The Five Levels of Appeal
Appeals Request Process
The following information must be included with your request for all appeal levels.
- Name
- Health Insurance Claim number (HICN)
- Dates of service
- Item/service at issue
- Signature
First Level—Redetermination (issued on or after May 1, 2005)
The first level of appeal is carried out by the fiscal intermediary/carrier.
- Time limit to initiate = 120 days from the date of the initial determination
- Time limit to complete the review = 60 days
- Amount in controversy—no minimum amount
Send the completed Centers for Medicare & Medicaid Services (CMS)-20027 form—Medicare Redetermination Request—to the appropriate contact
Second Level—Reconsideration
Please use the form included with the redetermination decision when sending the reconsideration appeal request.
The second level of appeal is carried out by the qualified independent contractor (QIC).
- Time limit to initiate = 180 days from the date of the redetermination decision
- Time limit to complete the review = 60 days
- Amount in controversy—no minimum amount
Send the completed CMS 20033 form—Medicare Reconsideration Request—to the appropriate contact .
Third Level—Administrative Law Judge Hearing
The third level of appeal is an administrative law judge (ALJ) hearing.
- Time limit to initiate = 60 days from the date of the QIC decision
- Time limit to complete the review = 90 days
- Amount in controversy = $120 (on or after January 1, 2008)
- Amount in controversy = $110 (Prior to January 1, 2008)
Send the completed CMS 20034A/B form—Request for Medicare Hearing by an ALJ—to the appropriate contact
Office of Medicare Hearings and Appeals  field office addresses.
Fourth Level - Medicare Appeals Council
The fourth level of appeal is carried out by the Medicare appeals council (MAC)
- Time limit to initiate = 60 days from the ALJ decision
- Time limit to complete the review = 90 days
- Amount in controversy—no minimum amount
Send requests for a MAC review to:
Department of Health and Human Services
Departmental Appeals Board, MS 6127
Medicare Appeals Council
330 Independence Avenue, SW
Cohen Building, Room G-644
Washington, DC 20201
Fifth Level—Federal Court Review
The fifth level of appeal is carried out by the Federal District Court
- Time limit to initiate = 60 days from the Medicare appeals council decision
- Amount in controversy = $1,180 (on or after January 1, 2008)
- Amount in controversy = $1,130 (Prior to January 1, 2008)
Send requests for a judicial review to:
Department of Health and Human Services
General Counsel
200 Independence Avenue, SW
Washington, DC 20201
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