What is the difference between a redetermination and a reconsideration?

A redetermination is the first level of a Medicare Part A or Part B appeal, decided by MAC staff who were not involved in the original claim decision, and you have 120 days to request it. A reconsideration is the second level, an independent review of the record by a Qualified Independent Contractor, and you have 180 days from receipt of the redetermination decision to request it. Evidence you leave out at reconsideration may be excluded at later levels unless you show good cause.

What Is a Medicare Reconsideration?

Medicare reconsideration

Short answer

A Medicare reconsideration is the second level of appeal for Original Medicare Part A and Part B claims: an independent review of the administrative record, including the initial determination and the redetermination, by a Qualified Independent Contractor (QIC).

Last reviewed October 30, 2026 by the Remitwright billing team. Editorial policy

Also written asQualified Independent Contractor reviewQIC reconsiderationsMedicare reconsiderationsQualified Independent ContractorQICCMS-20033

When the MAC’s redetermination goes against you, the appeal leaves the MAC. A Qualified Independent Contractor reviews the whole administrative record, the initial determination and the redetermination included, and a panel of physicians or other health care professionals may review questions of medical necessity^1,2. As at the first level, no minimum amount has to be in controversy¹.

You have 180 days from receipt of the redetermination decision, presumed to arrive 5 days after the date on the notice, and you file with form CMS-20033 or a written request carrying the required elements¹. If the MAC dismissed your redetermination instead of deciding it, the request for QIC review of that dismissal is due within 60 days². The QIC generally issues its decision within 60 days of receiving the request; when it cannot, it explains how to escalate the case to the Office of Medicare Hearings and Appeals, the third level^1,2. Documents sent after the request is filed can extend the QIC’s time frame².

This is the level where the file has to be complete. Documentation not submitted at reconsideration may be excluded from consideration at later appeal levels unless there is good cause¹, so the records the redetermination notice said were missing belong in the reconsideration packet, not in a later hearing. Money already taken has its own deadline. To keep delaying recoupment of an appealed overpayment, the reconsideration request has to arrive within 60 days of the redetermination decision, well before the 180-day appeal deadline runs out³.

Example

Medicare reconsideration in practice

A MAC upholds the denial of a cardiac monitor on redetermination because physician notes were missing. The biller files form CMS-20033 with the QIC inside 180 days of the presumed receipt of that decision and includes the notes the redetermination notice listed as missing, since evidence held back now may not be heard later. Hypothetical example.

Medicare reconsideration

Medicare reconsideration in practice

A Medicare reconsideration is part of claim appeals, one of the services a dedicated biller runs for you.

Questions about a Medicare reconsideration