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
0191- Polysomnography: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0026 - Nebulized Drugs: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0088 - Ancillary Services Billed Without an Approved Surgical Procedure Automated Ambulatory Surgery Center (ASC) All A/B MACs
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
0173-Surgical Dressings: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0054 - Ambulance Billed during Inpatient: Unbundling Automated Laboratory/Ambulance All A/B MACs
0154-Non-Emergency Ambulance Services- Advanced Life Support and Basic Life Support: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance All A/B MACs
0161-Therapeutic, Prophylactic, and Diagnostic Infusions: Incorrect Coding and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0130-Panniculectomy: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Professional Services All A/B 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
Page Last Modified:
09/10/2024 06:11 PM
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