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Appeals - Level 4: Review by the Medicare Appeals Council (Appeals Council)

To request that the Medicare Appeals Council (Appeals Council) review the ALJ's decision in your case, follow the directions in the ALJ's hearing decision you got in level 3. You must send your request to the address listed in the ALJ's hearing decision. You can file a request for Appeals Council review in 1 of 2 ways:

  1. Fill out a "Request for Review of an Administrative Law Judge (ALJ) Medicare Decision/Dismissal" form.
  2. Submit a written request to the Appeals Council that includes:
    • Your name and Medicare number. If you've appointed a representative, include the name of your representative.
    • The specific item(s) and/or service(s) and specific date(s) of service you're appealing. See your MSN or your ALJ hearing decision for this information.
    • A statement identifying the parts of the ALJ's decision with which you disagree and an explanation of why you disagree.
    • The date of the ALJ decision.
    • Your signature. If you've appointed a representative, include the signature of your representative.
    • If you're requesting that your case be moved from the ALJ to the Appeals Council because the ALJ hasn't issued a timely decision, include the hearing office in which the request for hearing is pending.

For more information about the Appeals Council review process, visit the Medicare Operations Division website, or call 1-800-MEDICARE.  

Note

If you want your doctor or other prescriber (for prescription drug appeals) to request this level of appeal on your behalf, you’ll need to submit an “Appointment of Representative” form.

In most cases, the Appeals Council will send you a written decision within 90 days of getting your request. If the Appeals Council doesn't issue a timely decision, you can ask the Appeals Council to move your case to the next level of appeal.

If you disagree with the Appeals Council's decision in level 4, you have 60 days after you get the Appeals Council's decision to request judicial review by a federal district court.