New Recovery Audit Contractor (RAC) Named
CMS has awarded a new contract for the Region 5 Recovery Audit Contractor (RAC). Region 5 handles RAC services for all DMEPOS claims. The new RAC will be Cotiviti GOV Services LLC. Performant, the RAC previously responsible for reviews in Region 5, remains under contract with CMS to support the RAC Program from an administrative and appeals perspective, while Cotiviti GOV Services LLC will soon start active reviews. Cotiviti GOV Services LLC will begin reviews in the Summer (2025). RAC Region 5 providers can rely on the review completion date specified in the review results letter, as well as the RAC’s name on the letter, to identify which contractor to reach for inquiries. If Performant receives inquiries regarding reviews conducted by Cotiviti GOV Services LLC, Performant customer service will inform providers to reach out to Cotiviti GOV Services LLC and Cotiviti GOV Services LLC will do the same.
Current Items/Services Under a RAC Review as of 06/13/2025
Cervical Orthoses: An automated review to determine if reasonable useful lifetime (RUL) requirements were met. Affected codes include L0112, L0113, L0120, L0130, L0140, L0150, L0160, L0170, L0172, L0174, L0180, L0190, L0200, L0220, L0700, L0710, L0810, L0820, L0830, L1000, L1001, L1005, L1200, L1300, L1310, L1499
Hip Orthoses: An automated review to determine if reasonable useful lifetime (RUL) requirements were met. Affected codes include L1600, L1610, L1620, L1650, L1652, L1660, L1681, L1686, L1690, L1630, L1640, L1680, L1685, L1700, L1710, L1730, L1755
AFO/KAFO: An automated review to determine if reasonable useful lifetime (RUL) requirements were met. Affected codes include L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2006, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L4350, L4360, L4361, L4370, L4386, L4387, L4396, L4397, L4631
Upper Extremity Orthoses: An automated review to determine if reasonable useful lifetime (RUL) requirements were met. Affected codes: L3650, L3660, L3670, L3671, L3674, L3675, L3677, L3678, L3702, L3710, L3720, L3730, L3740, L3760, L3761, L3762, L3763, L3764, L3765, L3766, L3806, L3807, L3808, L3809, L3900, L3901, L3904, L3905, L3906, L3908, L3912, L3913, L3915, L3916, L3917, L3918, L3919, L3921, L3923, L3924, L3929, L3930, L3931, L3956, L3960, L3961, L3962, L3967, L3971, L3973, L3975, L3976, L3977, L3978, L3980, L3981, L3982, L3984, L3995
Diabetic Shoes: A complex review to determine if the item was reasonable and necessary. Affected codes A5500, A5501, A5512, A5513
KO: An automated review to determine if reasonable useful lifetime (RUL) requirements were met Affected codes: L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1850, L1851, L1852, L1860, L2275, L2320, L2330, L2385, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2750, L2755, L2780, L2785, L2795, L2800, L2810, L2820, L2830, K0672
AFO/KAFO: A complex review to determine that services were reasonable and necessary. Affected codes: L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2106, L2108, L2112, L2114, L2116, L4350, L4360, L4361, L4386, L4387, L4631, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2126, L2128, L2132, L2134, L2136, L4370, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830
KO: A complex review to determine if the item was reasonable and necessary. Affected codes: L1810, L1812, L1820, L1830, L1831, L1832, L1833, L1836, L1843, L1845, L1850, L1851, L1852, L2397, L2395, L2810, L2385, L2395
KO: A complex review of off-the-shelf KOs to determine if the item was reasonable and necessary. Affected codes: L1812, L1820, L1830, L1831, L1833, L1836, L1848, L1850, L1851, and L1852
LSO/TLSO: A complex review to determine if Spinal Orthoses meet Medicare coverage criteria and/or is medically reasonable and necessary. Affected Codes: L0452, L0480, L0482, L0484, L0486, L0629, L0632, L0634, L0636, L0638, L0640, A9270, L0456, L0457, L0625, L0627, L0637, L0642, L0648, L0650, L0631, L0635, L0639, L0651
LSO/TLSO: An automated review for Reasonable Useful Lifetime (RUL) limits. Affected Codes: L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0622, L0623, L0624, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0641, L0642, L0643, L0648, L0649, L0650, L0651
Additional Documentation Requests: RAC Audit Limits for O&P
Additional Documentation Requests (ADRs) for specific suppliers categorized under the following supplier taxonomy codes:
52—Medical Supply Company with Prosthetist
53—Medical Supply Company with Orthotist-Prosthetist
56—Individual Certified Prosthetist
57—Individual Certified Prosthetist-Orthotis
51—Medical Supply Company with Orthotist
55—Individual Certified Orthotist
Have a hard limit of no more than 10 ADR requests per 45 days.
More About the RAC Program
Visit the RAC Region 5 Contractor
To find the latest updates, visit CMS’ site about RAC Audits.
The Region 5 RAC statement of work may be found here.