How do I appeal a Medicare claim denial?
Last updated Jul 19, 2026
Reviewed by Jason Burns, Editorial Steward
Published by Senior Direct Answers · Licensed under Citation License 1.0
Original Medicare appeals run through five levels: (1) redetermination by the Medicare Administrative Contractor, requested within 120 days of the Medicare Summary Notice (MSN) that shows the denial; (2) reconsideration by a Qualified Independent Contractor; (3) a hearing before an administrative law judge at HHS's Office of Medicare Hearings and Appeals; (4) review by the Medicare Appeals Council; and (5) judicial review in federal district court. Your MSN and each decision letter explain how and where to file the next appeal. Note that the minimum amount-in-controversy dollar thresholds required for an ALJ hearing and for federal court review are adjusted annually by CMS.
What the government has said, on the record
“The first two levels are conducted at CMS. They are administered by CMS and CMS' contractors. The third level is at the Office of Medicare Hearings and Appeals and is conducted by administrative law judges. The fourth level is at the Medicare Appeals Council, which is part of the Departmental Appeals Board and is also a separate agency within Health and Human Services. And the final level is with the Federal district courts”
— Nancy J. Griswold, Chief Administrative Law Judge, Office of Medicare Hearings and Appeals, HHS, Hearing, "Medicare Mismanagement Part II: Exploring Medicare Appeals Reform," Subcommittee on Energy Policy, Health Care and Entitlements, House Committee on Oversight and Government Reform, 2014-07-10 (source)
Editor's note: Quote is from oral Q&A colloquy (response to Rep. Gosar) in the printed hearing record, not the prepared statement; levels 1-2 terminology (redetermination/reconsideration) appears elsewhere in the record; none of the dollar thresholds are quoted.
Who said this
Nancy J. Griswold — Chief Administrative Law Judge, Office of Medicare Hearings and Appeals, HHS (current).
Also asked as
- How do I appeal a Medicare claim denial in 2026?
- What is the way to do I appeal a Medicare claim denial?
Source:
Last verified: 2026-07-18