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
0184-Total Hip Arthroplasty: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital; Professional Services J6, JE, JF, JH, JJ, JK, JL, JM, JN
0131-Pneumatic Compression Device: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0094 - Group 3 Pressure-Reducing Support Surfaces: 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
0158-Outpatient Therapy Services During Home Health: Unbundling Automated Outpatient Hospital; Outpatient Rehabilitation Facility (ORF); Skilled Nursing Facility (SNF)- Outpatient All A/B MACs
0190-Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements Complex SNF All A/B MACs
0166-Setup and Transportation Component by Portable Suppliers for Electrocardiogram Services: Unbundling Automated Professional Services All A/B MACs
0101- Ambulatory Payment Classification Coding Validation Complex Outpatient Hospital All A/B MACs
0049 - Ambulance Transfer between Skilled Nursing Facilities: Unbundling Automated Laboratory/Ambulance All A/B MACs
0039 - Ophthalmology Codes for New Patient: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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