Does the 120 days run from the date of service or from the notice?

From the notice. For someone with Original Medicare, the initial determination is communicated on the Medicare Summary Notice — CMS says exactly that on its first-level appeal page, and 42 CFR 405.921(a) sets what that notice has to tell you. The request for a redetermination must be filed within 120 calendar days from the date the party receives that notice (42 CFR 405.942(a)). The date of receipt is presumed to be 5 calendar days after the date on the notice unless there is evidence otherwise. The service itself may be six months old by then, which is normal and does not shorten anything.

Is there a minimum dollar amount to appeal?

Not at levels 1, 2, or 4. CMS puts it in one line on each of its own pages: 'A minimum monetary threshold on the claim is not required to request a redetermination,' and 'A minimum monetary threshold is not required to request a reconsideration.' Level 4 has no floor either — 42 CFR 405.1006 attaches the amount-in-controversy requirement to ALJ hearings and to judicial review only, and 42 CFR 405.1102, which governs a request for Council review, names no dollar figure. The floors are at level 3 and level 5: for calendar year 2026, $200 for an Administrative Law Judge hearing and $1,960 for judicial review, set by the notice published at 90 FR 55869 (CMS-4209-N) and effective for requests filed on or after 1 January 2026. Two or more claims can sometimes be aggregated to clear the floor under 42 CFR 405.1006(e), but only if they are related in the way that paragraph requires.

Can somebody file the appeal for me?

Yes, but the appointment has to be documented. An appointed representative acts on your behalf and the appointment must be in writing, signed and dated by both of you, and must contain all seven elements listed at 42 CFR 405.910(c), including your Medicare number and the representative's relationship to you. Form CMS-1696 collects all seven. Free help is also available from your State Health Insurance Assistance Program through shiphelp.org, and from 1-800-MEDICARE.

What happens if the QIC blows its own 60-day deadline?

It has to tell you it cannot finish and offer you the option of escalating to the Office of Medicare Hearings and Appeals, and it keeps working on the case unless you ask in writing to escalate (42 CFR 405.970(c)(2) and (d)). Escalating is not free of cost: an escalated appeal gets a 180-calendar-day adjudication period at OMHA instead of the usual 90 (42 CFR 405.1016(a) and (c)), so you may wait longer for a decision than if you had left it with the QIC.

The Five Levels of a Medicare Appeal, With Every Deadline

The notice that starts all of this usually arrives months after the appointment. Original Medicare sends a Medicare Summary Notice at least twice a year to people who had covered services in the period, so a denied claim from February can land in your mailbox in July (Medicare.gov, Medicare Summary Notice, read 18 August 2026). It is not a bill. It is a list, and somewhere in the list is a line saying Medicare did not pay, next to an amount that is now yours.

That MSN is the thing your appeal deadline hangs off. Not the date of service. Not the bill the provider sent afterward.

What follows is the ladder for Original Medicare — Part A and Part B claims — with the deadline for each rung, the form number, and the two rungs that have a dollar floor. I read the regulations and the agency pages on 18 August 2026 and linked each number to where it lives, because these figures move and one of them moves every January. I am not a lawyer or a claims professional. The links are so you can check me.

This is not the private-insurance appeal you may have run before

If you have appealed to a commercial insurer, you have seen a two-track system: an internal appeal decided inside the insurance company, then an external review by an independent organization. That structure comes from a different body of law, and I have written about telling those two tracks apart in internal appeal vs external review.

Original Medicare does not work that way. There is no "internal" stage in the commercial sense, because the first decision was not made by a company deciding on its own money. It was made by a Medicare Administrative Contractor processing a claim under federal rules. What you get instead is one continuous federal ladder of five levels, defined at 42 CFR part 405, subpart I, and each level is decided by a different body than the one before it:

Level	Who decides	Deadline to file	They answer in	Form	Dollar floor
1. Redetermination	The MAC, staff not involved in the first decision	120 days from receipt	60 days	CMS-20027	none
2. Reconsideration	A Qualified Independent Contractor	180 days from receipt	60 days	CMS-20033	none
3. Hearing	An ALJ or attorney adjudicator at OMHA	60 days from receipt	90 days	OMHA-100	$200 (2026)
4. Council review	The Medicare Appeals Council at HHS	60 days from receipt	90 days	DAB-101	none
5. Judicial review	A federal district court	60 days from receipt	—	civil complaint	$1,960 (2026)

Medicare Advantage and Part D also have five levels, but the first two rungs are different animals — your plan reconsiders, and a request there is due within 60 calendar days of receiving the plan's determination (42 CFR 422.582(b)). If your card says anything other than Medicare alone, read your plan's notice rather than this table.

