Changes to Amount in Controversy Announced for Appeals in 2025

Novitas Solutions has announced that there are changes to the Amount in Controversy (AIC) for appeals filed on or after January 1, 2025. The AIC requires the claims value in dispute to meet the threshold for obtaining an Administrative Law Judge (ALJ) hearing and a judicial review in federal district court. The AIC is recalculated and published on an annual basis and is identified in a provider’s appeal notice of decision.

The AIC for appeals filed on or after January 1, 2025:

• ALJ hearing will increase to $190.
• Federal district court will increase to $1900.

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 = AIC

Novitas Solutions is the Medicare Administrative Contractor (MAC) for Jurisdiction JL, which includes DC, DE, MD, NJ, and PA.