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 11-20 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0210 - Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B 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
0208-Enteral Nutrition Therapy with Dates of Service on/after September 5 2021: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0206-Positron Emission Tomography (PET) for Initial Treatment Strategy in Oncologic Conditions: Medical Necessity and Documentation Requirements Complex Hospital Outpatient; Professional Services All A/B MACs
0205-Next Generation Sequencing: Medical Necessity and Documentation Requirements Complex Laboratory All A/B MACs
0204-Vagus Nerve Stimulation: 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
0201-Hospice Continuous Home Care: Medical Necessity and Documentation Requirements Complex Hospice All HHH MACs
0200-Air Ambulance: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0198-Deep Brain Stimulation- Inpatient Procedure: Medical Necessity and Documentation Requirements Complex Inpatient All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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