Levels of Appeals and Time Limits for Filing

Table of Contents

• Five Levels of Appeals: Overview
  • Level One – Redetermination
  • Level Two – Reconsideration (QIC)
  • Level Three – Administrative Law Judge (ALJ)
  • Level Four – Medicare Appeals Council (MAC)
  • Level Five – Federal Court Review

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Five Levels of Appeals: Overview

Level One – Redetermination

• Time Limit for Filing a Redetermination - 120 days from date of receipt of the initial determination notice
• Amount in Controversy - No minimum (none)

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Level Two – Reconsideration (QIC)

• Time Limit for Filing a Reconsideration - 180 days from date of receipt of the redetermination decision
• Amount in Controversy - No minimum (none)

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Level Three – Administrative Law Judge (ALJ)

• Time Limit for Filing an ALJ - 60 days from the date of receipt of the reconsideration (QIC decision)
• Amount in Controversy - For requests filed on or after 1/1/2024, at least $180 remains in controversy. For requests filed on or after 1/1/2023, at least $180 remains in controversy.

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Level Four – Medicare Appeals Council (MAC)

• Time Limit for Filing with the Medicare Appeals Council - 60 days from date of receipt of the ALJ decision
• Amount in Controversy - No minimum (none)

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Level Five – Federal Court Review

• Time Limit for Filing for a Federal Court Review - 60 days from date of receipt of the MAC decision
• Amount in Controversy - For requests filed on or after 1/1/2024, at least $1,840 remains in controversy. For requests filed on or after 1/1/2023, at least $1,850 remains in controversy.

Note: Additional resources to help you determine how to file an appeal within the time limit are available in this Appeals section of our website.

Reference: CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 29, Section 310. 

Revised 1/25/2024