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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 state that a Group 3 power wheelchair may be covered for enrollees with a mobility limitation that is 
due to a neurological condition, myopathy, or congenital skeletal deformity. A Group 3 power wheelchair with 
multiple power options requires that the enrollee meet coverage criteria for a power tilt and recline seating 
system, or that the enrollee use a ventilator which is mounted on the wheelchair. You can find this in the Local 
Coverage Determination (LCD): 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 the enrollee is at high risk for development of a pressure 
ulcer and is unable to perform a functional weight shift; or, the enrollee utilizes intermittent catheterization for 
bladder management and is unable to independently transfer from the wheelchair to bed; or, the power seating 
system is needed to manage increased tone or spasticity. You can find this in the Local Coverage 
Determination (LCD): Wheelchair Options/Accessories (L33792). 
 
The rules also say that swingaway, retractable, or removable hardware (E1028) is non-covered if the primary 
indication for its use is to allow the beneficiary to move close to desks or other surfaces. Procedure code E2311 
describes the electronic components that allow the beneficiary to control two or more of the following motors 
from a single interface (e.g., proportional joystick, touchpad, or non-proportional interface): power wheelchair 
drive, power tilt, power recline, power shear reduction, power leg elevation, power seat elevation, power 
standing. 
 
A harness (E2313) describes all of the wires, fuse boxes, fuses, circuits, switches, etc. that are required for the 
operation of an expandable controller. It also includes all the necessary fasteners, connectors, and mounting 
hardware. Code E2313 is separately billable in addition to an expandable controller both at initial issue and 
with complete replacement of the expandable controller. Code K0108 must not be used for any component or 
feature of an expandable controller at the time of initial issue. The reimbursement for any type of complete 
expandable controller is included in the allowance for codes E2377/E2376 plus E2313.  
 
 You can find this information in the Local Coverage Article for Wheelchair Options/Accessories - Policy 
Article (A52504). 
 
The rules say that a positioning seat cushion (E2605, E2606), positioning back cushion (E2613, E2614, E2615, 
E2616, E2620, E2621), and positioning accessory (E0953, E0955, E0956, E0957, E0960) are covered for a 
beneficiary who meets both of the following criteria: 
1. The beneficiary has a manual wheelchair or a power wheelchair with a sling/solid seat/back and the 
beneficiary meets Medicare coverage criteria for it; and 
2. The beneficiary has any significant postural asymmetries for certain conditions.  
A combination skin protection and positioning seat cushion (E2607, E2608, E2624, E2625) is covered for a 
beneficiary who meets the criteria for both a skin protection seat cushion and a positioning seat cushion. You 
can find this information in Local Coverage Determination (LCD) Wheelchair Seating (L33312). 
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.