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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 say that up to two batteries (E2359, E2361, E2363, E2365, E2371, K0733) at any one time are 
allowed if required for a power wheelchair. 
 
POWER TILT AND/OR RECLINE SEATING SYSTEMS (E1002, E1003, E1004, E1005, E1006, E1007, 
E1008, E1009, E1010, E1012): 
 
A power seating system  tilt only, recline only, or combination tilt and recline  with or without power 
elevating legrests will be covered if criteria 1, 2, and 3 are met and if criterion 4, 5, or 6 is met: 
     The beneficiary meets all the coverage criteria for a power wheelchair described in the Power Mobility 
Devices LCD; and 
 
    A specialty evaluation that was performed by a licensed/certified medical professional, such as a physical 
therapist (PT) or occupational therapist (OT) or practitioner who has specific training and experience in 
rehabilitation wheelchair evaluations of the beneficiarys seating and positioning needs. The PT, OT, or 
practitioner may have no financial relationship with the supplier; and 
 
    The wheelchair is provided by a supplier that employs a RESNA-certified Assistive Technology Professional 
(ATP) who specializes in wheelchairs and who has direct, in-person involvement in the wheelchair selection 
for the beneficiary. 
    The beneficiary is at high risk for development of a pressure ulcer and is unable to perform a functional 
weight shift; or 
    The beneficiary 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. 
 
If these criteria are not met, the power seating component(s) will be denied as not reasonable and necessary. 
One example (not all-inclusive) of a covered indication for swingaway, retractable, or removable hardware 
(E1028) would be to move the component out of the way so that a beneficiary can perform a slide transfer to a 
chair or bed. You can find this information in Medicare's Local Coverage Determination (LCD): Wheelchair 
Options/Accessories (L33792). 
 
The rules say that a skin protection seat cushion (E2603, E2604, E2622, E2623) is 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 either of the following (a or b): 
        Current pressure ulcer or past history of a pressure ulcer on the area of contact with the seating surface as 
reflected in a diagnosis code listed in Group 1 of the ICD-10 code list in the LCD-related Policy Article; or 
        Absent or impaired sensation in the area of contact with the seating surface or inability to carry out a 
functional weight shift as reflected in a diagnosis code listed in Group 2 of the ICD-10 code list in the LCD-
related Policy Article. 
 
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 this information in Medicare's Local Coverage Determination (LCD): Wheelchair Seating 
(L33312). 
 
The rules say that non-Expandable Controller - An electronic system that controls the speed and direction of the power wheelchair drive mechanism. Only a standard proportional joystick (used for hand or chin control) 
can be used as the input device. This system may be in the form of an integral controller or a remotely placed 
controller. The non-expandable controller: 
 
    May have the ability to control up to 2 power seating actuators through the drive control (for example, seat 
elevator and single actuator power elevating legrests). (Note: Control of the power seating actuators though the 
Control Input Device would require the use of an additional component, E2310 or E2311.) 
    May allow for the incorporation of an attendant control. 
 
Expandable Controller - An electronic system that is capable of accommodating one or more of the following 
additional functions: 
 
    Proportional input devices (e.g., mini, compact, or short throw joysticks, touchpads, chin control, head 
control, etc.) other than a standard proportional joystick. 
    Non-proportional input devices (e.g., sip and puff, head array, etc.) 
    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: 
 
    A separate display (i.e., for alternate control devices) 
    Other electronic devices (e.g., control of an augmentative speech device or computer through the chairs 
drive control) 
    An attendant control 
 
A harness (E2313) describes all the wires, fuse boxes, fuses, circuits, switches, etc. that are required for the 
operation of an expandable controller (E2377). It also includes all the necessary fasteners, connectors, and 
mounting hardware.ou 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.