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
0184-Total Hip Arthroplasty: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital; Professional Services J6, JE, JF, JH, JJ, JK, JL, JM, JN
0131-Pneumatic Compression Device: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0094 - Group 3 Pressure-Reducing Support Surfaces: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0147-Magnetic Resonance Imaging Procedures: Excessive Units Automated Outpatient Hospital; Professional Services All A/B MACs
0134-Cryosurgery of the Prostate: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0202- Skilled Nursing Facility (SNF) Consolidated Billing for Ambulance Transports: Unbundling Automated Ambulance All A/B MACs
0051 - Global versus Technical Component/Professional Component Reimbursements: Unbundling Automated Laboratory/Ambulance; Professional Services All A/B MACs
0062 - Radiology: Technical Component during Inpatient Stay Automated Professional Services All A/B MACs
0056 - Evaluation and Management Services in Skilled Nursing Facilities: Incorrect Coding Automated Professional Services All A/B MACs
0100-Add-on Code Paid without Primary Code and/or Denied Primary Code- Clinical Laboratory Automated Laboratory/Ambulance All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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