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 61-70 of 152 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0100-Add-on Code Paid without Primary Code and/or Denied Primary Code- Clinical Laboratory Automated Laboratory/Ambulance All A/B MACs
0101- Ambulatory Payment Classification Coding Validation Complex Outpatient Hospital All A/B MACs
0103-Urological Supplies: Medical Necessity and Documentation Requirements Complex DME Physician/DME Supplier All DME MACs
0104-Add-on Code Paid without Primary Code and/or Denied Primary Code- Ambulatory Surgical Center Automated Ambulatory Surgical Center (ASC) All A/B MACs
0107-Custom Fabricated Knee Orthoses: Medical Necessity and Documentation Requirements Complex DME Physician/ DME Supplier All DME MACs
0108-Facility versus Non-Facility Reimbursement: Incorrect Coding Automated Professional Services All A/B MACs
0109-Skilled Nursing Facility (SNF) Consolidated Billing Part B (Full) Automated Laboratory/Ambulance; Professional Services All A/B MACs
0110-Skilled Nursing Facility Consolidated Billing: Part B – Use of Modifier 26, Professional Component Automated Professional Services All A/B MACs
0111-Transthoracic Echocardiography: Medical Necessity and Documentation Requirements Complex Inpatient Hospital; Outpatient Hospital; Skilled Nursing Facility (SNF) All A/B MACs
0112-Monthly Capitation Payment for End-stage Renal Disease: 4 or More Visits per Month Automated Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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