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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0110-Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component Automated Professional Services All A/B MACs
0147-Magnetic Resonance Imaging Procedures: Excessive Units Automated Outpatient Hospital; Professional Services All A/B MACs
0051 - Global versus Technical Component/Professional Component Reimbursements: Unbundling Automated Laboratory/Ambulance; Professional Services All A/B MACs
0099-Skilled Nursing Facility Consolidated Billing: Unbundling Automated Outpatient Hospital All A/B MACs
0062 - Radiology: Technical Component during Inpatient Stay Automated Professional Services All A/B MACs
0014 - Glucose Monitor Supplies When Billed With Same Dates of Service as Glucose Monitor: Unbundling Automated DME Physician/DME Supplier All DME MACs
0149-Subsequent Hospital Visit and Discharge Day Management on the Same Day: Unbundling Automated Professional Services All A/B MACs
0167-Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0016 - Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision Automated DME Physician/DME Supplier All DME MACs
0155-Upper Limb Orthotics within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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