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 11-20 of 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
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
0161-Therapeutic, Prophylactic, and Diagnostic Infusions: Incorrect Coding and Documentation Requirements Complex Outpatient Hospital 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
0154-Non-Emergency Ambulance Services- Advanced Life Support and Basic Life Support: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance All A/B MACs
0098-Critical Care Professional Services: Unbundling Automated Professional Services 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
0110-Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component Automated Professional Services All A/B MACs
0138-Skilled Nursing Facility Consolidated Billing for Therapies: Unbundling Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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