C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER B—MEDICARE PROGRAM › PART 405—FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED › Subpart I—Determinations, Redeterminations, Reconsiderations, and Appeals Under Original Medicare (Part A and Part B)

42 C.F.R. § 405.1112

Content of request for review

Read at: eCFRecfr.gov CornellLII GovInfogovinfo.gov CasesGoogle Scholar

(a) The request for Council review must be filed with the entity specified in the notice of the ALJ's or attorney adjudicator's action. The request for review must be in writing and may be made on a standard form. A written request that is not made on a standard form is accepted if it contains the beneficiary's name; Medicare number; the specific service(s) or item(s) for which the review is requested; the specific date(s) of service; the date of the ALJ's or attorney adjudicator's decision or dismissal order, if any; and the name of the party or the representative of the party; and any other information CMS may decide.

(b) The request for review must identify the parts of the ALJ's or attorney adjudicator's action with which the party requesting review disagrees and explain why he or she disagrees with the ALJ's or attorney adjudicator's decision, dismissal, or other determination being appealed. For example, if the party requesting review believes that the ALJ's or attorney adjudicator's action is inconsistent with a statute, regulation, CMS Ruling, or other authority, the request for review should explain why the appellant believes the action is inconsistent with that authority.

(c) The Council will limit its review of an ALJ's or attorney adjudicator's actions to those exceptions raised by the party in the request for review, unless the appellant is an unrepresented beneficiary. For purposes of this section only, we define a representative as anyone who has accepted an appointment as the beneficiary's representative, except a member of the beneficiary's family, a legal guardian, or an individual who routinely acts on behalf of the beneficiary, such as a family member or friend who has a power of attorney.

[82 FR 5123, Jan. 17, 2017, as amended at 84 FR 19871, May 7, 2019]
Notes of Decisions
Cited in 9 cases (5 in the last 5 years), 2010–2026 · leading case: Palm Valley Health Care, Inc. v. Alex Azar, II, Se, 947 F.3d 321 (5th Cir. 2020).
Sort: Relevance Newest Treatment
Palm Valley Health Care, Inc. v. Alex Azar, II, Se, 947 F.3d 321 (5th Cir. 2020). “42 C.F.R. § 405.1112 (c). The regulation tells a party that it must inform the Appeals Council if it believes the ALJ’s ruling “is inconsistent with a statute, regulation, CMS ruling, or other authority.”
Rehab. Hosp. of Phenix City, LLC v. Becerra (M.D. Ala. 2024). · cites it 17× “” 42 C.F.R. § 405.1112 (a)–(b). Appeals to the Council may be made on a standard form, but it is not required.”
Morton Plant Hosp. Ass'n, Inc. v. Sebelius, 747 F. Supp. 2d 1349 (M.D. Fla. 2010). “See 42 C.F.R. § 405.1112 (b)-(c) (requiring a provider to specify issues for review by the Council).”
Encompass Health Rehab. Hosp. of Charleston, LLC v. Becerra (D.S.C. 2024). · cites it 15× “See 42 C.F.R. § 405.1112 (a). The fifth level of review is judicial review in a federal district court.”
Rehab. Hosp. of Phenix City, LLC v. Sec'y, U.S. Dept of Health & Human Servs. (11th Cir. 2025). · cites it 2× “” 42 C.F.R. § 405.1112 (b). It also provides that “if the party requesting review believes that the .”
New Lifecare Hospitals of North Carolina LLC v. Cochran (D.D.C. 2020). “2020) (citing 42 C.F.R. § 405.1112 (b), (c)). But the regulations here impose no such requirement.”
Encompass Health Rehab. Hosp. of Sarasota, LLC v. Becerra (M.D. Fla. 2024). “1112(b), the Council impermissibly treated Encompass differently than other providers by declining to offer a detailed analysis of Encompass’s appeals.”
Encompass Health Rehab. Hosp. v. Robert Kennedy, Jr. (4th Cir. 2026). “∗ First, it contends the district court erred in finding its requests for review before the Council didn’t satisfy the requirements of 42 C.F.R. § 405.1112 (b). Section 405.1112(b) specifies a “request for review must identify the parts of the ALJ’s .”
United Med. Healthcare, Inc. v. Dep't of Health & Human Servs., 889 F. Supp. 2d 832 (E.D. La. 2012). “We only want to appeal the decision on 14 of those claims”).”
Annotations are extracted automatically from the opinions in the Syfert caselaw corpus and ranked by authority, recency, and treatment. Dots show Syfertize treatment of the citing case itself.