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October 26, 2015

Updated 2016 Amount in Controversy (AIC) for Administrative Law Judge Hearings or Federal District Court Appeals

The Centers for Medicare & Medicaid Services (CMS) has notified Medicare contractors of the update to the Amount in Controversy (AIC) required to sustain Administrative Law Judge (ALJ) or Federal District Court appeal rights beginning January 1, 2016.

  • The amount remaining in controversy requirement for ALJ hearing requests made on or before December 31, 2015, is $150. This amount will remain at $150 for ALJ hearing requests filed on or after January 1, 2016.
  • The amount that must remain in controversy for Federal District Court review requests filed on or before December 31, 2015 is $1,460. This amount will increase to $1,500 for appeals to Federal District Court filed on or after January 1, 2016.

Please ensure that your staff is aware of these changes.

For additional information about appeals, refer to the Medicare Appeals Process factsheet, which provides an overview of the Medicare Part A and Part B administrative appeals process available to providers, physicians and other suppliers who provide services and supplies to Medicare beneficiaries, as well as details on where to obtain more information about this appeals process. The factsheet is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedicareAppealsProcess.pdfExternal PDF on the CMS Web site.

If you have any questions, please contact a CGS Customer Service Representative by calling the CGS Provider Contact Center at 1.866.276.9558 and choose Option 1.

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