HHZ Respiratory Review

Medicare DME appeal: CPAP and oxygen step by step

2 min read By HHZ Editorial Next review

Original Medicare has 5 appeal levels. Start with a redetermination by the Medicare Administrative Contractor, filed by the date on your Medicare Summary Notice (120 days on the sample DME MSN); a decision usually comes within 60 days. Next come a QIC reconsideration (request within 180 days), an ALJ hearing ($200 minimum in 2026, request within 60 days), the Medicare Appeals Council (60 days) and federal court ($1,960 minimum in 2026). Source: Medicare.gov, checked 13 October 2026.

Sources: Medicare.gov Appeals in Original Medicare and sample DME Medicare Summary Notice, checked 13 October 2026. This is general information, not legal advice. Medicare Advantage plans have their own appeal process.

The 5 levels

LevelWho decidesDeadline to askDecision time2026 minimum amount
1. RedeterminationMedicare Administrative Contractor (MAC)Date on your MSN (120 days on the sample DME MSN)Generally 60 daysNone
2. ReconsiderationQualified Independent Contractor (QIC)180 days after the MAC decision or MSN60 daysNone
3. Hearing or record reviewOffice of Medicare Hearings and Appeals (ALJ)60 days after the QIC decisionNot stated$200
4. ReviewMedicare Appeals Council60 days after the ALJ decisionNot statedNone stated
5. Judicial reviewFederal district court60 days after the Council decisionNot stated$1,960

Filing a level 1 appeal

  1. Find the denied item on your Medicare Summary Notice.
  2. Either fill out the Redetermination Request Form, or circle the item on a copy of your MSN and explain in writing why you disagree.
  3. Include your name, address and Medicare Number, the items and dates, why they should be covered, and supporting information (for example a doctor’s note).
  4. Mail it to the address on the last page of your MSN.

Before you start, Medicare.gov suggests asking your supplier for information that could make your appeal stronger. If the denial was due to missing paperwork, the supplier may be able to resubmit the claim.

Common CPAP and oxygen denial reasons to check

Look at the MSN notes and check them against the coverage rules: CPAP adherence after the trial period (Medicare CPAP rules), oxygen qualifying tests (Medicare oxygen coverage) and resupply frequency (CPAP supplies schedule).

Verdict

File on time, attach your doctor’s records and keep copies of everything.

Related: Medicare CPAP coverage, Medicare oxygen coverage, DME assignment explained, ABN explained.

See also: appealing a Medicare Advantage denial.

Frequently asked questions

How long do I have to appeal a denied CPAP or oxygen claim?
For the first level (redetermination), file by the date on your Medicare Summary Notice. Medicare's sample DME MSN says you have 120 days. If you miss it, you may still appeal if you can show good cause.
How long does a Medicare appeal take?
Medicare.gov says the contractor generally decides a level 1 appeal within 60 days, and the QIC decides a level 2 reconsideration within 60 days.
What is the minimum amount for an ALJ hearing?
$200 in 2026 for level 3, and $1,960 for federal court review at level 5, per Medicare.gov. You may be able to combine claims to meet the level 5 amount.
What should I include?
Your name, address and Medicare Number; the items and dates you're appealing; why they should be covered; and any helpful information, like a doctor's note. Ask your supplier for documentation that could strengthen the appeal.
Can someone appeal for me?
Yes. Include an Appointment of Representative form or another written document with the required elements.

Advance Beneficiary Notice (ABN) for CPAP and oxygen

What a Medicare Advance Beneficiary Notice of Non-coverage (ABN) means when a CPAP, oxygen or DME supplier gives you one: the 3 options, appeal rights, unassigned suppliers and when no ABN is needed. From Medicare.gov and CMS.

Medicare Advantage appeal for CPAP or oxygen (2026)

How to appeal a Medicare Advantage plan's denial of CPAP, oxygen or other DME: organization determinations, the 65-day deadline, 30-day, 60-day and 72-hour timelines, automatic IRE review and the 2026 ALJ threshold. From Medicare.gov.

Medicare Advantage vs Original Medicare for DME

How Original Medicare and Medicare Advantage differ for durable medical equipment like CPAP and home oxygen: suppliers, prior authorization, costs, out-of-pocket limits, Medigap and travel, from Medicare.gov and CMS.

Medicare DME assignment explained (2026)

What 'accepts assignment' means for Medicare CPAP, oxygen and DME suppliers: participating vs non-participating, opt-out providers, rental months, upfront costs and the questions to ask. From Medicare.gov and CMS.