Changes to Amount in Controversy (AIC) for Appeals in 2019

The claims value in dispute must meet the threshold for obtaining an Administrative Law Judge (ALJ) hearing and a judicial review in Federal District Court. This is called the “amount in controversy.” The amount in controversy is recalculated and published on an annual basis, and is identified in your appeal notice of decision.

The AIC for appeals filed on or after January 1, 2019:

ALJ hearing will remain at $160

Federal District Court will increase from $1,600 to $1,630

The amount in controversy is calculated in the following manner:

Amount Charged minus Medicare payments already made or awarded = Subtotal Balance

Subtotal Balance minus any applicable Deductible/Coinsurance = Amount in Controversy


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