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LIST OF MODIFIERS

Modifier - as the name implies a modifier will modify a service / procedure or an item under certain circumstances for appropriate reimbur...

TFL for Each Level of Appeal


The time limits for filing appeals vary according to the type of appeal:

Redetermination - The time limit for filing a request for redetermination is 120 days from the date of receipt of the Medicare Summary Notice (MSN) or Remittance Advice (RA). 

QIC Reconsideration - The time limit for filing a request for reconsideration is 180 days from the date of receipt of the notice of the redetermination. If a party requests QIC review of a MAC’s dismissal of a request for redetermination, the time limit for filing is 60 days from the date of receipt of the MAC’s dismissal notice.

ALJ Hearing - The time limit for filing a request for an ALJ hearing is 60 days from the date of receipt of the reconsideration notice.

Appeals Council Review - The time limit for filing a request for review by the Appeals Council is 60 days from the date of receipt of the ALJ’s decision.

Judicial Review - The time limit for filing for judicial review is 60 days from the date of the Appeals Council's decision.

When the filing deadline for a redetermination ends on a Saturday, Sunday, legal holiday, or any other nonwork day, the MAC shall apply a rollover period that extends the filing deadline to the first working day after the Saturday, Sunday, legal holiday, or other nonwork day. For example, if the filing deadline for a redetermination falls on the Saturday before Columbus Day, the filing deadline is extended to the first working day after the Columbus Day holiday.

These time limits may be extended if 'GOOD CAUSE' for late filing is shown.

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