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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 patients 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 if an attendant control (E2331) is provided in addition to a beneficiary-operated drive control 
system, it will be denied as non-covered. A power seat elevation feature (E2300) and power standing feature 
(E2301) are non-covered because they are not primarily medical in nature. 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. 
 
Expandable Controller - An electronic system that is capable of accommodating one or more of the 
following additional functions: 
a. Proportional input devices (e.g., mini, compact, or short throw joysticks, touchpads, chin control, head 
control, etc.) other than a standard proportional joystick. 
b. Non-proportional input devices (e.g., sip and puff, head array, etc.) 
c. 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: 
d. A separate display (i.e., for alternate control devices) 
e. Other electronic devices (e.g., control of an augmentative speech device or computer through the chair's 
drive control) 
f. An attendant control   
A power tilt and recline seating system (E1006-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; 
 
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). You can find this information in Medicare's Local Coverage Article 
Wheelchair Options/Accessories - Policy Article (A52504). 
 
The rules say wheelchair seat and back cushion codes are all-inclusive. Use of HCPCS code K0108 or any 
other HCPCS code to separately bill for added components such as the foam blocks, gel packs, air cells, or 
equivalent material is incorrect coding. You can find this information in Medicare's Local Coverage Article 
Wheelchair Seating - Policy Article (A52505). 
 
The rules say reimbursement for the wheelchair codes includes all labor charges involved in the assembly of 
the wheelchair. Reimbursement also includes support services, such as delivery, set-up, and education about 
the use of the PMD. A seat elevator is a statutorily noncovered option on a power wheelchair. You can find this 
information in Medicare's Local Coverage Article Power Mobility Devices - Policy Article (A52498). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.