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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 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.  
 
The rules say a power tilt and recline seating system (E1006, E1007, E1008) 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; two motors 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. It does not 
include a headrest. It must have the following features: ability to tilt to greater than or equal to 20 degrees from 
horizontal; ability to recline to greater than or equal to 150 degrees from horizontal; back height of at least 20 
inches; ability to support beneficiary weight of at least 250 pounds. 
 
A power leg elevation feature (E1010, E1012) involves dedicated motor(s) and related electronics with or 
without variable speed programmability which allows the legrest to be raised and lowered independently of the 
recline and/or tilt of the seating system. It includes a switch control which may or may not be integrated with 
the power tilt and/or recline control(s). It includes either articulating or non-articulating legrests. The unit of 
service of code E1010 is a pair. The unit of service for code E1012 is each. Miscellaneous options, 
accessories, or replacement parts for wheelchairs that do not have a specific HCPCS 
code and are not included in another code should be coded K0108. If multiple miscellaneous accessories are 
provided, each should be billed on a separate claim line using code K0108. When billing more than one line 
item with code K0108, ensure that the additional information can be matched to the appropriate line item on the 
claim. It is also helpful to reference the line item to the submitted charge. If a supplier chooses to bill separately 
for a component that is included in another code, code A9900 must be used. 
 
Power Wheelchair Basic Equipment Package - Each power wheelchair code is required to include all these 
items on initial issue (i.e., no separate billing/payment at the time of initial issue, unless otherwise noted). The 
statement that an item may be separately billed does not necessarily indicate coverage. 
 
Footrests/foot platform. There is no separate billing/payment if fixed, swingaway, or detachable footrests or a 
foot platform without angle adjustment are provided. There is no separate billing for angle adjustable footplates 
with Group 1 or 2 PWCs. Angle adjustable footplates may be billed separately with Group 3, 4 and 5 PWCs. 
 
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 Medicare's Local Coverage Article Wheelchair Options/Accessories - Policy 
Article (A52504). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.