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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 a Group 3 power wheelchair (PWC) with single power option is covered if: 
     A. All of the coverage criteria for a PWC are met; and 
     B. The beneficiarys mobility limitation is due to a neurological condition, myopathy, or congenital 
deformity; and 
     C. The beneficiary has had a specialty evaluation that was performed by a licensed/certified medical 
professional, such as a physical therapist (PT) or occupational therapist (OT), or practitioner who has specific 
training and experience in rehabilitation wheelchair evaluations and that documents the medical necessity for 
the wheelchair and its special features (see Documentation Requirements section). The PT, OT, or practitioner 
may have no financial relationship with the supplier; and 
     D. The wheelchair is provided by a supplier that employs a Rehabilitation Engineering and Assistive 
Technology Society of North America (RESNA) certified Assistive Technology Professional (ATP) who 
specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection for the 
beneficiary. 
     E. Criterion 1 or 2 is met; and 
          1. The beneficiary meets coverage criteria for a power tilt and recline seating system (see Wheelchair 
Options and Accessories policy) and the system is being used on the wheelchair. 
          2. The beneficiary uses a ventilator which is mounted on the wheelchair. 
 
If the PWC base is not covered, then related accessories will be denied. You can find this information in the 
Local Coverage Determination (LCD) for Power Mobility Devices (L33789). 
 
The rules say that a power seating system  tilt only, recline only, or combination tilt and recline  with or 
without power elevating legrests will be covered if criteria 1, 2, and 3 are met and if criterion 4, 5, or 6 is met: 
 
    1. The beneficiary meets all the coverage criteria for a power wheelchair described in the Power Mobility 
Devices LCD; and 
    2. A specialty evaluation that was performed by a licensed/certified medical professional, such as a physical 
therapist (PT) or occupational therapist (OT) or practitioner who has specific training and experience in 
rehabilitation wheelchair evaluations of the beneficiarys seating and positioning needs. The PT, OT, or practitioner may have no financial relationship with the supplier; and 
    3. The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology 
Professional (ATP) who specializes in wheelchairs and who has direct, in-person involvement in the 
wheelchair selection for the beneficiary. 
    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) for Wheelchair Options/Accessories 
(L33792). 
 
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 information in the Local Coverage Article for Wheelchair Options/Accessories - Policy 
Article (A52504). 
 
Codes E2310 and E2311 describe electronic components that allow the patient to control two or more of the 
following motors from a single interface, e.g., proportional joystick, touchpad, or nonproportional interface: 
Power tilt 
Power recline, with or without shear reduction 
Combination power tilt and recline, with or without shear reduction 
Power leg elevation with or without articulation, power center mount elevating foot platform with or without 
articulating properties. 
The interface includes a function selection switch that allows the patient 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 interface code includes an allowance for fixed mounting hardware for 
the control box and the display box, if present. You can find this information in the Local Coverage Article for 
Power Mobility Devices - Policy Article (A52498). 
 
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.