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
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
0164-Bilateral Indicator '3': Incorrect Coding Automated Professional Services All A/B MACs
0126-Endoscopy Procedures: Diagnostic and Surgical Billed Same Day Automated Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0072 - Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments Automated Outpatient Hospital All A/B 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
0054 - Ambulance Billed during Inpatient: Unbundling Automated Laboratory/Ambulance All A/B MACs
0028 - Annual Wellness Visit: Excessive Units Automated Professional Services All A/B MACs
0153-Ambulatory Surgical Center Coding Validation Complex Ambulatory Surgical Center (ASC) All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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