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 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0021 - Tracheostomy Suction Pumps and Suction Catheters: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0069 - Respiratory Assist Devices: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0106-Parenteral Nutrition: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0135-Cardiac Rehabilitation: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0139-Vertebroplasty or Kyphoplasty: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0064 - Facility Duplicate Claims Automated Inpatient Hospital; Outpatient Hospital; Skilled Nursing Facility (SNF) All A/B MACs
0067-Inpatient Psychiatric Facility Services: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Inpatient Psychiatric Facility (IPF) All A/B MACs
0153-Ambulatory Surgical Center Coding Validation Complex Ambulatory Surgical Center (ASC) All A/B MACs
0205-Next Generation Sequencing: Medical Necessity and Documentation Requirements Complex Laboratory All A/B MACs
0211-Prolonged Service Codes: Unbundling Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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