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 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0016 - Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision Automated DME Physician/DME Supplier All DME MACs
0018 - Spring-Powered Devices: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0019 - Durable Medical Equipment Billed while Inpatient: Unbundling Automated DME Physician/DME Supplier All DME MACs
0020 - Patient Lifts: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0021 - Tracheostomy Suction Pumps and Suction Catheters: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0022 - Inpatient Psychiatric Admission Billed without Source of Admission Equal to "D" Automated Inpatient Hospital; Inpatient Psychiatric Facility (IPF) All A/B MACs
0023 - High Frequency Chest Wall Oscillation Devices: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0024 - Spinal Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0026 - Nebulized Drugs: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0027 - Endomyocardial Biopsies and Right Heart Catheterizations that were not Distinct Services Complex Outpatient Hospital; Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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