Amount in controversy thresholds climbing in 2025

Effective Oct 25, 2024

Published Oct 25, 2024

Last Reviewed Oct 28, 2024

CMS is updating the dollar amount in controversy required to sustain appeal rights for an Administrative Law Judge (ALJ) hearing or Federal District Court review in 2025.

In order to request a hearing by an ALJ, the amount remaining in controversy must meet the threshold requirement. That amount is $180 in 2024 and will climb to $190 next year. That is the first increase since 2021.

If the appeal is escalated to the Federal District Court for review, the amount in controversy must be at least $1,840 in 2024. That amount will increase to $1,900 for appeals in 2025.

See more on the appeals process at https://www.cms.gov/medicare/appeals-grievances/fee-for-service/third-level-appeal.

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