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 141-150 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements Complex Hospice HH/Hospice MACs
0212-Hospice General Inpatient Care: Medical Necessity and Documentation Requirements Complex Hospice J15, J6, JK, JM
0186-Duplex Scans of Extracranial Arteries: Medical Necessity and Documentation Requirements Complex Outpatient Hospital J5, J6, J8, J15, JH, JK, JL, JN (JE, JF, JJ, JM are excluded)
0219-Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac Joint: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services J5, J6, J8, J15, JJ, JK, JM
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
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
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0119-Transforaminal Epidural Steroid Injection: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JE, JF, JH, JL
0143-Vitamin D Assay Testing: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance JE/JF
0010 - Cardiac Positron Emission Tomography Scans: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JN
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09/06/2023 05:05 PM
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