The clock starts at receipt, and "receipt" is a legal guess

Every deadline above is measured from the date you receive a notice. Since nobody records that, the rules presume receipt is 5 calendar days after the date printed on the notice, unless there is evidence to the contrary — 42 CFR 405.942(a)(1) for level 1, and the same presumption again at 405.962(a)(1), 405.1002(a)(3), and 405.1102(a)(2).

Two things follow, and they pull in opposite directions.

The presumption is a small gift: it quietly adds five days. And filing is measured by arrival, not by postmark. The regulation says the request "is considered as filed on the date it is received by the contractor" (405.942(a)(2)), with the identical rule for the QIC at 405.962(a)(2) and for the ALJ level at 405.1002(a)(4). So the five days the presumption gave you can vanish in transit.

The practical version: take the date printed on the notice, add the filing window, write that on the calendar, and treat it as the day the appeal must already be in their hands. Never mind the extra five days. They are an argument to have if you need one, not a plan.

Levels 1 and 2 are paperwork, and paperwork has its own traps

Level 1, redetermination. File within 120 days of receiving the MSN, with the MAC that made the determination. CMS says the request "must be sent to the MAC that made the initial claim determination" and that the contractor's details are on the MSN itself (CMS, First Level of Appeal, read 18 August 2026); Medicare.gov points you at the last page, where the step-by-step appeal directions sit. You can use form CMS-20027, or write a letter carrying the same elements, or follow the MSN's own instructions and circle the disputed line on a copy of the notice, explain in writing why you disagree, and mail it. CMS puts the threshold question to bed in one sentence on that page: "A minimum monetary threshold on the claim is not required to request a redetermination." A $38 claim gets the same machinery as a $38,000 one. Some MACs take appeal requests through their own portal; whether yours does is a question for the phone number printed on the MSN, because it varies by contractor and this page cannot tell you.

Level 2, reconsideration. If the Medicare Redetermination Notice goes against you, a Qualified Independent Contractor — a different organization, which took no part in level 1 — reviews the whole record. You have 180 days from receipt (42 CFR 405.962(a)), and the form is CMS-20033. Send it to the QIC named on the redetermination notice, not back to the MAC.

Here is the detail that catches people who are being diligent. Every time you send additional evidence after filing, the decision-maker's 60-day clock stretches by up to 14 more days, at both levels — 405.950(b)(3) for the MAC and 405.970(b)(3) for the QIC. Trickling in three supporting documents across three weeks can push the answer out by six weeks. Ask your doctor's office for everything you want considered before you file, then file once, complete.

That request to the provider is the same document-gathering move as asking for an itemized bill: name what you want, in writing, and give a date by which you need it.

Level 3 is where a dollar floor appears

To get a hearing before an Administrative Law Judge, the amount remaining in controversy has to clear a threshold that Congress set at $100 in 2003 and that is re-indexed to the medical care component of the CPI every year (42 CFR 405.1006(b)). For calendar year 2026 it is $200 for an ALJ hearing and $1,960 for judicial review, effective for requests filed on or after 1 January 2026, per the CMS notice published on 4 December 2025 (90 FR 55869, CMS-4209-N). The prior year's figures were $190 and $1,900.

Check that figure against the Federal Register notice rather than a summary page. On 18 August 2026 the CMS page for level 3 showed the 2026 figure of $200, while the CMS page for level 5 was still saying "for calendar year 2025, the amount in controversy threshold is $1,900." Both pages are official; one had simply not been refreshed. Medicare.gov, read the same day, gave $1,960 for 2026.

If a single claim is too small, claims can sometimes be added together. Not any two claims you happen to hold, though. Under 405.1006(e)(1) the claims have to have been reconsidered by a QIC already, and they have to be related — for one person appealing alone, the delivery of similar or related services; for several people combining claims, common issues of law and fact. An ALJ decides whether they are. Part A and Part B claims can go in the same pile.

The trap in that paragraph is the clock. The aggregation has to be asked for within 60 calendar days after you receive the last of the reconsiderations you want to combine, which is a window that tends to close while you are still deciding whether the fight is worth having.

The filing itself: 60 days from receipt of the reconsideration, on form OMHA-100 or in a letter containing the same information, by mail or through the OMHA e-Appeal Portal, whose web address is printed on that same CMS level 3 page. A copy of that request also has to go to any other party who was sent the QIC's reconsideration, with something showing it went: the certification box on the OMHA-100, a "cc" line naming the recipient, a certificate of service, or a mailing receipt (42 CFR 405.1014(d)). A beneficiary appealing without a representative is carved out of the penalty for skipping it; anyone else who fails twice has the hearing request dismissed. The hearing is usually held by phone or video, and can be in person if the ALJ finds good reason.

