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 71-80 of 152 entries
Issue Name Review Type Provider Type MAC Jurisdiction Date Approved
0114-Durable Medical Equipment Billed during Hospice Period: Unbundling Automated DME Physician, DME Supplier All DME MACs
0115-Physician Claims with Place of Service Home Overlapping Inpatient Hospital Stay: Services Billed Not Rendered Automated Professional Services All A/B MACs
0116-Modifiers TC and 26: Incorrect Coding Automated Professional Services All A/B MACs
0119-Transforaminal Epidural Steroid Injection: Medical Necessity and Documentation Requirements Complex Outpatient Hospital; Professional Services JE, JF, JH, JL
0123-Technical Component of Diagnostic Procedures during Inpatient: Unbundling Automated Professional Services All A/B MACs
0124-Part B Therapies During Inpatient: Unbundling Automated Professional Services All A/B MACs
0126-Endoscopy Procedures: Diagnostic and Surgical Billed Same Day Automated Ambulatory Surgical Center (ASC); Outpatient Hospital; Professional Services All A/B MACs
0128-Spinal Orthoses within the Reasonable Useful Lifetime: Excessive Units Automated DME Physician/DME Supplier All DME MACs
0129-Hyperbaric Oxygen Therapy for Diabetic Wounds: Medical Necessity and Documentation Requirements Complex Outpatient Hospital All A/B MACs
0130-Panniculectomy: Medical Necessity and Documentation Requirements Complex Ambulatory Surgical Center (ASC); Inpatient Hospital; Professional Services All A/B MACs
Page Last Modified:
09/06/2023 05:05 PM
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