Changes to the Amount in Controversy Thresholds for Medicare Appeals

Beginning on or after January 1, 2020, the amount in controversy needed by Medicare providers will change as follows:

  • $170 for Administrative Law Judge (ALJ) hearings. (2019 – $160)
  • $1,670 for judicial review (2019 – $1,630)

The Center for Medicare and Medicaid Services (CMS) every year announces annual adjustments to the amount in controversy threshold needed for ALJ hearings and judicial review under the Medicare Appeals process.

Should your company or provider group require additional assistance with filing an appeal (redetermination, reconsideration, ALJ, DAB, etc..) kindly contact Mr. Rafael (Ralph) Gaitan, Esq. for additional information at [email protected] or at (786) 440-8115.