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 51-60 of 152 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0088 - Ancillary Services Billed Without an Approved Surgical Procedure Automated Ambulatory Surgery Center (ASC) All A/B MACs
0089 - Clinical Social Worker during Inpatient: Unbundling Automated Professional Services All A/B MACs
0090 - Laboratory/Pathology Technical Component for Inpatient or Outpatient Hospitals: Unbundling Automated IDTF (Independent Diagnostic Testing Facility); Laboratory; Professional Services All A/B MACs
0091 - Duplicate Claims- Professional Services Automated Professional Services All A/B MACs
0092 - Percutaneous Implantation of Neurostimulator Electrode Array: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0093 - Implantable Automatic Defibrillators- Outpatient Procedure: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Outpatient Hospital All A/B MACs
0094 - Group 3 Pressure-Reducing Support Surfaces: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0095-Facet Joint Interventions: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0098-Critical Care Professional Services: Unbundling Automated Professional Services All A/B MACs
0099-Skilled Nursing Facility Consolidated Billing: Unbundling Automated Outpatient Hospital All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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