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 150 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0014 - Glucose Monitor Supplies Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
0030 - Osteogenesis Stimulators: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0114-Durable Medical Equipment Billed during Hospice Period: Unbundling Automated DME Physician, DME Supplier All DME MACs
0151-Physician/Non-physician Practitioner Coding Validation Complex Professional Services All A/B MACs
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JN
0217-Muscle Flap with Breast Reconstruction or Breast Prosthesis Insertion: Unbundling Complex Professional Services All A/B MACs
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital All A/B MACs
0166-Setup and Transportation Component by Portable Suppliers for Electrocardiogram Services: Unbundling Automated Professional Services All A/B MACs
0198-Deep Brain Stimulation- Inpatient Procedure: Medical Necessity and Documentation Requirements Complex Inpatient All A/B MACs
0110-Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component Automated Professional Services All A/B MACs
Page Last Modified:
09/10/2024 06:11 PM
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