How Much Does a Denial Have to Be Worth to Reach a Judge?

CMS published the CY2027 appeal thresholds this morning: $200 to reach an ALJ, and judicial review crossing $2,000 for the first time. The $200 has not moved in two years, and the regulation under it computes that number six different ways depending on what you are appealing. Which one applies decides whether 97 percent of your Part B volume can be appealed at all.

A two-page notice went into the Federal Register this morning and set the price of admission to a Medicare judge for all of next year.

Two hundred dollars.

CMS-4213-N is the annual amount-in-controversy adjustment, and it is close to the least-read recurring document the agency publishes. It runs the same statutory arithmetic every autumn, prints a five-year table, and gets filed. This edition holds the ALJ threshold at $200 for a second straight year and pushes judicial review from $1,960 to $2,000, the first time in the twenty-three years this table has existed that the number has started with a two.

Neither figure is interesting by itself. What makes the notice worth twenty minutes is the regulation underneath it, which computes "the amount remaining in controversy" six different ways depending on what you are appealing, and one of those ways quietly decides whether most of what you bill can reach level three at all.

"Two hundred dollars of what, exactly?"

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