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
0183-Specialty Care Transport: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0200-Air Ambulance: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0202- Skilled Nursing Facility (SNF) Consolidated Billing for Ambulance Transports: Unbundling Automated Ambulance All A/B MACs
0088 - Ancillary Services Billed Without an Approved Surgical Procedure Automated Ambulatory Surgery Center (ASC) All A/B MACs
0104-Add-on Code Paid without Primary Code and/or Denied Primary Code- Ambulatory Surgical Center Automated Ambulatory Surgical Center (ASC) All A/B MACs
0153-Ambulatory Surgical Center Coding Validation Complex Ambulatory Surgical Center (ASC) All A/B MACs
0003 - Sacral Neurostimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Outpatient Hospital; Professional Services Urinary incontinence- All A/B MACs Fecal incontinence- JE, JF, JH, JL, JN, J15
0157-Discontinued Procedure Prior to the Administration of Anesthesia: Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital All A/B MACs
0002 - Cataract Removal: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital J6, J15, JE, JF, JH, JJ, JK, JL, JM, JN
0093 - Implantable Automatic Defibrillators- Outpatient Procedure: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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