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 111-120 of 150 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0171-Erythropoiesis Stimulating Agents for Cancer Patients: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services All A/B MACs
0173-Surgical Dressings: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0174-Cervical Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier DME MACs
0176-Annual Wellness Visit: Incorrect Coding Complex Professional Services All A/B MACs
0177-Hospital Beds: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0178-Manual Wheelchairs: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0179-Procedures that Include Imaging: Unbundling Automated Professional Services All A/B MACs
0182-Reduction of Technical Component, Diagnostic Cardiovascular Services Automated Professional Services All A/B MACs
0183-Specialty Care Transport: Medical Necessity and Documentation Requirements Complex Ambulance All A/B MACs
0184-Total Hip Arthroplasty: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital; Professional Services J6, JE, JF, JH, JJ, JK, JL, JM, JN
Page Last Modified:
09/10/2024 06:11 PM
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