Approved RAC Topics

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 1-10 of 153 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 J6, J15, JE, JF, JH, JJ, JK, JL, JM, JN
0003 - Sacral Neurostimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Outpatient Hospital; Professional Services Urinary incontinence- All A/B MACs Fecal incontinence- JE, JF, JH, JL, JN, J15
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 When Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
0015 - Enteral Nutrition Therapy: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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