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 21-30 of 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0028 - Annual Wellness Visit: Excessive Units Automated Professional Services All A/B MACs
0030 - Osteogenesis Stimulators: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
0038 - Visits to Patients in Swing Beds: Incorrect Coding Automated Professional Services All A/B MACs
0039 - Ophthalmology Codes for New Patient: Incorrect Coding Automated Professional Services All A/B MACs
0042-Evaluation and Management Services for Office or Other Outpatient Visit Billed for Hospital Inpatients: Incorrect Coding Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
0046 - Durable Medical Equipment Rentals- Multiple Billing within the Same Month Automated DME Physician/ DME Supplier All DME MACs
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0049 - Ambulance Transfer between Skilled Nursing Facilities: Unbundling Automated Laboratory/Ambulance All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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