Updated August 3, 2026. Quick answer: Original Medicare has five levels of appeal, and the deadlines are set by regulation: 120 days for the first, 180 for the second, then 60 for each of the rest. The clock runs from when you receive the notice — and receipt is presumed to be five days after the date on it unless you can show otherwise.
The deadlines, from the regulations
405.942: ‘Any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination’ (receipt presumed ‘5 calendar days after the date of the notice of initial determination, unless there is evidence to the contrary’). 405.962(a): ‘any request for a reconsideration must be filed within 180 calendar days from the date the party receives the notice of the redetermination.’ 405.1014(c)(1): ‘Within 60 calendar days from the date the party receives notice of the QIC’s reconsideration or dismissal.’ 405.1102: ‘within 60 calendar days after receipt of the ALJ’s or attorney adjudicator’s decision or dismissal’ (receipt presumed ‘5 calendar days after the date of the notice’). 405.1130: ‘A party may file an action in a Federal district court within 60 calendar days after the date it receives notice of the Council’s decision.’
— 42 CFR §§ 405.942, 405.962, 405.1014, 405.1102, 405.1130, via Cornell Legal Information Institute
| Level | What it is | Deadline |
|---|---|---|
| 1 | Redetermination — by the contractor that processed the claim | 120 days from receipt of the initial determination |
| 2 | Reconsideration — by a Qualified Independent Contractor | 180 days from receipt of the redetermination |
| 3 | Hearing before an administrative law judge | 60 days from receipt of the reconsideration or dismissal |
| 4 | Review by the Departmental Appeals Board of HHS | 60 days from receipt of the decision or dismissal |
| 5 | Judicial review in federal district court | 60 days from receipt of the Board’s decision |
The five-day rule is the one that catches people
Every deadline runs from receipt, not from the date printed on the notice — and the regulation presumes you received it five calendar days after that date unless there is evidence to the contrary.
That cuts both ways. It quietly gives you five extra days. And it means a notice that genuinely arrived late is worth documenting, because the presumption is rebuttable and the envelope may be the evidence.
There is a minimum amount at levels 3 and 5
42 CFR 405.1006: ‘the required amount remaining in controversy must be $100 increased by the percentage increase in the medical care component of the consumer price index for all urban consumers (U.S. city average) as measured from July 2003 to the July preceding the current year involved,’ rounded to the nearest $10. For judicial review: ‘the required amount remaining in controversy must be $1,000 or more, adjusted as specified in paragraphs (b)(1) and (b)(2) of this section.’ No MSN-specific language was…
— 42 CFR § 405.1006 (via Cornell Legal Information Institute); CMS.gov/Medicare.gov unreachable (403 Forbidden) for MSN-specific and current-AIC-figure language
Levels 1 and 2 have no minimum — any denied claim can be appealed, however small. At the administrative-law-judge level a minimum applies, set as a base figure indexed to medical inflation, and a larger minimum applies to go to federal court.
We are not printing this year’s figures. The regulation gives the indexing formula rather than a number, and the published current amounts sit on a government site that would not serve us. Small claims can also be combined to reach the threshold, which is worth asking about before assuming you are below it.
What we could not confirm. Everything above is quoted from the regulations and the statute. We could not reach Medicare’s own consumer-facing pages, so two things are stated as the law words them rather than as Medicare labels them: the level-3 decider is an administrative law judge and level 4 is the Departmental Appeals Board — you will often see these called OMHA and the Medicare Appeals Council, which is standard usage we could not verify from source today. We also could not confirm from Medicare that the process formally starts from the Medicare Summary Notice, though that is the notice most people are holding. Use the instructions printed on your own notice — it names the body and the address.
What to do
- Read the notice for its own deadline and address. Yours governs.
- Appeal in writing and keep a dated copy. The date you filed is the fact everything turns on.
- Say why the service was necessary, and get your doctor to say it too. Most first-level denials are about documentation rather than eligibility.
- Do not stop at level one. A redetermination is a review by the same contractor that denied it; the independent look comes at level two.
- Watch the shortening clock. 120 days, then 180, then 60 — the windows get tighter as you go up, which is the opposite of what people expect.
Related: auditing the bill first · charity care · what a disputed bill does to your credit.
General information drawn from the United States Code and the Code of Federal Regulations, not legal or benefits advice. Social Security rules and figures change; every figure here carries the period it applies to. Your own earnings record and the correspondence you have received govern your case, and SSA is the only source for either. We sell nothing and we are not affiliated with the Social Security Administration.