Medicare Appeal Deadlines at Every Level: How to Calendar 120, 180, and 60 Days Without Losing Your Appeal

Introduction

Medicare appeal rights are valuable, but they are also fragile. Miss a filing deadline and your appeal may be dismissed, no matter how strong the underlying case. Miss a shorter recoupment deadline and the MAC may begin collecting an overpayment while you appeal. Miss an evidence deadline and important documentation may be excluded from consideration.

Medicare's appeal deadlines are not difficult once you understand them, but there are many of them, and they do not all start from the same event. Some run from the date you receive a notice, some from the date on a demand letter, and some from the date a request is received by the appeals entity. This article lays out every major Medicare fee-for-service appeal deadline, explains how to count the days, and offers a practical system for calendaring so you never lose an appeal because of timing.

This article is educational and does not replace legal or professional advice. Always confirm deadlines using the notice you received and the current regulations.

The Core Appeal Deadlines

Level 1: Redetermination by the MAC

• Deadline: 120 calendar days from the date a party receives the notice of initial determination, under 42 CFR 405.942.

• Receipt presumption: The notice is presumed received five calendar days after the date on the notice, unless there is evidence to the contrary.

• When it counts as filed: The regulation provides that a request is considered filed on the date the contractor receives it.

• Decision timeframe: The MAC generally issues its decision within 60 days.

Level 2: Reconsideration by a QIC

• Deadline: 180 calendar days from the date of receipt of the redetermination decision, under 42 CFR 405.962.

• Receipt presumption: Five days after the date on the notice.

• Decision timeframe: CMS states that the QIC generally sends its decision within 60 days of receiving the request.

Level 3: ALJ Hearing at OMHA

• Deadline: 60 days from receipt of the reconsideration decision.

• Amount in controversy: $200 for requests filed in 2026 and $200 for requests filed on or after January 1, 2027.

• Decision timeframe: Generally 90 days from receipt of the request for hearing, subject to extensions.

Level 4: Medicare Appeals Council

• Deadline: 60 days from receipt of the ALJ or attorney adjudicator decision or dismissal.

• Receipt presumption: Five days after the date on the notice.

• Amount in controversy: None.

• Decision timeframe: Generally 90 days from receipt of the request for review, or 180 days for cases escalated from OMHA.

Level 5: Federal District Court

• Deadline: 60 days from receipt of the Council's decision, or from receipt of the Council's notice that it cannot decide the case within its timeframe, in escalated cases.

• Amount in controversy: $1,960 for 2026 and $2,000 for requests filed on or after January 1, 2027.

The Recoupment Deadlines: 30 and 60 Days

For overpayments, two shorter deadlines can be just as important as the filing deadlines. Under Section 1893(f)(2) of the Social Security Act and 42 CFR 405.379, CMS generally may not recoup an overpayment while a timely redetermination or reconsideration is pending, but only if:

• The redetermination is filed within 30 days of the date of the overpayment demand letter, and

• The reconsideration is filed within 60 days of the date of the redetermination decision.

Filing after these windows but within the standard 120-day or 180-day periods preserves your appeal rights, but the MAC may begin recoupment. After the QIC decision, recoupment may proceed even if an ALJ hearing is requested.

Why These Deadlines Matter

For large overpayments, recoupment can mean withheld payments on current claims, which can affect cash flow significantly. Filing within 30 and 60 days can protect your organization while the first two levels proceed.

Note the Different Starting Points

• The 30-day redetermination window for recoupment runs from the date of the demand letter.

• The 120-day redetermination filing deadline runs from receipt of the initial determination notice.

These dates may be different. Calendar both.

Escalation Timeframes

When an appeals entity does not decide on time, appellants may be able to escalate:

• QIC to OMHA: If the QIC cannot complete its decision within the applicable timeframe, it must notify the parties and advise the appellant of the right to escalate to OMHA. Escalation requires a written request to the QIC.

• OMHA to Council: If OMHA does not issue a decision within the applicable timeframe, the appellant may request escalation to the Council. The Council then has 180 days to act.

• Council to federal court: If the Council does not act within its timeframe, the appellant may request escalation, and may then file in federal court within 60 days of receiving the Council's notice.

Escalation is optional and involves trade-offs. For example, escalating from OMHA means giving up the ALJ hearing.

Dismissal Appeal Deadlines

If an appeal is dismissed, there are separate deadlines:

• MAC dismissal of a redetermination request: CMS explains that a party may request QIC review of the dismissal within 60 days of receipt of the dismissal.

