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 121-130 of 152 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
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
0185-Total Knee Arthroplasty: Medical Necessity and Documentation Requirements Complex Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center, Professional Services J6, JE, JF, JH, JJ, JK, JL, JM, JN
0186-Duplex Scans of Extracranial Arteries: Medical Necessity and Documentation Requirements Complex Outpatient Hospital J5, J6, J8, J15, JH, JK, JL, JN (JE, JF, JJ, JM are excluded)
0187-Nerve Conduction Studies: Excessive Units Complex Outpatient Hospital All A/B MACs
0189-Continuous Glucose Monitor: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0190-Skilled Nursing Facility with Patient-Driven Payment Model: Medical Necessity and Documentation Requirements Complex SNF All A/B MACs
0191- Polysomnography: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0192-Ventricular Assist Device: Medical Necessity and Documentation Requirements Complex Inpatient Hospital All A/B MACs
0195-Implantable Automatic Defibrillators- Inpatient Procedure: Medical Necessity and Documentation Requirements Complex Inpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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