corroborate the documentation in the beneficiary's medical 
documentation and confirm that Medicare coverage criteria have been met. You can see this in the Centers for 
Medicare and Medicaid Services, Internet Only Manual, Publication 100-08, Medicare Program Integrity 
Manual Chapter 3, 3.3.2.1. 
The rules say a standard walker and related accessories are covered if all of the following criteria (1-3) are met: 
1. The beneficiary has a mobility limitation that significantly impairs his/her ability to participate in one or 
more mobility-related activities of daily living (MRADL) in the home.  
 
A mobility limitation is one that: 
a. Prevents the beneficiary from accomplishing the MRADL entirely, or 
b. Places the beneficiary at reasonably determined heightened risk of morbidity or mortality 
secondary to the attempts to perform the MRADL, or 
c. Prevents the beneficiary from completing the MRADL within a reasonable time frame; and 
2. The beneficiary is able to safely use the walker; and 
3. The functional mobility deficit can be sufficiently resolved with use of a walker. 
A heavy duty walker (E0149) is covered for beneficiaries who meet coverage criteria for a standard walker and 
who weigh more than 300 pounds. If an E0149 walker is provided and if the beneficiary weighs 300 pounds or 
less, it will be denied as not reasonable and necessary. 
 
You can find this information in the Local Coverage Determination (LCD): Walkers (L33791). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.