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
0011 - Inappropriate Billing of Home Visit Professional Service Evaluation and Management Codes During Hospital Inpatient Stay Automated Professional Services All A/B MACs
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
0016 - Continuous Passive Motion Billed without Total Knee Replacement or Total Knee Revision Automated DME Physician/DME Supplier All DME MACs
0003 - Sacral Neurostimulation: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Outpatient Hospital; Professional Services Urinary incontinence- All A/B MACs Fecal incontinence- JE, JF, JH, JL, JN, J15
0037 - Hospital Services: Excessive Units Automated Professional Services All A/B MACs
0047 - Panretinal (Scatter ) Laser Photocoagulation: Excessive Frequency Automated Outpatient Hospital; Professional Services J6, JK, J15
0038 - Visits to Patients in Swing Beds: Incorrect Coding Automated Professional Services All A/B MACs
0039 - Ophthalmology Codes for New Patient: Incorrect Coding Automated Professional Services All A/B MACs
0042-Evaluation and Management Services for Office or Other Outpatient Visit Billed for Hospital Inpatients: Incorrect Coding Automated Professional Services All A/B MACs
0043 - New Patient Visits: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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