A power wheelchair is covered when all of the following criteria are met:

1. The patient's condition is such that without the use of a wheelchair the patient would otherwise be bed or chair confined, and;
2. The patient's condition is such that a wheelchair is medically necessary and the patient is unable to operate a wheelchair manually and;
3. The patient is capable of safely operating the controls for the power wheelchair.

A patient who requires a power wheelchair usually is totally nonambulatory and has severe weakness of the upper extremities due to a neurologic or muscular disease/condition.