Fifth Level of Appeal: Judicial Review in Federal District Court

Any party to the Medicare Appeals Council (Appeals Council) decision or an appellant who requests escalation to Federal district court if the Appeals Council does not complete its review of an administrative law judge's (ALJ's) decision within the applicable adjudication period, may seek Federal court review if the amount remaining in controversy (AIC) satisfies the requirements set forth in 42 CFR §405.1006(c).  A link to this section of the regulation is provided below in "Related Links".  

The AIC is recalculated each year and may change.  For 2012, the AIC threshold is $1,350.  For 2013, the AIC threshold is $1,400.  The appellant must request a Federal District Court hearing within 60 days of receipt of the Medicare Appeals Council's decision.  To view the AIC Federal Register notices, see the "Related Links" section below.

Filing a Request for Judicial Review

The Medicare Appeals Council's decision will contain information about the procedures for requesting judicial review.

Please note that the amount in controversy required to request a judicial review is increased annually by the percentage increase in the medical care component of the consumer price index for all urban consumers.