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. § 405.942

Time frame for filing a request for a redetermination

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(a) Time frame for filing a request. Except as provided in paragraph (b) of this section, any request for redetermination must be filed within 120 calendar days from the date a party receives the notice of the initial determination.

(1) For purposes of this section, the date of receipt of the initial determination will be presumed to be 5 calendar days after the date of the notice of initial determination, unless there is evidence to the contrary.

(2) The request is considered as filed on the date it is received by the contractor.

(b) Extending the time frame for filing a request. General rule. If the 120 calendar day period in which to file a request for a redetermination has expired and a party shows good cause, the contractor may extend the time frame for filing a request for redetermination.

(1) How to request an extension. A party may file a request for an extension of time for filing a request for a redetermination with the contractor. The party should include any evidence supporting the request for extension. The request for redetermination extension must—

(i) Be in writing;

(ii) State why the request for redetermination was not filed within the required time frame; and

(iii) Meet the requirements of § 405.944.

(2) How the contractor determines if good cause exists. In determining if a party has good cause for missing a deadline to request a redetermination, the contractor considers—

(i) The circumstances that kept the party from making the request on time;

(ii) If the contractor's action(s) misled the party; and

(iii) If the party had or has any physical, mental, educational, or linguistic limitations, including any lack of facility with the English language, that prevented the party from filing a timely request or from understanding or knowing about the need to file a timely request.

(3) Examples of good cause. Examples of circumstances when good cause may be found to exist include, but are not limited to, the following situations:

(i) The party was prevented by serious illness from contacting the contractor in person, in writing, or through a friend, relative, or other person; or

(ii) The party had a death or serious illness in his or her immediate family; or

(iii) Important records of the party were destroyed or damaged by fire or other accidental cause; or

(iv) The contractor gave the party incorrect or incomplete information about when and how to request a redetermination; or

(v) The party did not receive notice of the determination or decision; or

(vi) The party sent the request to a Government agency in good faith within the time limit, and the request did not reach the appropriate contractor until after the time period to file a request expired.

[70 FR 11472, Mar. 8, 2005, as amended at 74 FR 65333, Dec. 9, 2009]
Notes of Decisions
Cited in 4 cases (2 in the last 5 years), 2011–2025 · leading case: Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014).
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Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014). “42 C.F.R §§ 405.942(a), 405.944(b). The provider must explain the basis for its disagreement with the determination and may submit any relevant evidence.”
Haro v. Sebelius, 789 F. Supp. 2d 1179 (D. Ariz. 2011). “31, Attachment E at BS 305); 42 C.F.R. § 405.942 (a) (filing for redetermination); 42 U.”
First United Methodist Church v. Becerra (D. Neb. 2022). · cites it 3× “” 42 C.F.R. § 405.942 (a). “[T]he date of receipt of the initial determination will be presumed to be 5 calendar days after the date of the notice of initial determination, unless there is evidence to the contrary.”
Ashli Healthcare, Inc. v. Kennedy (E.D. Cal. 2025). “42 C.F.R. §§ 405.942 (a), 10 405.980(c). 11 Because prepayment review of all of the over 1 billion 12 annual Medicare claims would be unfeasible, Medicare relies in 13 part on post-payment audits to ensure the claims are medically 14 necessary and meet the requirements of the…”
— 42 C.F.R. § 405.942(a) — 1 case
Cgi Fed. Inc. v. United States, 118 Fed. Cl. 337 (Fed. Cl. 2014). “42 C.F.R §§ 405.942(a), 405.944(b). The provider must explain the basis for its disagreement with the determination and may submit any relevant evidence.”
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