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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0196-Deep Brain Stimulation- Outpatient Procedure: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services All A/B MACs
0195-Implantable Automatic Defibrillators- Inpatient Procedure: Medical Necessity and Documentation Requirements Complex Inpatient Hospital All A/B MACs
0192-Ventricular Assist Device: Medical Necessity and Documentation Requirements Complex Inpatient Hospital All A/B MACs
0191- Polysomnography: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0190-Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements Complex SNF All A/B MACs
0189-Continuous Glucose Monitor: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0187-Nerve Conduction Studies: Excessive Units Complex Outpatient Hospital All A/B MACs
0186-Duplex Scans of Extracranial Arteries: Medical Necessity and Documentation Requirements Complex Outpatient Hospital J5, J6, J8, J15, JH, JK, JL, JN (JE, JF, JJ, JM are excluded)
0185-Total Knee Arthroplasty: Medical Necessity and Documentation Requirements Complex Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Professional Services J6, JE, JF, JH, JJ, JK, JL, JM, JN
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
Page Last Modified:
09/06/2023 05:05 PM
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