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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0171-Erythropoiesis Stimulating Agents for Cancer Patients: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services All A/B MACs
0190-Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements Complex SNF All A/B MACs
0165-Positron Emission Tomography for Dementia and Neurodegenerative Diseases: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services All A/B MACs
0027 - Endomyocardial Biopsies and Right Heart Catheterizations that were not Distinct Services Complex Outpatient Hospital; Professional Services All A/B MACs
0134-Cryosurgery of the Prostate: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0204-Vagus Nerve Stimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements Complex Hospice HH/Hospice MACs
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
0198-Deep Brain Stimulation- Inpatient Procedure: Medical Necessity and Documentation Requirements Complex Inpatient All A/B MACs
0140-Pulmonary Rehabilitation: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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