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
0089 - Clinical Social Worker during Inpatient: Unbundling Automated Professional Services All A/B MACs
0016 - Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision Automated DME Physician/DME Supplier All DME MACs
0155-Upper Limb Orthotics within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0123-Technical Component of Diagnostic Procedures during Inpatient: Unbundling Automated Professional Services All A/B MACs
0099-Skilled Nursing Facility Consolidated Billing: Unbundling Automated Outpatient Hospital All A/B MACs
0090 - Laboratory/Pathology Technical Component for Inpatient or Outpatient Hospitals: Unbundling Automated IDTF (Independent Diagnostic Testing Facility); Laboratory; Professional Services All A/B MACs
0061 - Nursing Facility Services: Excessive Units Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
0179-Procedures that Include Imaging: Unbundling Automated Professional Services All A/B MACs
0018 - Spring-Powered Devices: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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