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 21-30 of 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0211-Prolonged Service Codes: Unbundling Automated Professional Services All A/B MACs
0008 - Bariatric Surgery-Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital All A/B MACs
0086 - Observation Evaluation & Management (E&M) Services Billed Same Day as Inpatient Admission: Unbundling Automated Professional Services All A/B MACs
0169-Outpatient Services within 3 Days Prior to and Including the Date of a Hospital Admission: Unbundling Automated Outpatient Hospital All A/B MACs
0164-Bilateral Indicator '3': Incorrect Coding Automated Professional Services All A/B MACs
0126-Endoscopy Procedures: Diagnostic and Surgical Billed Same Day Automated Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0205-Next Generation Sequencing: Medical Necessity and Documentation Requirements Complex Laboratory All A/B MACs
0072 - Outpatient Service Overlapping or During an Inpatient Stay: Duplicate Payments Automated Outpatient Hospital All A/B MACs
0054 - Ambulance Billed during Inpatient: Unbundling Automated Laboratory/Ambulance All A/B MACs
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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