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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JN
0151-Physician/Non-physician Practitioner Coding Validation Complex Professional Services All A/B MACs
0187-Nerve Conduction Studies: Excessive Units Complex Outpatient Hospital All A/B MACs
0144-Prefabricated Knee Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital All A/B MACs
0173-Surgical Dressings: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0189-Continuous Glucose Monitor: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0209-Parenteral Nutrition Therapy with Dates of Service on/after September 5, 2021: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0092 - Percutaneous Implantation of Neurostimulator Electrode Array: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0139-Vertebroplasty or Kyphoplasty: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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