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 153 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0208-Enteral Nutrition Therapy with Dates of Service on/after September 5 2021: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0209-Parenteral Nutrition Therapy with Dates of Service on/after September 5, 2021: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0210 - Hypoglossal Nerve Stimulation for Obstructive Sleep Apnea: Medical Necessity and Documentation Requirements Complex Outpatient Hospital, Ambulatory Surgical Center, Professional Services All A/B MACs
0211-Prolonged Service Codes: Unbundling Automated Professional Services All A/B MACs
0212-Hospice General Inpatient Care: Medical Necessity and Documentation Requirements Complex Hospice J15, J6, JK, JM
0214-Transurethral Waterjet Ablation of the Prostate for Benign Prostatic Hyperplasia (BPH) with Lower Urinary Tract Symptoms (LUTS): Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0215-Canes, Crutches, and Walkers within the Reasonable Useful Lifetime: Excessive Units Automated DME by Supplier; DME by Physician All DME MACs
0216-Wearable Automatic External Defibrillators: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0217-Muscle Flap with Breast Reconstruction or Breast Prosthesis Insertion: Unbundling Complex Professional Services All A/B MACs
0218-Medical Supplies Billed from Consolidated Billing List During a Home Health Episode: Unbundling Automated DME Physician/ DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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