My equipment was denied. Now what?
Pick the reason listed on your denial letter. We'll explain what it means and what to do next.
How to appeal, step by step
Each level has its own deadline. Miss one and you usually start over — put the dates on your calendar.
1Redetermination
Who reviews it: The Medicare contractor that denied the claim
120 days from the date on your Medicare Summary Notice
Most DME denials are paperwork problems. Attach the order, the face-to-face visit note, and the medical-necessity documentation before you argue anything else.
2Reconsideration
Who reviews it: An independent review entity (QIC)
180 days from the redetermination decision
Send every document now. New evidence is limited after this level.
3Administrative Law Judge hearing
Who reviews it: An administrative law judge (OMHA)
60 days from the reconsideration decision, if the amount in dispute meets the yearly minimum
You can appear by phone or video. Ask your prescriber to write one page explaining why no cheaper item works for you.
4Medicare Appeals Council
Who reviews it: The Departmental Appeals Board
60 days from the judge's decision
This level reviews whether the rules were applied correctly, not new facts.
5Federal district court
Who reviews it: A federal judge
60 days from the Council decision, if the amount in dispute meets the yearly minimum
Rare for equipment claims. Talk to a legal aid office or your State Health Insurance Assistance Program first.
What to put in your appeal packet
- The denial letter or Medicare Summary Notice (all pages)
- Your prescriber's written order, signed and dated
- The face-to-face or telehealth visit note that documents the need
- Chart notes showing what was already tried and why it did not work
- The supplier's itemized claim with the HCPCS code billed
- A short letter from you describing daily impact in your home
- Any prior authorization number or reference number you were given
Download your appeal packet
One PDF with the checklist, the steps with deadlines, and a personalized letter. Anything you leave blank prints as a line you can fill in by hand.
Educational information only — this is not an eligibility determination. Eligibility for VA health care, TRICARE, Medicare, Medicaid, and Marketplace coverage depends on your individual circumstances and official program rules, which can change. Confirm your own eligibility and coverage with the official source or the agency directly.