Medicare Appeal Form CMS-20027: Filing, Deadlines, and Where to Send It

Form CMS-20027 is the Medicare Redetermination Request Form, and you use it to appeal a denied Original Medicare claim within 120 calendar days of receiving your denial notice. Download it as a one-page PDF from the CMS website, or call 1-800-MEDICARE (1-800-633-4227) to have one sent to you.1Centers for Medicare & Medicaid Services. Medicare Redetermination Request Form The form is short. The work is in the paperwork you attach to it.

Gather Your Documents First

Start with your Medicare Summary Notice. The MSN is the quarterly statement Medicare mails after processing a claim, listing what was billed, what Medicare paid, and what you may owe.2Medicare. Medicare Summary Notice The last page walks through how to appeal and, more importantly, gives you the mailing address of the specific Medicare contractor that handled the claim. You will pull several pieces of information from the MSN to complete the form.

Have these ready before you sit down:

  • Your Medicare number, exactly as printed on your card.
  • The date or dates of the denied service, copied precisely from your MSN.
  • The date printed on the initial determination notice. Your 120-day clock starts five days after this date, since Medicare presumes it takes that long for the notice to reach you.3GovInfo. 42 CFR 405.942 – Time Frame for Filing a Request for a Redetermination
  • A letter from your treating physician explaining why the denied service or item was medically necessary. In most appeals this is the single most persuasive document.
  • Supporting medical records: test results, imaging reports, surgical notes, or treatment records that back up your doctor’s explanation. Put them in chronological order so a reviewer can follow the story.

Medicare’s coverage standard is whether a service is “reasonable and necessary for the diagnosis or treatment of illness or injury.”4Social Security Administration. 42 USC 1395y – Exclusions From Coverage and Medicare as Secondary Payer Your evidence needs to show the denied service meets it.

Filling Out Each Field

The form fits on a single page, but a few fields carry most of the weight.

  • Beneficiary’s name and Medicare number. Match your Medicare card exactly. A missing middle initial can keep the contractor from linking your appeal to the right claim.
  • Date the service or item was received. Use mm/dd/yyyy and match the MSN precisely; even a one-day mismatch causes delays.
  • Item or service you wish to appeal. Describe the specific service or supply, using the same wording that appears on your MSN so the reviewer can find the claim.
  • Date of the initial determination notice. Copy this from your MSN. The form asks you to attach a copy of that notice.
  • Late filing reason. If more than 120 days have passed since you received the denial, explain why here. Leave it blank if you are within the deadline.
  • Reason for disagreement. This field decides most appeals. Write a specific explanation tied to your evidence, not a general plea. Something like: “My treating physician prescribed [treatment] because my diagnosis of [condition] requires it, as documented in the attached records,” lands very differently than “I need this service.”
  • Additional information and evidence. Check the box indicating you are submitting evidence and attach it. If more records are coming, note what and when; everything must arrive before the contractor issues its decision.
  • Person appealing. Check whether you are the beneficiary, a provider or supplier, or a representative, and provide a phone number the contractor can actually reach.

You are not strictly required to use CMS-20027. CMS accepts any written request that contains your name, Medicare number, the specific services and dates at issue, your reason for disagreeing, and the name of the person appealing.5Centers for Medicare & Medicaid Services. First Level of Appeal – Redetermination by a Medicare Contractor The form is easier because it prompts you for each required piece.

Where to Send It

Mail the completed form and every attachment to the contractor address printed on your MSN. Each MSN names the specific contractor that processed the claim, and sending your appeal to any other Medicare office can cause it to miss the deadline. Use certified mail with return receipt so you have proof of the date you sent it and the date the contractor received it. Some contractors accept electronic submissions through a secure portal, which gives you an instant confirmation; check your MSN or the contractor’s website for your jurisdiction.

Before sealing the envelope, verify:

  • Every required field on the form is filled in.
  • Your MSN or initial determination notice is attached.
  • Your physician’s letter and supporting medical records are in the same package.
  • You have kept a full copy of everything you are sending.

Mark the 120-day deadline on your calendar the day the denial arrives. A single day late gives the contractor grounds to dismiss the appeal.

If You Missed the 120-Day Deadline

You can still file after 120 days if you have good cause. CMS evaluates late-filing requests case by case and recognizes situations such as:

  • A serious illness that kept you from contacting the appeals reviewer.
  • Death or serious illness in your immediate family.
  • Records destroyed by fire, flood, hurricane, or a similar event.
  • Incorrect or incomplete information from the contractor about how or when to file.
  • Never receiving the determination notice.
  • Physical, mental, or language limitations that delayed you, including needing documents in Braille or large print.6Centers for Medicare & Medicaid Services. Medicare Appeals Good Cause for Late Filing

Write your explanation in the late-filing field on the form and attach documentation, such as hospital records showing you were incapacitated during the filing window.

Having Someone Else File for You

To let a family member, friend, or attorney handle the appeal, file Form CMS-1696 (Appointment of Representative) with your request. You and the representative both sign it, and the appointment is good for one year from the signing date or through the end of the claim or appeal, whichever is later.7Centers for Medicare & Medicaid Services. Appointment of Representative (Form CMS-1696) Your representative certifies they have not been disqualified or suspended from practicing before HHS. If they charge a fee, that fee may be subject to HHS review, and providers or suppliers who furnished the services at issue cannot charge a fee for representing you. Send CMS-1696 to the same address as the appeal.

What Happens After You File

The contractor sends an acknowledgment that your appeal is in the system, then has 60 calendar days to review the original claim, look at your new evidence, and mail a written decision called a Medicare Redetermination Notice.8eCFR. 42 CFR 405.950 – Time Frame for Making a Redetermination Every time you submit new evidence after filing, the 60-day clock can extend by up to 14 days, so get everything into the initial package if you can.

The notice will say the denial was upheld, partially reversed, or fully reversed. A favorable decision means the claim gets updated and payment processed. If it goes against you in whole or in part, the notice explains how to escalate to Level 2, a reconsideration by a Qualified Independent Contractor, which you file within 180 days using Form CMS-20033 or a written request.9Centers for Medicare & Medicaid Services. Reconsideration by a Qualified Independent Contractor Each level after that (an Administrative Law Judge hearing, the Medicare Appeals Council, and federal court) has its own form, deadline, and, at some levels, a minimum dollar threshold. The notice you receive at each stage tells you exactly where to go next.

When CMS-20027 Is Not the Right Form

CMS-20027 is only for Original Medicare (Parts A and B) claims. If you are enrolled in a Medicare Advantage (Part C) plan, you file a “health plan reconsideration” directly with your plan, and the deadline is 60 calendar days from the plan’s denial notice rather than 120.10eCFR. 42 CFR 422.582 – Request for a Standard Reconsideration Follow the instructions on that denial notice; if your plan upholds the denial, it automatically forwards the case to an Independent Review Entity, and you do not need to file separately. If waiting for a standard decision could seriously harm your health, ask for an expedited appeal, which the plan must decide within 72 hours.11Medicare. Appeals in Medicare Health Plans

A different process also applies when a hospital, skilled nursing facility, home health agency, or hospice tells you covered services are ending sooner than you think they should. Those fast-track appeals go to your area’s Beneficiary and Family Centered Care Quality Improvement Organization (BFCC-QIO), not to the Medicare contractor, and follow deadlines printed on notices you receive from the facility.12Medicare. Fast Appeals CMS-20027 is not used in either situation.