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.
- Original Medicare (Fee-for-service) Appeals
- CMS Claims Processing Manual (Pub. 100-04), Chapter 29 – Appeals of Claims Decisions
Level of Appeal | Time Limit to File a Request | Minimum Dollar Amount in Controversy |
---|---|---|
Third Level of Appeal: Administrative Law Judge | 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 Council | Within 60 days of receipt of the ALJ hearing decision or dismissal | None |
Fifth Level of Appeal: Federal Court Review | 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