How to appeal an Original Medicare denial
The short answer
An Original Medicare appeal starts from your Medicare Summary Notice. You have 120 days from the day you receive it to ask for a redetermination, and the notice prints the date you must file by.
Deadlines, decision times and your rights
These are the limits in the federal rules. Your plan can give you more time but not less. If your denial letter prints an earlier date, go by the earlier one.
Deadline to appeal
120 days from when you receive the notice (counted as 125 days from the notice date)
Rule: 42 CFR 405.942(a)
What the rule says
Except as provided in paragraph (b) of this section, any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination.
Contact the Quality Improvement Organization no later than the day you are discharged
Rule: 42 CFR 405.1206(b)(1)
What the rule says
The request must be made no later than the day of discharge and may be in writing or by telephone.
By NOON of the day after you receive the provider's termination notice
Rule: 42 CFR 405.1202(b)(1)
What the rule says
A beneficiary who wishes to exercise the right to an expedited determination must submit a request for a determination to the QIO in the State in which the beneficiary is receiving those provider services, in writing or by telephone, by no later than noon of the calendar day following receipt of the provider's notice of termination. If the QIO is unable to accept the beneficiary's request, the beneficiary must submit the request by noon of the next day the QIO is available to accept a request.
How long they have to decide
60 days after the contractor receives your request
Rule: 42 CFR 405.950(a)
What the rule says
The contractor mails, or otherwise transmits, written notice of the redetermination or dismissal to the parties to the redetermination at their last known addresses within 60 calendar days of the date the contractor receives a timely filed request for redetermination.
60 days after the QIC receives your request
Rule: 42 CFR 405.970(a)
What the rule says
Within 60 calendar days of the date the QIC receives a timely filed request for reconsideration following a contractor redetermination or any additional time provided by paragraph (b) of this section, the QIC mails, or otherwise transmits to the parties at their last known addresses, written notice of— (1) The reconsideration;
The next level
180 days from when you receive the redetermination (counted as 185 days from its date)
Rule: 42 CFR 405.962(a)
What the rule says
Except as provided in paragraph (b) of this section and in § 405.974(b)(1), regarding a request for QIC reconsideration of a contractor's dismissal of a redetermination request, any request for a reconsideration must be filed within 180 calendar days from the date the party receives the notice of the redetermination.
60 days from when you receive the QIC decision (counted as 65 days from its date)
Rule: 42 CFR 405.1002(a)
What the rule says
A party to a QIC reconsideration has a right to a hearing before an ALJ if— (1) The party files a written request for an ALJ hearing within 60 calendar days after receipt of the notice of the QIC's reconsideration.
Your rights along the way
- Missed the deadline? Ask for more time for good cause. Medicare may extend the deadline if you show good cause. 42 CFR 405.942(b)
Each rule links to its text in the Electronic Code of Federal Regulations. Checked against the regulation text on November 10, 2026. The Lamdis app works out your dates from these same rules.
Start with the Medicare Summary Notice
The Medicare Summary Notice (MSN) lists each service, what Medicare paid and what it denied. Medicare.gov says to file your appeal by the date in the MSN. Circle the items you disagree with and explain why, or use the redetermination request form.
The deadlines
You have 120 days from the day you receive the notice, and Medicare presumes you received it 5 days after its date (42 CFR 405.942(a)). The Medicare contractor has 60 days to decide. If it says no, you can ask a Qualified Independent Contractor to reconsider within 180 days (42 CFR 405.962(a)).
If you miss the deadline, you may still be able to appeal by showing good cause, for example illness or disability (Medicare.gov).
The five levels
- Redetermination by the Medicare Administrative Contractor
- Reconsideration by a Qualified Independent Contractor
- Hearing with an administrative law judge, if enough money is at stake
- Medicare Appeals Council
- Federal district court
When covered care is ending
If you are in the hospital or getting skilled nursing, home health or hospice care and think it is ending too soon, you can ask for a fast appeal to an independent reviewer called a BFCC-QIO (Medicare.gov). In a hospital you should receive a notice called “An Important Message from Medicare about Your Rights” within 2 days of admission. See hospital stay denials.
Free help
Your State Health Insurance Assistance Program gives free, personalized counseling to people with Medicare (Medicare.gov). Find your SHIP.
Questions people ask
How long do I have to appeal an Original Medicare denial?
120 days from the day you receive the Medicare Summary Notice (42 CFR 405.942(a)). The MSN prints the exact date.
What if I missed the deadline?
You can still ask, and explain the good cause for filing late (Medicare.gov).
Sources
- Medicare.gov: Appeals in Original Medicare
You must file your appeal by the date in the MSN.
- eCFR: 42 CFR 405.942, Time frame for filing a request for a redetermination
any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination
- eCFR: 42 CFR 405.962, Timeframe for filing a request for a reconsideration
any request for a reconsideration must be filed within 180 calendar days from the date the party receives the notice of the redetermination
- Medicare.gov: Fast appeals
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.
- Medicare.gov: Filing an appeal
SHIPs are state programs that get money from the federal government to give free local health insurance counseling to people with Medicare.
- SHIP Technical Assistance Center: Get Medicare Help from Your Local SHIP Program
Get one-on-one counseling from a trusted, unbiased source.
This page is general information about appeal rules in the United States. It is not legal or medical advice. Rules can change, and your plan’s documents and your denial letter control the dates that apply to you.