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.

RAC Topic

Showing 141-150 of 151 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
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
0219-Minimally-Invasive Surgical (MIS) Fusion of the Sacroiliac Joint: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services J5, J6, J8, J15, JJ, JK, JM
0220-Hip Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Supplier, DME Physician All DME MACs
0221- Hospice Care- Extended Length of Stay: Medical Necessity and Documentation Requirements Complex Hospice HH/Hospice MACs
0222-Non-Physician Billed Without Correct Assistant at Surgery Modifier: Incorrect Coding Automated Professional Services All A/B MACs
Page Last Modified:
11/19/2024 05:55 PM
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