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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 cover a Power Mobility Device (PMD) (i.e., power wheelchair or scooter) for 
a person who meets the following criteria:  
 
1. The person must have a personal mobility deficit;  
2. The deficit must impair their participation in mobility related activities of daily living (MRADLs) such 
as toileting, feeding, grooming and bathing in customary locations within the home;  
3. The persons condition must not be able to be ameliorated by a walker, cane or manual wheelchair; and 
4. The person must be capable of safely operating the PMD.  
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 280.3(B). 
 
The rules say MEDICAL RECORD DOCUMENTATION 
 
In the event of a claim review, information contained directly in the contemporaneous medical record is the 
source required to justify payment except as noted elsewhere for prescriptions and CMNs. The medical record 
is not limited to treating practitioners office records but may include records from hospitals, nursing facilities, 
home health agencies, other healthcare professionals, etc. (not all-inclusive). Records from suppliers or 
healthcare professionals with a financial interest in the claim outcome are not considered sufficient by 
themselves for determining that an item is reasonable and necessary. DMEPOS suppliers are reminded that: 
 
    Supplier-produced records, even if signed by the treating practitioner, and attestation letters (e.g. letters of 
medical necessity) are deemed not to be part of a medical record for Medicare payment purposes. 
    Templates and forms, including CMS CMNs, are subject to corroboration with information in the medical 
record. 
    A prescription is not considered to be part of the medical record. Medical information intended to 
demonstrate compliance with coverage criteria may be included on the prescription but must be corroborated 
by information contained in the medical record. 
    The beneficiarys medical record must contain sufficient documentation of the beneficiarys medical 
condition to substantiate the necessity for the type and quantity of items ordered and for the frequency of use or 
replacement (if applicable). The information should include the beneficiarys diagnosis and other pertinent 
information including, but not limited to, duration of the beneficiarys condition, clinical course (worsening or 
improvement), prognosis, nature and extent of functional limitations, other therapeutic interventions and 
results, past experience with related items, etc.  
In addition to the general requirements discussed above, certain DMEPOS items may have specific 
documentation requirements. Details regarding these policy specific requirements are contained in the 
applicable LCD-related Policy Article. You can find this information in Medicare's Local Coverage Article 
Standard Documentation Requirements for All Claims Submitted to DME MACs (A55426). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.