OMHA has 90 calendar days to issue a decision, counted from the day the request reaches the office named in the reconsideration (42 CFR 405.1016(a)). You can waive that period, and it stretches for a court-ordered stay or a stay you asked for yourself (405.1016(d)). If the 90 days pass and nothing has been issued, you have a choice rather than a remedy: ask in writing to escalate the case to the Medicare Appeals Council, or leave it where it is, in which case it stays with OMHA until a decision comes (405.1016(e) and (f)).

Levels 4 and 5: the Council, then a courtroom

The Medicare Appeals Council, part of the HHS Departmental Appeals Board, takes requests within 60 days of receipt of the ALJ decision (42 CFR 405.1102(a)(1)), on form DAB-101 or electronically. No dollar minimum applies. Its review is de novo and it aims to decide within 90 days (42 CFR 405.1100(c)).

After that, a civil action in federal district court, filed within 60 calendar days of receiving the Council's decision, in the district where you live (42 CFR 405.1130 and 405.1136(b)), with $1,960 remaining in controversy for 2026. The defendant is the Secretary of HHS. This is the rung where the cost of proceeding without a lawyer usually stops being theoretical.

Missing a deadline is bad, not fatal

The rules build in a repair. A contractor may extend the 120-day window for good cause, and in deciding whether good cause exists it must consider what kept you from filing, whether its own actions misled you, and whether any physical, mental, educational, or linguistic limitation got in the way — 42 CFR 405.942(b)(2). The listed examples include serious illness, a death or serious illness in the immediate family, records destroyed by fire, being given incorrect information by the contractor, and never receiving the notice at all. The QIC applies those same standards (405.962(b)(3)), so does OMHA at level 3 (405.1014(e)(1)), and so does the Council (405.1102(b)).

Good cause is not automatic, and it has to be asked for: put the request in writing, file it with the late appeal, and say specifically why the appeal is late.

One track this article does not cover, and it is the urgent one. If you are being told that covered services are ending, none of the deadlines above apply to you. You call the Beneficiary and Family Centered Care Quality Improvement Organization named on the notice the provider has to hand you, and the deadline is measured in hours.

Which hour depends on where you are. In a hospital, the notice is "An Important Message from Medicare About Your Rights," which the hospital must deliver no later than two calendar days after admission (42 CFR 405.1205(b)), and the request for review has to reach the QIO no later than the day you are scheduled to be discharged (42 CFR 405.1206(b)(1)).

Anywhere else — a skilled nursing facility, home health agency, rehab facility, hospice — the notice is a "Notice of Medicare Non-Coverage," and the regulation sets the deadline at noon of the calendar day after you receive it (42 CFR 405.1202(b)(1)); Medicare.gov states the same deadline the way the notice itself puts it, as noon of the day before the termination date printed on the form (Medicare.gov, Fast appeals, read 18 August 2026). If the QIO decides against you, the next step is a QIC by noon of the following day again (405.1204(b)(1)). Filing late does not end your appeal rights, but it drops the coverage protection that keeps you from being billed while the review runs (405.1204(b)(4)). Do not put any of that in an envelope.

Before the envelope goes out

Find the MSN. Look at the date printed on its face — not the date of service — and write two lines in your calendar:

Redetermination due: notice date plus 120 days. This is the day it has to arrive, so mail it a week early, and send it in a way that gives you a delivery date you can point at later.
Follow up: filing date plus 60 days. That is when the MAC owes you an answer, and each set of documents you sent after filing may have pushed it back by up to 14 days.

Then, before you send anything, ask the treating provider's office in writing for the records and the letter of medical necessity you want considered, so the whole package goes in one envelope and no 14-day extension gets triggered. If you want a family member to handle it, complete CMS-1696 and send it in the same envelope. If you would rather have someone walk through the notice with you first, your State Health Insurance Assistance Program does it for free — find your state's number at shiphelp.org.

Denial notices from commercial plans behave differently in almost every respect, including which sentence sets your clock; that is the subject of how to read a denial letter.

Two of the numbers on this page have a shelf life. The dollar floors are reset every January by a Federal Register notice, and the CMS summary pages do not all catch up at the same speed — that is why the threshold paragraph above names the notice instead of the page. When the calendar year 2027 figures publish, this page gets the new citation, and the date at the top changes with it. The contact page is the fastest way to tell me a citation has stopped saying what I claim it says; the about page says what this site is and is not.