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 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0027 - Endomyocardial Biopsies and Right Heart Catheterizations that were not Distinct Services Complex Outpatient Hospital; Professional Services All A/B MACs
0046 - Durable Medical Equipment Rentals- Multiple Billing within the Same Month Automated DME Physician/ DME Supplier All DME MACs
0028 - Annual Wellness Visit: Excessive Units Automated Professional Services All A/B MACs
0050-Add-on Codes Paid without Primary Code and/or Denied Primary Code Automated Outpatient/Professional Services All A/B MACs
0026 - Nebulized Drugs: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0051 - Global versus Technical Component/Professional Component Reimbursements: Unbundling Automated Laboratory/Ambulance; Professional Services All A/B MACs
0012 - Blood Glucose Monitors with Integrated Voice Synthesizer: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0020 - Patient Lifts: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0054 - Ambulance Billed during Inpatient: Unbundling Automated Laboratory/Ambulance All A/B MACs
0013 - Ankle-Foot Orthoses and Knee-Ankle-Foot Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
Page Last Modified:
09/06/2023 05:05 PM
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