Review by a Federal District Court

If the Medicare Appeals Council (Appeals Council) issues an adverse decision or denies a request to review an Office of Medicare Hearings and Appeals Administrative Law Judge's (ALJ's) or attorney adjudicator's decision, the enrollee or the enrollee's representative may request a review by a Federal District Court.

An enrollee's prescriber may not request a Federal District Court review on an enrollee's behalf unless the prescriber is also the enrollee's representative.

For more information about appointing a representative, see section 20 in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, in the "Downloads" section below.

How to Request a Review by a Federal District Court

All requests must be made in writing and must be filed with the proper Federal District Court within 60 calendar days from the date of the Appeals Council's decision notice.  The enrollee may request judicial review of an ALJ's or attorney adjudicator's decision if the Appeals Council denied the request for review.  In all instances, the amount remaining in controversy (AIC) must meet the threshold requirement.  This amount is recalculated each year and may change. For calendar year 2019, the amount in controversy is $1,630. For calendar year 2020, the amount in controversy rises to $1,670.  To view the Federal Register AIC notices, see the "Related Links" section below.  If the Appeals Council's decision is unfavorable, or request for Appeals Council review was denied, the decision notice will contain the information needed to file a request for review by a Federal District Court.

For more information about how the amount remaining in controversy is computed, see section 70.2 in the Parts C & D Enrollee Grievances, Organization/Coverage Determinations, and Appeals Guidance, in the "Downloads" section below.

For a description of the procedures an appellant must follow in requesting judicial review, see Title 42, Part 423, sections 2130 through 2140 of the Code of Federal Regulations (CFR).  Click on the links in the "Related Links" section below.

Page Last Modified:
10/16/2019 11:44 AM