CMS Adds Pain Procedures to RAC and OIG Audits

On May 11, CMS posted a notice indicating its plans to conduct Recovery Audit Contractor (RAC) audits for medical necessity for spinal cord neurostimulator procedures reported with CPT codes 63685, 63650 and 63655. A RAC’s primary task is to review Medicare claims data and supporting medical documentation to determine if a claim was appropriately paid. Each RAC is responsible for identifying overpayments and underpayments in a geographically defined area. More information on the RAC audit process is available here.

In addition, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) recently announced that it would prepare a report to be released in 2022, examining Medicare Part B payments for spinal pain management services. Services under review include facet joint injections, facet joint denervation sessions, lumbar epidural injections and trigger point injections. The OIG will determine if the services billed by physicians complied with Medicare policies.