CMS-20033 Medicare Reconsideration Request form – 2nd level of appeal

June 25, 2018

Medicare Form Summary

You’ll need the CMS-20033 form if Medicare denies your first appeal.

What you’ll need:

• Name and Medicare number
• Service or item you wish to appeal
• Date the service or item was received
• A clear explanation of why you disagree with the redetermination decision
• Any evidence that supports your claim, including information provided by your doctor

Other important information:

• Medicare’s redetermination decision will be communicated through a Medicare Redetermination Notice (MRN), a Medicare Summary Notice (MSN), or a Remittance Advice (RA).
• This form must be filed within 180 days of receiving your Redetermination Request denial.

Kayla Pearce

Kayla Pearce is a Content Developer at Medicare World in Memphis, TN. She has backgrounds in professional and creative writing and over a decade of experience in research and editing. She is deeply interested in literature, poetry, cats, and dessert.