Medicare appeals: the five levels and fast appeals, in Medicare’s words

Original Medicare has five levels of appeal: redetermination by the Medicare Administrative Contractor, reconsideration by a Qualified Independent Contractor, a decision by the Office of Medicare Hearings and Appeals, review by the Medicare Appeals Council, and judicial review in federal district court. CMS says any party to the initial determination, including beneficiaries, providers, and suppliers, has the right to appeal. Medicare.gov also describes fast appeals when covered services are ending, including from home health agencies, skilled nursing facilities, and comprehensive outpatient rehabilitation facilities. Deadlines are quoted as each page states them.

Quoted from official pages checked November 10, 2026. Confirm current requirements, fees, and dates on those sites. This page is not legal advice and does not guarantee eligibility, certification, or licensure.

Sources read on November 10, 2026: Medicare.gov’s Appeals, Appeals in Original Medicare, and Fast appeals pages, written for people with Medicare; and CMS’s Original Medicare (Fee-for-service) Appeals page (page last modified August 25, 2026) and First Level of Appeal page (page last modified March 10, 2026). Medicare.gov states a minimum dollar amount for some levels each year; those amounts are not copied here. Medicare Advantage and drug plan appeals follow the plan’s own rules and are not covered.

Who can appeal

CMS’s overview states: “Once an initial claim determination is made, any party to that initial determination, such as beneficiaries, providers, and suppliers – or their respective appointed representatives – has the right to appeal the Medicare coverage and payment decision.” It states: “There are five levels in the Medicare Part A and Part B appeals process.”

Medicare.gov’s appeals page tells people with Medicare they can file an appeal if Medicare or their plan refuses to “Cover a health care service, supply, item, or drug you think Medicare should cover.” Or to “Pay for a health care service, supply, item, or drug you already got.” It states: “If you’re in a Medicare Advantage plan, other health plan, or a drug plan, check your plan materials, or contact your plan, for details about your appeal rights.”

Level 1: redetermination

Medicare.gov states: “You must file your appeal by the date in the MSN.” CMS’s first-level page states: “The appellant (the individual filing the appeal) has 120 days from the date of receipt of the initial claim determination to file a redetermination request.” It adds: “The notice of initial determination is presumed to be received 5 calendar days after the date of the notice, unless there is evidence to the contrary.” Both are quoted as read and are not reconciled here.

CMS states: “A redetermination must be requested in writing.” And: “A minimum monetary threshold on the claim is not required to request a redetermination.” Medicare.gov states: “You’ll generally get a decision from the Medicare Administrative Contractor (MAC) within 60 days after they get your appeal.” On late filing, it states: “If you miss the deadline for appealing, you may still file an appeal and get a decision if you can show good cause for missing the deadline”.

Levels 2 to 5

Level 2, reconsideration by a Qualified Independent Contractor (QIC): Medicare.gov states: “You have 180 days after you get the MAC’s decision letter or an MSN to ask for a level 2 appeal”. It also states: “The QIC will send you a decision within 60 days after the QIC gets your appeal request.”
Level 3, Office of Medicare Hearings and Appeals (OMHA): “If you’re dissatisfied with the QIC’s decision, you have 60 days from the date of the QIC’s decision to ask for a level 3 appeal.” Medicare.gov says a case at this level must meet a minimum dollar amount, which it states for each year.
Level 4, Medicare Appeals Council: “You have 60 days after you get the decision to move to appeals level 4, by asking for a review by the Medicare Appeals Council (Appeals Council).”
Level 5, federal district court: “You have 60 days after you get the Appeals Council’s decision to ask for judicial review by a federal district court.” A minimum dollar amount also applies, as Medicare.gov states it.

Medicare.gov states: “At each level you'll get a decision letter with instructions on how to move to the next level.”

Fast appeals when services are ending

Medicare.gov’s fast appeals page states: “You may have the right to ask for a fast appeal if you think your services are ending too soon (or that you’re being discharged too soon) from one of these providers:” Its list is hospital, skilled nursing facility (SNF), home health agency (HHA), comprehensive outpatient rehabilitation facility (CORF), and hospice care facility. It states: “Your provider will give you a notice telling you how to ask for a fast appeal.” And: “With a fast appeal, an independent reviewer, called a Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO), will decide if your covered services should continue.”

Where the ABN fits

On the ABN, Option 1 reads in part: “I understand that if Medicare doesn’t pay, I’m responsible to pay, but I can appeal to Medicare by following the directions on the MSN.” Option 2 reads in part: “I understand I can’t appeal, since Medicare isn’t billed.” See the Medicare ABN.

What this page does not do

It copies no dollar amounts, it does not decide any claim or appeal, and it does not cover Medicare Advantage, Part D, or Medicaid appeals. It is not legal, billing, or compliance advice. Confirm current rules with the agency that publishes them, your employer, and your state board.