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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 
 
Pneumatic compression devices are covered only when prescribed by a physician and when they are used with 
appropriate physician oversight, i.e., physician evaluation of the patient's condition to determine medical 
necessity of the device, assuring suitable instruction in the operation of the machine, a treatment plan defining 
the pressure to be used and the frequency and duration of use, and ongoing monitoring of use and response to 
treatment. 
 
The determination by the physician of the medical necessity of a pneumatic compression device must include: 
 
    The patient's diagnosis and prognosis; 
    Symptoms and objective findings, including measurements which establish the severity of the condition; 
    The reason the device is required, including the treatments which have been tried and failed; and 
    The clinical response to an initial treatment with the device. 
 
The clinical response includes the change in pre-treatment measurements, ability to tolerate the treatment 
session and parameters, and ability of the patient (or caregiver) to apply the device for continued use in the 
home. 
 
The only time that a segmented, calibrated gradient pneumatic compression device (HCPCs code E0652) 
would be covered is when the individual has unique characteristics that prevent them from receiving satisfactory pneumatic compression treatment using a nonsegmented device in conjunction with a segmented 
appliance or a segmented compression device without manual control of pressure in each chamber. 
 
You can find this information in Medicare's National Coverage Determination (NCD): Pneumatic Compression 
Devices (280.6). 
 
The rules say that 
 
III - LYMPHEDEMA EXTENDING ONTO THE CHEST, TRUNK AND/OR ABDOMEN 
 
A segmented, calibrated gradient pneumatic compression device (HCPCS code E0652) is only covered when 
the individual has unique characteristics which prevent them from receiving adequate satisfactory pneumatic 
compression treatment using a nonsegmented device along with a segmented appliance or compression device 
without manual control of the pressure in each chamber. 
 
A PCD coded as E0652, is covered for the treatment of lymphedema extending onto the chest, trunk and/or 
abdomen when all of the following are met: 
 
    The beneficiary has lymphedema of an extremity as defined above 
    The coverage criteria for an E0650 or E0651 are met 
    The beneficiary has lymphedema extending onto the chest, trunk and/or abdomen that extends past the limits 
of a standard compression sleeve, and the chest, trunk and/or abdominal lymphedema has failed to improve 
with a four-week trial. (See below for trial guidelines.) 
 
A PCD coded as E0652 used to treat lymphedema extending onto the chest, trunk and/or abdomen that does not 
meet all of the requirements above is not eligible for reimbursement. Claims will be denied as not reasonable 
and necessary. 
 
A PCD coded as E0652 used to treat lymphedema not extending onto the chest, trunk and/or abdomen or CVI 
is not eligible for reimbursement. Claims will be denied as not reasonable and necessary. 
 
 
PCD related accessories (E0655, E0656, E0657, E0660, E0665, E0666, E0667, E0668, E0669, E0670, E0671, 
E0672, E0673) are eligible for reimbursement only when the appropriate, related base PCDs (E0650, E0651, 
E0652, E0675) meets the applicable coverage criteria for that type of PCD. If the base PCD is not covered, 
related accessories are not eligible for reimbursement. Claims for related items will be denied as not reasonable 
and necessary. 
 
PCD CODE SELECTION (E0650, E0651, E0652, E0675, E0676) 
 
A PCD coded as E0650 or E0651 is used for lymphedema or CVI. An E0650 compressor with a segmented 
appliance/sleeve (E0671, E0672, E0673) is considered functionally equivalent to an E0651 compressor with a 
segmented appliance/sleeve (E0667, E0668, E0669). You can find this information in Medicare's Local 
Coverage Determination (LCD): Pneumatic Compression Devices (L33829). 
 
If you want to read these Medicare rules, you can go to this website www.medicareappeal.com.