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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 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: 
 
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 
 
The beneficiary has any significant postural asymmetries that are due to one of the following (a or b): 
 
A diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-related Policy Article; or 
 
A diagnosis code listed in Group 3 of the ICD-10 code list in the LCD-related Policy Article. 
 
You can find these rules in the Local Coverage Determination (LCD) Wheelchair Seating L33312. 
 
The rules say that a power standing feature (E2301) is non-covered because it is 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 standing feature, it will be denied as non-covered. 
 
A power standing system (E2301) includes: a solid seat platform and a solid back; detachable or flip-up fixed 
height armrests; hinged legrests; anterior knee supports; fixed or flip-up footplates; a motor and related 
electronics with or without variable speed programmability; a basic 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 move the 
beneficiary to a standing position; ability to support beneficiary weight of at least 250 pounds. 
 
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. If it is ordered for this indication, a gray (GY) 
modifier must be added to the code. Code E1028 is used for 
 
Swingaway hardware used with remote joysticks or touchpads, 
 
Swingaway or flip-down hardware for head control interfaces E2327, E2328, E2329, E2330, and 
 
Swingaway hardware for an indicator display box that is related to the multi-motor electronic connection codes 
E2310 or E2311. 
 
Code E1028 is not to be used for swingaway hardware used with a sip and puff interface (E2325) because 
swingaway hardware is included in the allowance for that code. Code E1028 is not to be used for hardware on a 
wheelchair tray (E0950). Do not use E1028 in addition to E1020 (Residual limb support system) as it includes 
swingaway hardware. You can find these rules in the Local Coverage Article (LCA) Wheelchair 
Options/Accessories - Policy Article A52504. 
 
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.