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 101-110 of 152 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0154-Non-Emergency Ambulance Services- Advanced Life Support and Basic Life Support: Medical Necessity and Documentation Requirements Complex Laboratory/Ambulance All A/B MACs
0155-Upper Limb Orthotics within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/ DME Supplier All DME MACs
0157-Discontinued Procedure Prior to the Administration of Anesthesia: Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital All A/B MACs
0158-Outpatient Therapy Services During Home Health: Unbundling Automated Outpatient Hospital; Outpatient Rehabilitation Facility (ORF); Skilled Nursing Facility (SNF)- Outpatient All A/B MACs
0160-Intravenous Immune Globulin for the Treatment of Autoimmune Blistering Diseases: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0161-Therapeutic, Prophylactic, and Diagnostic Infusions: Incorrect Coding and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0164-Bilateral Indicator '3': Incorrect Coding Automated Professional Services All A/B MACs
0165-Positron Emission Tomography for Dementia and Neurodegenerative Diseases: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services All A/B MACs
0166-Setup and Transportation Component by Portable Suppliers for Electrocardiogram Services: 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
Page Last Modified:
09/06/2023 05:05 PM
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