Skip to Main Content

Print | Bookmark | | Font Size: + |

3rd – 5th Levels of Appeal

Providers, suppliers and beneficiaries (or their respective appointed representatives) have the right to appeal a Medicare coverage and payment decision. There are five levels in the Medicare appeals process. A provider, supplier or beneficiary that is dissatisfied with an appeal decision at the prior level may file a request to the next level of appeal.

Level of Appeal Time Limit to File a Request Minimum Dollar Amount in Controversy
Third Level of Appeal: Administrative Law JudgeExternal Website Within 60 days of receipt of the reconsideration decision or dismissal $180 for requests filed on or before December 31, 2024
$190 for requests filed on or after January 1, 2025
Fourth Level of Appeal: Department Appeals Board (DAB) Review/Appeals CouncilExternal Website Within 60 days of receipt of the ALJ hearing decision or dismissal None
Fifth Level of Appeal: Federal Court ReviewExternal Website Within 60 days of receipt of the Appeals Council decision $1,840 for requests filed on or before December 31, 2024
$1,900 for requests filed on or after January 1, 2025

Updated: 10.30.24

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved