Medicare Reconsideration Request (CMS-20033): Filing Deadline and Steps

CMS Form 20033 is the Medicare Reconsideration Request form. You file it with a Qualified Independent Contractor (QIC) after a Medicare Administrative Contractor has already reviewed and upheld a claim denial at the first appeal level. You have 180 days from the date you receive the redetermination notice to submit it, and the QIC generally issues a decision within 60 days.1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor2eCFR. 42 CFR Part 405 Subpart I – Reconsiderations

When You Use This Form

Form CMS-20033 is only for the second level of the Medicare fee-for-service appeals process. If your MAC has not yet issued a redetermination on the claim, you cannot skip ahead to a reconsideration.3Medicare.gov. Appeals in Original Medicare Any party to that first-level redetermination can request reconsideration: the beneficiary, the provider or supplier who furnished the service, or an authorized or appointed representative. No dollar threshold applies at this level.2eCFR. 42 CFR Part 405 Subpart I – Reconsiderations

The current version of the form is CMS-20033 (01/20), available as a PDF from the CMS forms page.4Centers for Medicare & Medicaid Services. CMS 20033 – Medicare Reconsideration Request Form Using the form is not mandatory. CMS accepts any written request that contains the required information, but the form keeps you from leaving out a required element by accident.1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor

Information the Form Requires

Every reconsideration request must include the beneficiary’s identifying information, the service in dispute, and the contractor that issued the redetermination. On the form, that breaks down as follows:

  • The beneficiary’s name and Medicare Beneficiary Identifier (MBI).
  • A description of the specific service or item you are disputing and the date it was received.
  • The date printed on the redetermination notice from your MAC. Attach a copy of that notice.
  • The name of the MAC that issued the redetermination. If you attach the notice, this field is optional.
  • For providers and suppliers, an indication of whether the appeal involves an overpayment.
  • Your role in the appeal (beneficiary, provider or supplier, or representative) along with your name, mailing address, and phone number. Email is optional.

These fields track the regulatory minimums at 42 CFR § 405.964.5eCFR. 42 CFR 405.964 – Place and Method of Filing a Request for a Reconsideration A request missing any of them can be rejected.

Writing the Statement of Disagreement

The most important part of the form is the open-text field that begins, “I do not agree with the redetermination decision on my claim because.” This is where the appeal is won or lost. Explain in plain language why the MAC got it wrong: why the service was medically necessary, why the coding was correct, or why the documentation supports coverage. Reference the specific denial reason from the redetermination notice and address it directly.6Centers for Medicare & Medicaid Services. Medicare Reconsideration Request Form (CMS-20033)

Vague statements like “I believe this claim should be paid” give the QIC nothing to work with. The more specifically you identify the factual or clinical basis for your position, the better the reviewer can locate the relevant material in the record. A separate field labeled “Additional information Medicare should consider” gives you room for anything that doesn’t fit into your main argument.

Attaching Evidence

The form has two checkboxes: “I have evidence to submit” and “I do not have evidence to submit.” If you check the first, you can either attach the evidence to the form or include a statement describing what you plan to submit and when. All evidence must reach the QIC before it issues its decision.6Centers for Medicare & Medicaid Services. Medicare Reconsideration Request Form (CMS-20033) CMS also recommends including a copy of the Medicare Redetermination Notice (MRN) or Remittance Advice (RA).1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor

Do not save documentation for later. If the redetermination cited missing records as the reason for denial, attaching those records now is the most direct way to fix the problem. Evidence you leave out at this stage is harder to introduce later. At the next appeal level, an Administrative Law Judge will require you to show “good cause” for not submitting it earlier.7eCFR. 42 CFR 405.1028 – Review of Evidence Submitted by Parties

The 180-Day Filing Deadline

You must file within 180 calendar days of receiving the redetermination notice. CMS presumes you received the notice five days after the date printed on it, unless you have evidence showing otherwise.2eCFR. 42 CFR Part 405 Subpart I – Reconsiderations The clock stops on the date the QIC receives your request, not the date you mail it. If you are close to the deadline, use fax or the online portal for a same-day timestamp.

If more than 180 days have passed, the form asks you to explain the reason for late filing.6Centers for Medicare & Medicaid Services. Medicare Reconsideration Request Form (CMS-20033) The QIC can grant an extension for good cause, but you must submit the extension request in writing along with the reconsideration request itself, with supporting evidence.8eCFR. 42 CFR 405.962 – Timeframe for Filing a Request for a Reconsideration

CMS recognizes several circumstances as good cause:

  • Serious illness that prevented you from contacting the appeals reviewer.
  • Death or serious illness in your immediate family.
  • Records destroyed or damaged by fire, flood, hurricane, or a similar event.
  • Incorrect or incomplete information from the contractor about how or when to file.
  • You never received the determination or decision notice.
  • You filed the request in good faith with the wrong government agency within the time limit.
  • You needed documents in an accessible format such as large print or Braille, and that caused a delay.
  • Physical, mental, educational, or language limitations that delayed your filing, including time spent getting help from a State Health Insurance Assistance Program (SHIP) or senior center.

Include evidence supporting the circumstance you claim, whether that is a hospital record, a disaster declaration, or a written statement describing the barrier.9Centers for Medicare & Medicaid Services. Medicare Appeals Good Cause for Late Filing

Where to Send the Form

File your completed CMS-20033 with the QIC identified on your redetermination notice.5eCFR. 42 CFR 405.964 – Place and Method of Filing a Request for a Reconsideration Jurisdiction is split by claim type and geography. As of 2025:

  • Part A East: C2C Innovative Solutions. Mail, fax (904-539-4074), or online portal at c2cinc.com.
  • Part A West: Maximus, Inc. Mail, fax (585-869-3346), or online portal at qicappeals.cms.gov.
  • Part B North: C2C Innovative Solutions. Mail, fax (904-539-4081), or online portal at c2cinc.com.
  • Part B South: C2C Innovative Solutions. Mail, fax (904-539-4090), or online portal at c2cinc.com.
  • Durable Medical Equipment (DME): Maximus, Inc. Mail, fax (585-869-3314), or online portal at qicappeals.cms.gov.

Maps showing which QIC covers each state, along with mailing addresses, appear under “Downloads” on the CMS second-level appeal page.1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor The redetermination notice itself also identifies the correct QIC and includes filing instructions.

What Happens After You File

The QIC is an independent organization with no role in the original claim decision or the first-level redetermination. It reviews your request, the evidence you submitted, and the existing record, and generally sends a written decision to all parties within 60 days.1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor That clock can be extended if you submit additional evidence after your initial filing or if the QIC granted a late-filing extension.

The decision may reverse the denial in full or in part, uphold it, or modify the original determination. If the outcome is unfavorable, the notice will explain your rights to continue to the next level.

If the QIC misses the 60-day deadline, it must notify you and describe your right to escalate the appeal directly to the Office of Medicare Hearings and Appeals. Escalation is optional. You can wait for the QIC to finish, or file a written escalation request with the QIC following the instructions in that notice.1Centers for Medicare & Medicaid Services. Second Level of Appeal: Reconsideration by a Qualified Independent Contractor

If the Reconsideration Is Denied

An unfavorable reconsideration opens the door to a hearing before an Administrative Law Judge at OMHA. You have 60 days from the date you receive the QIC’s decision to file, using OMHA Form 100 by mail or through the OMHA e-Appeal Portal. Unlike reconsideration, the ALJ level requires a minimum amount in controversy of $200 for 2026, and you can combine claims to meet it.10Centers for Medicare & Medicaid Services. Third Level of Appeal: Decision by Office of Medicare Hearings and Appeals (OMHA)

One tactical point worth repeating: any evidence you did not submit to the QIC will require a good-cause showing at the ALJ level.7eCFR. 42 CFR 405.1028 – Review of Evidence Submitted by Parties Treat the reconsideration as your best chance to build the record.