Changes to Amount in Controversy (AIC) For Appeals in 2022

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, 2022:

• ALJ hearing will remain the same at $180
• Federal district court will remain the same at $1,760

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

Example
$500 (amount charged) – $0 (Medicare payment made) = $500 (subtotal balance)
$500 (subtotal balance) – $100 (coinsurance) = $400 (balance)
$400 (balance) = $400 (AIC)

Source: https://www.novitas-solutions.com/webcenter/portal/MedicareJL/pagebyid?contentId=00254506