• QIC dismissal of a reconsideration request: CMS explains that a party may request OMHA review within 60 days after receipt of the dismissal, or ask the QIC to vacate the dismissal within six months of the date the dismissal was mailed.

• ALJ or attorney adjudicator dismissal: A party may request Council review within 60 days of receipt of the dismissal.

Other Important Timeframes in the Appeals Process

Evidence at Reconsideration

Providers and suppliers should submit all evidence by the time the QIC issues its reconsideration. Evidence not submitted at the reconsideration level may be excluded at later levels unless good cause is shown.

Evidence at the ALJ Level

Under 42 CFR 405.1018, parties generally must submit written evidence with the request for hearing or within 10 calendar days of receiving the notice of hearing.

Notice of Hearing

OMHA explains that the ALJ sends a notice of hearing at least 20 days before the hearing, and appellants should return Form OMHA-102 within five days of receiving the notice.

Statistical Sampling Appeals

If you disagree with a statistical sample or extrapolation, 42 CFR 405.1014(a)(3) requires you to file the request for hearing for all sampled claims you wish to appeal within 60 calendar days of receiving the last reconsideration if the claims were not all addressed in a single reconsideration, and to state your reasons in the request.

CMS Own-Motion Referral

CMS may refer an ALJ decision to the Council for own-motion review, generally within 60 days of the decision. A favorable ALJ decision may not be final until that period passes.

Related Deadlines Outside the Appeals Process

Reopenings

Reopenings are separate from appeals. Under 42 CFR 405.980, a contractor may reopen an initial determination within one year for any reason, within four years for good cause, and at any time in cases of fraud or similar fault. Providers can also request reopening of clerical errors. Reopening requests do not extend appeal deadlines, so do not rely on a reopening request to protect your appeal rights.

ADR Responses

ADR deadlines come before the appeals process. Providers generally have 45 calendar days to respond to MAC, RAC, and SMRC requests and 30 days for UPIC requests.

Late Documentation Reopening

CMS's Program Integrity Manual explains that MACs may reopen claims denied for non-response if documentation is received within a reasonable period, generally 15 calendar days after the denial.

How to Count the Days

Use Calendar Days

Medicare appeal deadlines are expressed in calendar days. Weekends and holidays count.

Start With the Date on the Notice

1. Identify the date printed on the notice or decision.

2. Add five days for the presumed receipt date, unless you have evidence you received it later.

3. Add the applicable period: 120, 180, or 60 days.

4. The result is the last day for the appeal to be received.

Example: Redetermination

• Notice of initial determination dated March 1.

• Presumed received March 6.

• 120 days after March 6 is July 4.

• The request must be received by the MAC by that date.

Example: Recoupment Protection

• Demand letter dated March 1.

• File the redetermination within 30 days of March 1, by March 31, to limit recoupment.

Plan for Receipt, Not Mailing

Because requests are considered filed when received, the date you mail an appeal is not what matters. Use electronic submission methods, such as MAC portals, the QIC appeals portal, the OMHA e-Appeal Portal, the DAB E-File system, or esMD, where available, and keep confirmation of receipt.

Do Not Rely on the Last Day

If a deadline falls on a weekend or holiday, do not assume it moves. File well before the deadline.

Why Receipt Dates Matter So Much

Because Medicare presumes receipt five days after the date on a notice, a notice that arrives late or is misrouted inside your organization can quietly consume much of your filing period. If you actually received a notice later than five days after its date, keep evidence, such as a date-stamped envelope or mail log, in case you need to rely on the later date. Conversely, never assume you have extra time simply because a notice reached the right person late.

Building a Deadline Calendar System

Step 1: Log Every Notice the Day It Arrives

Record the type of notice, the date on the notice, the date actually received, the claim or appeal numbers, and the amount.

Step 2: Calculate Every Applicable Deadline

For each notice, calculate:

• The appeal filing deadline.

• Any recoupment protection deadline.

• Any evidence submission deadline.

• Any escalation date.

Step 3: Set Internal Targets

Set internal targets well ahead of the official deadline. For example:

• Redetermination of an overpayment: target day 20 after the demand letter.

• Reconsideration of an overpayment: target day 45 after the redetermination decision.

• ALJ request: target day 40 after receipt of the reconsideration.

• Council request: target day 40 after receipt of the ALJ decision.

Step 4: Use Automated Reminders

Set reminders at 30, 14, 7, and 3 days before each internal target and official deadline.

Step 5: Assign Responsibility

Assign each appeal to an owner and a backup.

Step 6: Track Submissions and Confirmations

Record the submission date, method, and confirmation for every filing.

Step 7: Track Decision Dates

Calendar the expected decision date for each level so you can identify delays and consider escalation.

