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Proposed RAC Topics

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Issue Name Review Type Claim Type Region and State Date Posted
2A158-Cryosurgery of the Prostate Medical Necessity Complex Outpatient Hospital, Ambulatory Surgical Center, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A150-Evaluation and Management (E&M) Same Day as Admission to a Nursing Facility Automated Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A155-PET Scans Paid without Tracer Codes for IDTF (Independent Diagnostic Testing Facility) Automated Independent Diagnostic Testing Facility RAC 1-4
All A/B MACs
12/4/2018
2A161-Complex Medical Necessity Vertebroplasty and Kyphoplasty (Vetebral Augmentation) Complex Outpatient Hospital, Ambulatory Surgical Ceter, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
0A174-Complex Chest X-Ray Complex Outpatient Hospital JE, JF 12/4/2018
0A179-IV Hydration Administration Complex Outpatient Hospital JE 12/4/2018
5A149-Pneumatic Compression Device Complex DME by Supplier, DME by Provider RAC 5
DME (A,B,C,D)
12/4/2018
2A159-Cardiac Rehabilitation Complex Outpatient Hospital JM 12/4/2018
2A094-Hyperbaric Oxygen Therapy (HBOT) for Diabetic Wounds Complex Outpatient Hospital RAC 1-4
All States
12/4/2018
4A157-SNF-Consolidated Billing for Therapies Automated Physician/Non-Physician Practitioner, Physical Therapist, Occupational Therapist, Speech Language Pathologist RAC 1-4
All States
12/4/2018
2A147-Medical Necessity Panniculectomy Complex Outpatient Hospital, Ambulatory Surgical Center, Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A139-Initial Observation Services Billed for Subsequent Observation Days Automated Physician/Non-Physician Practitioner RAC 1-4
All A/B MACs
12/4/2018
4A156-Excessive Units of Subsequent Hospital and Nursing Care Facility (Telehealth) Automated Physician/Non-Physician Services RAC 1-4
All MACs
12/04/2018
5A183-Off-the-Shelf-Knee Orthosis Complex DME by Supplier/DME by Physician RAC 5
All DME
02/05/2019
4A173-ASC Services During a Covered Part A SNF Stay Automated Ambulatory Surgical Center, SNF RAC 1-4
All States
02/05/2019
2A095-ERFA and EVLT for LE Varicose Veins Complex OPH, ASC, and Physician/NPP First Coast, NGS, Novitas, Palmetto, WPS, CGS, and Noridian 02/05/2019
5A170-Therapeutic Shoes and Inserts for Persons with Diabetes Complex DME by Supplier, DME by Physician A,B,C and D 02/05/2019
4A151-Unbundling of CT Scans Automated Professional Services (Physician/Non-physician Practitioner) and Outpatient Hospital All 2/5/2019
4A165-Unbundling of MRI Procedures Automated Professional Services (Physician/Non-physician Practitioner), Outpatient Hospital All 2/5/2019
4A167-Mohs Surgery Pathology Billed by Separate Provider Automated Professional Services All 2/5/2019
2A160-Pulmonary Rehabilitation Complex Outpatient Hospital All 2/5/2019
0A175-Non-Emergent Basic Life Support (BLS) Ambulance Services & Associated Ground Mileage (A0425, A0428) Complex Ambulance Providers and Suppliers All 02/05/2019
0A178- Vitamin D Assay Testing (83206,83652) Complex Outpatient Hospital JE 02/05/2019
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