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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 POWER WHEELCHAIRS (K0013): 
 
A power wheelchair is covered if: 
 
   a. All of the basic coverage criteria (A-C) are met; and 
   b. The beneficiary does not meet coverage criterion D, E, or F for a POV; and 
   c. Either criterion J or K is met; and 
   d. Criteria L, M, N, and O are met; and 
   e. Any coverage criteria pertaining to the specific wheelchair type (see below) are met. 
 
   J. The beneficiary has the mental and physical capabilities to safely operate the power wheelchair that is 
provided; or 
 
   K. If the beneficiary is unable to safely operate the power wheelchair, the beneficiary has a caregiver who is 
unable to adequately propel an optimally configured manual wheelchair, but is available, willing, and able to 
safely operate the power wheelchair that is provided; and 
 
   L. The beneficiarys weight is less than or equal to the weight capacity of the power wheelchair that is 
provided and greater than or equal to 95% of the weight capacity of the next lower weight class PWC  i.e., a 
Heavy Duty PWC is covered for a beneficiary weighing 285  450 pounds; a Very Heavy Duty PWC is 
covered for a beneficiary weighing 428  600 pounds; an Extra Heavy Duty PWC is covered for a beneficiary 
weighing 570 pounds or more. 
 
   M. The beneficiarys home provides adequate access between rooms, maneuvering space, and surfaces for 
the operation of the power wheelchair that is provided. 
 
   N. Use of a power wheelchair will significantly improve the beneficiarys ability to participate in MRADLs 
and the beneficiary will use it in the home. For beneficiaries with severe cognitive and/or physical 
impairments, participation in MRADLs may require the assistance of a caregiver.  
   O. The beneficiary has not expressed an unwillingness to use a power wheelchair in the home. 
 
If a PWC will be used inside the home and if coverage criteria (a)-(e) are not met, it will be denied as not 
reasonable and necessary. 
 
If a PWC will only be used outside the home, see related Policy Article for information concerning 
noncoverage. 
 
A custom motorized/power wheelchair base (K0013) will be covered if: 
 
   1. The beneficiary meets the general coverage criteria for a power wheelchair; and 
   2. The specific configurational needs of the beneficiary are not able to be met using wheelchair cushions, or 
options or accessories (prefabricated or custom fabricated), which may be added to another power wheelchair 
base. 
 
If coverage criterion 1 for K0013 is not met, the claim will be denied as not reasonable and necessary. 
 
If coverage criterion 2 for K0013 is not met, the claim will be denied for incorrect coding (see related Policy 
Article for additional information). A custom motorized/power wheelchair base is not reasonable and necessary 
if the expected duration of need for the chair is less than three months (e.g., post-operative recovery). You can 
find this information in the Local Coverage Determination (LCD) for Power Mobility Devices (L33789). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.