Step 8: Review Weekly

Hold a weekly review of upcoming deadlines with the appeals team.

A Deadline Reference List

• Redetermination: 120 days from receipt of the initial determination.

• Redetermination to limit recoupment: 30 days from the demand letter date.

• MAC decision: generally 60 days.

• Reconsideration: 180 days from receipt of the redetermination.

• Reconsideration to limit recoupment: 60 days from the redetermination decision.

• QIC decision: generally 60 days.

• ALJ hearing request: 60 days from receipt of the reconsideration.

• ALJ evidence: with the request or within 10 days of the notice of hearing.

• Notice of hearing response: return Form OMHA-102 within 5 days.

• ALJ decision: generally 90 days.

• Council request: 60 days from receipt of the ALJ decision.

• Council decision: generally 90 days, or 180 days for escalated cases.

• Federal court: 60 days from receipt of the Council's decision or escalation notice.

• MAC dismissal review: 60 days to the QIC.

• QIC dismissal: 60 days for OMHA review, or 6 months to request the QIC vacate.

• ALJ dismissal review: 60 days to the Council.

• Reopening: 1 year for any reason, 4 years for good cause, any time for fraud or similar fault.

Managing Deadlines for Large Volumes of Appeals

Organizations that file many appeals, such as hospitals responding to RAC reviews or suppliers facing extrapolated overpayments, need extra structure:

• Group related claims by notice date so deadlines can be managed together.

• Use a database or appeals management system rather than spreadsheets alone.

• Track each claim individually, even when filed together, because decisions may arrive at different times.

• Watch for partial decisions, which may require further appeals for some claims and not others.

• Reconcile appeal decisions with remittance advice to confirm payments and adjustments.

• For extrapolated overpayments, track the sample claims and the overall overpayment separately, and confirm recalculation after each favorable decision.

Deadlines and Representatives

When a consultant, billing company, or attorney manages appeals for your organization:

• Require them to report every notice received and every deadline calculated.

• Ask for copies of all filings and confirmations.

• Hold regular status meetings.

• Keep your own deadline calendar as a backup.

Contractor guidance has made clear that a billing company's or consultant's failure to file on time generally does not establish good cause for late filing. The provider remains responsible for its appeal rights.

Deadlines After a Favorable Decision

A favorable decision does not always end the process:

• Confirm that the MAC effectuates the decision, such as paying the claim or adjusting the overpayment.

• Watch for CMS own-motion referrals of favorable ALJ decisions, generally within 60 days.

• If an overpayment was recouped, confirm any refund and interest owed to you under applicable rules.

• Update your records to reflect the final outcome.

A Sample Timeline for an Overpayment Appeal

• Day 0: Demand letter dated.

• By day 30: File redetermination to limit recoupment.

• About 60 days after filing: Redetermination decision.

• Within 60 days of the redetermination decision: File reconsideration to continue limiting recoupment.

• About 60 days after filing: QIC decision.

• Within 60 days of receipt of the QIC decision: Request ALJ hearing, if the amount in controversy is met. Recoupment may begin.

• About 90 days after filing, subject to extensions: ALJ decision.

• Within 60 days of receipt of the ALJ decision: Request Council review if needed.

Common Deadline Mistakes

• Counting from the date received instead of the date on the notice plus five days, or the reverse.

• Confusing the 30-day recoupment window with the 120-day filing deadline.

• Mailing an appeal on the last day instead of making sure it is received by the deadline.

• Assuming weekends and holidays extend the deadline.

• Relying on a reopening request to preserve appeal rights.

• Missing evidence deadlines at the ALJ level.

• Failing to file all sampled claims together in extrapolation cases.

• Not calendaring CMS's own-motion referral window after a favorable ALJ decision.

• Losing track of multiple claims and notices with different dates.

What If You Miss a Deadline?

If a filing deadline is missed, you may request an extension for good cause. Under 42 CFR 405.942(b), the request must be in writing, explain why the request was not filed on time, and include supporting evidence. The same good cause standards apply at the QIC level, and similar standards apply at later levels. Good cause is evaluated case by case and is not guaranteed. A companion article explains how to request a good cause extension.

Frequently Asked Questions

How long do I have to file a Medicare redetermination?

120 days from receipt of the initial determination notice. For overpayments, file within 30 days of the demand letter to limit recoupment.

How long do I have to file a reconsideration?

180 days from receipt of the redetermination decision. For overpayments, file within 60 days of the redetermination decision to continue limiting recoupment.

How long do I have for the ALJ, Council, and federal court?

60 days at each of these levels, measured from receipt of the prior decision.

