Approved RAC Topics

Do you have questions or concerns about the Recovery Audit Program? Please e-mail us at RAC@cms.hhs.gov. Please Do Not send Personal Health Information to this e-mail address.

Note: CMS often receives referrals of potential improper payments from the MACs, UPICs, and Federal investigative agencies (e.g., OIG, DOJ). At CMS discretion, CMS may require the RAC to review claims, based on these referrals. These CMS-Required RAC reviews are conducted outside of the established ADR limits.


Showing 1-25 of 162 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0001 - Inpatient Hospital MS - DRG Coding Validation Complex Inpatient Hospital All A/B MACs
0002 - Cataract Removal: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital CGS, First Coast, NGS, Noridian, Novitas, Palmetto, WPS (for DOS on/after 2/11/2024)
0003 - Sacral Neurostimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Outpatient Hospital; Professional Services All A/B MACs (Urinary Frequency), CGS/Noridian and Palmetto (fecal incontinence)
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital All A/B MACs
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JN
0011 - Inappropriate Billing of Home Visit Professional Service Evaluation and Management Codes During Hospital Inpatient Stay Automated Professional Services All A/B MACs
0012 - Blood Glucose Monitors with Integrated Voice Synthesizer: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0013 - Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0014 - Glucose Monitor Supplies Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
0016 - Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision Automated DME Physician/DME Supplier All DME MACs
0018 - Spring-Powered Devices: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0019 - Durable Medical Equipment Billed while Inpatient: Unbundling Automated DME Physician/DME Supplier All DME MACs
0020 - Patient Lifts: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0021 - Tracheostomy Suction Pumps and Suction Catheters: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0022 - Inpatient Psychiatric Admission Billed without Source of Admission Equal to "D" Automated Inpatient Hospital; Inpatient Psychiatric Facility (IPF) All A/B MACs
0023 - High Frequency Chest Wall Oscillation Devices: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0024 - Spinal Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0026 - Nebulized Drugs: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0028 - Annual Wellness Visit: Excessive Units Automated Professional Services All A/B MACs
0030 - Osteogenesis Stimulators: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
0038 - Visits to Patients in Swing Beds: Incorrect Coding Automated Professional Services All A/B MACs
0039 - Ophthalmology Codes for New Patient: Incorrect Coding Automated Physician; Professional Services All A/B MACs
0042-Evaluation and Management Services for Office or Other Outpatient Visit Billed for Hospital Inpatients: Incorrect Coding Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
11/19/2024 05:55 PM
Help with File Formats and Plug-Ins