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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 elevating leg rests are covered if: 

1. The beneficiary has a musculoskeletal condition or the presence of a cast or brace which prevents 90-
degree flexion at the knee; or 
2. The beneficiary has significant edema of the lower extremities that requires an elevating leg rest; or 
3. The beneficiary meets the criteria for and has a reclining back on the wheelchair. 

The rules also say that 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 1, 2, and 3 are met and if criterion 4, 5, or 6 is met: 

4. The beneficiary meets all the coverage criteria for a power wheelchair described in the Power Mobility 
Devices LCD; and 
5. 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 beneficiary's seating and positioning needs. 
The PT, OT, or practitioner may have no financial relationship with the supplier; and if these criteria are 
not met, the power seating component(s) will be denied as not reasonable and necessary. 
6. 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. 
7. The beneficiary is at high risk for development of a pressure ulcer and is unable to perform a functional 
weight shift; or 8. The beneficiary utilizes intermittent catheterization for bladder management and is unable to 
independently transfer from the wheelchair to bed; or 
9. The power seating system is needed to manage increased tone or spasticity. 

You can find this information in the Local Coverage Determination (LCD) Wheelchair Options/Accessories 
(L33792). 
 
The rules say that 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 (LCA) Power Mobility Devices (A52498). 
 
The rules say that Medicare will pay for durable medical equipment that is mainly used to serve a medical 
purpose. Items such as hospital beds, respirators, wheelchairs and crutches are examples of equipment that are 
clearly used for medical purposes. Medicare will not pay for: 
 
1. Equipment that is primarily and customarily used for nonmedical purposes. Examples include air 
conditioners, humidifiers, dehumidifiers and electric air cleaners; 
2. Equipment used for a patient's comfort or for the convenience of a person caring for the patient. Examples 
include elevators, stairway elevators, physical fitness equipment and self-help devices such as grab bars. You 
can find these rules in the Centers for Medicare and Medicaid Services, Internet Only Manual, Publication 100-
02, Medicare Benefit Policy Manual, Chapter 15, Section 110.1. 
 
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.