Updated October 19, 2026. Quick answer: Form CMS-20027 is the Medicare Redetermination Request Form, the first level of appeal for Original Medicare claims. The regulation sets a 120 calendar day limit from the date you receive the initial determination, and receipt is presumed to be 5 calendar days after the date on the notice, so the practical deadline is 125 days after the notice date. Send a copy of the notice with the request.
Quick reference
| Item | As printed on the form or stated in the regulation |
|---|---|
| What the form is | Request for a redetermination, the 1st level of Medicare appeal |
| Deadline | 120 days from the date you receive the initial determination (calendar days) |
| Receipt presumed | 5 days after the date of the notice (calendar days) |
| Counted from the notice date | 125 days (120 plus 5, calendar days) |
| Attach | A copy of the initial determination notice, plus your evidence |
| Late filing | State your reason on the form; the contractor may extend for good cause |
| Who may appeal | The beneficiary, a provider or supplier, or a representative |
What a redetermination is for
A redetermination asks the Medicare contractor that made the original decision to look at it again. You use it when a Medicare Summary Notice or another initial determination says a claim was denied or paid less than you expected. Our guide to the five levels of Medicare billing appeals explains what comes after this first step. Form CMS-20027 is a single page, and the agency marks it OMB exempt.
The clock: 120 days from receipt, not from the notice date
The rule is in the regulation: “any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination.” The same section says how receipt is counted: “the date of receipt of the initial determination will be presumed to be 5 calendar days after the date of the notice of initial determination, unless there is evidence to the contrary.”
Counting both periods from the notice date, the outside date is 125 calendar days. A worked example, computed here and not stated in the regulation: a notice dated June 1, 2026 is presumed received June 6, 2026 (June 1 plus 5 days), and 120 calendar days after June 6 is October 4, 2026. Filing is measured on arrival: “The request is considered as filed on the date it is received by the contractor.” Mail it early enough that it arrives, not merely so that it is postmarked, before the date.
What the form asks
The form collects the beneficiary’s name and Medicare number, the date the service or item was received, the item or service you want to appeal, and the date of the initial determination. It tells you to “please include a copy of the notice with this request”. There is also a line for the name of the Medicare contractor that made the determination, which the form marks not required, and one question that is for providers and suppliers only.
The core of the request is two open boxes: why you disagree with the decision, and any additional information Medicare should consider. You then say whether you have evidence to submit. The form adds “all evidence must be received prior to the issuance of the redetermination”, so promised evidence needs a stated plan for when it will arrive.
Filing late, and who signs
A late request is not automatically dead. The form asks: “If you received your initial determination notice more than 120 days ago, include your reason for the late filing:” The regulation lets the contractor “extend the time frame for filing a request for redetermination” when a party shows good cause. Its examples include that “The party did not receive notice of the determination or decision” and that “The party was prevented by serious illness from contacting the contractor in person, in writing, or through a friend, relative, or other person”.
The form’s final block records who is appealing, with check boxes for Beneficiary, Provider or Supplier, and Representative, then a name, street address, telephone number and an optional email and date. For the claims that usually start this process, see observation versus inpatient status.
The edition read for this page is Form CMS-20027 (01/20) as the agency served it on 2026-10-19. Check the edition printed on the copy you use, because a later edition can change the questions, the mailing instructions and the evidence asked for.
Common mistakes
- Counting 120 days from the date printed on the notice. The regulation counts from receipt, presumed to be 5 days after that date, so the outside date is 125 days after the notice.
- Leaving out the copy of the notice, which the form asks you to include.
- Saying evidence will follow without saying what it is or when, when all evidence must arrive before the redetermination is issued.
- Mailing the request so that it is postmarked in time but arrives late. The regulation treats the request as filed when the contractor receives it.
Related: Medicare billing appeals, Medicare notices and their deadlines, and Social Security and Medicare forms.
Sources
- Form CMS-20027 (01/20), Medicare Redetermination Request Form, 1st Level of Appeal: https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/downloads/cms20027.pdf
- 42 CFR 405.942, Time frame for filing a request for a redetermination (eCFR, read 2026-10-19): https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405/subpart-I/section-405.942
Read from the Social Security Administration and Centers for Medicare and Medicaid Services documents linked above on October 19, 2026. General information, not legal or benefits advice. Your own facts decide the outcome, and Social Security at 1-800-772-1213 is the right place to confirm anything consequential.