When is a notice considered received?

Five days after the date on the notice, unless there is evidence it was received later.

Do deadlines move if they fall on a weekend?

Do not assume so. File well before the deadline and confirm receipt.

Does a reopening request extend my appeal deadline?

No. Reopenings are separate from appeals. File your appeal on time even if a reopening request is pending.

Is the 30-day recoupment window counted from receipt or from the letter date?

The 30-day window for redeterminations is generally counted from the date of the demand letter, so act quickly when an overpayment demand arrives.

Can I file appeals electronically?

Yes. Options include MAC portals, the QIC appeals portal, the OMHA e-Appeal Portal, the DAB E-File system, and esMD, depending on the level and contractor. Electronic filing helps you prove timely receipt.

What should I do if I find a deadline has already passed?

File the appeal immediately with a written good cause explanation and supporting evidence.

Conclusion

Medicare appeal deadlines follow a clear pattern: 120 days for redetermination, 180 days for reconsideration, and 60 days for the ALJ, Council, and federal court, with a five-day presumption for receipt of notices. For overpayments, the 30- and 60-day recoupment windows can be just as important. Escalation, dismissal, evidence, and reopening timeframes add further dates to track. By logging every notice immediately, calculating every deadline, setting internal targets, using electronic filing, confirming receipt, and reviewing deadlines regularly, providers can protect their appeal rights and avoid losing valid appeals to timing errors.

How HealthBridge Can Help

HealthBridge is a healthcare management consulting firm that helps providers build appeal tracking systems, calculate and calendar deadlines across all levels, prepare timely appeals, protect against recoupment, and request good cause extensions when needed. If you need help managing Medicare appeal deadlines, please get in touch with us. We will be happy to help you with this topic.

References

• Centers for Medicare & Medicaid Services. Original Medicare (Fee-for-Service) Appeals. https://www.cms.gov/medicare/appeals-grievances/fee-for-service

• Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor. https://www.cms.gov/medicare/appeals-grievances/fee-for-service/second-level-appeal

• Centers for Medicare & Medicaid Services. Fourth Level of Appeal: Review by the Medicare Appeals Council. https://www.cms.gov/medicare/appeals-grievances/fee-for-service/fourth-level-appeal

• Centers for Medicare & Medicaid Services. Fifth Level of Appeal: Judicial Review in Federal District Court. https://www.cms.gov/medicare/appeals-grievances/fee-for-service/fifth-level-appeal

• U.S. Department of Health and Human Services, Office of Medicare Hearings and Appeals. Request an ALJ Hearing. https://www.hhs.gov/about/agencies/omha/filing-an-appeal/coverage-and-claims-appeals/request-an-alj-hearing/index.html

• U.S. Department of Health and Human Services, Departmental Appeals Board. Appeals to the Medicare Appeals Council. https://www.hhs.gov/about/agencies/dab/different-appeals-at-dab/appeals-to-council/index.html

• Federal Register. Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2026 (December 4, 2025). https://www.govinfo.gov/content/pkg/FR-2025-12-04/html/2025-21879.htm

• Federal Register. Medicare Program; Medicare Appeals; Adjustment to the Amount in Controversy Threshold Amounts for Calendar Year 2027 (Public Inspection, September 2026). https://public-inspection.federalregister.gov/2026-19016.pdf

• Electronic Code of Federal Regulations. 42 CFR 405.942, Time Frame for Filing a Request for a Redetermination. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405/subpart-I/subject-group-ECFR3ec6343ada14c59/section-405.942

• Electronic Code of Federal Regulations. 42 CFR 405.962, Timeframe for Filing a Request for a Reconsideration. https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-B/part-405/subpart-I/subject-group-ECFR533a2e506b78025/section-405.962

• Electronic Code of Federal Regulations. 42 CFR 405.980, Reopening of Initial Determinations, Redeterminations, Reconsiderations, Hearings, and Reviews. https://www.ecfr.gov/current/title-42/section-405.980

• Electronic Code of Federal Regulations. 42 CFR 405.1014, Request for an ALJ Hearing. https://www.ecfr.gov/current/title-42/section-405.1014

• Electronic Code of Federal Regulations. 42 CFR 405.1018, Submitting Evidence. https://www.ecfr.gov/current/title-42/section-405.1018

• Electronic Code of Federal Regulations. 42 CFR 405.379, Limitation on Recoupment of Provider and Supplier Overpayments. https://www.ecfr.gov/current/title-42/section-405.379

• U.S. Social Security Administration. Social Security Act, Section 1893, Medicare Integrity Program. https://www.ssa.gov/OP_Home/ssact/title18/1893.htm