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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 if an attendant control (E2331) is provided in addition to a beneficiary-operated drive control 
system, it will be denied as non-covered.  
 
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. However, if individual 
components of the harness are replaced, code K0108 should be used. 
 
Miscellaneous options, accessories, or replacement parts for wheelchairs that do not have a specific Healthcare 
Common Procedure Coding System (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. 
 
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 leg rests; 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. 
 
You can find this information in the Local Coverage Article (LCA): Wheelchair Options/Accessories 
(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 the Local Coverage Article (LCA): Wheelchair Seating (A52505). 
 
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.