Federal programs / Original Medicare (Parts A and B)
Original Medicare (Parts A and B)
Five levels. Level 1 is a redetermination by the Medicare Administrative Contractor named on your Medicare Summary Notice; level 2 is a reconsideration by a Qualified Independent Contractor.
| Form | Use it to | Deadline | Issued by |
|---|---|---|---|
| CMS-20027, Medicare Redetermination Request | Level 1: ask the MAC to look again | 120 days from receipt of the Medicare Summary Notice (42 CFR 405.942) | CMS |
| CMS-20033, Medicare Reconsideration Request | Level 2: ask the QIC to review the redetermination | 180 days from the redetermination notice (42 CFR 405.962) | CMS |
| CMS-1696, Appointment of Representative | Let someone act for you at any level | File with the appeal it accompanies | CMS |
Where it goes
The MAC address printed on the Medicare Summary Notice for level 1; the QIC address on the redetermination notice for level 2. Medicare.gov explains each level.
The rule
42 CFR Part 405, Subpart I. Links verified 2026-09-15; the notice you received controls over anything here.
Want the appeal itself written to the criteria, with the rule cited? Apellica's generator is free; a reviewer can also read the denial first.