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. § 405.966

Evidence to be submitted with the reconsideration request

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(a) Evidence submitted with the request. When filing a request for reconsideration, a party should present evidence and allegations of fact or law related to the issue in dispute and explain why it disagrees with the initial determination, including the redetermination.

(1) This evidence must include any missing documentation identified in the notice of redetermination, consistent with § 405.956(b)(6).

(2) Absent good cause, failure to submit all evidence, including documentation requested in the notice of redetermination prior to the issuance of the notice of reconsideration precludes subsequent consideration of that evidence.

(b) Evidence submitted after the request. Each time a party submits additional evidence after filing the request for reconsideration, the QIC's 60 calendar day decisionmaking timeframe is automatically extended by up to 14 calendar days for each submission. This extension does not apply to timely submissions of documentation specifically requested by a QIC, unless the documentation was originally requested in the notice of redetermination.

(c) Exception for beneficiaries and State Medicaid Agencies that file reconsideration requests. (1) Beneficiaries and State Medicaid Agencies that file requests for reconsideration are not required to comply with the requirements of paragraph (a) of this section. However, the automatic 14 calendar day extension described in paragraph (b) of this section applies to each evidence submission made after the request for reconsideration is filed.

(2) Beneficiaries who are represented by providers or suppliers must comply with the requirements of paragraph (a) of this section.

[70 FR 11472, Mar. 8, 2005, as amended at 74 FR 65334, Dec. 9, 2009]
Notes of Decisions
Cited in 8 cases (6 in the last 5 years), 2018–2025 · leading case: Sahara Health Care, Inc. v. Alex Azar, II, Secreta, 975 F.3d 523 (5th Cir. 2020).
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Sahara Health Care, Inc. v. Alex Azar, II, Secreta, 975 F.3d 523 (5th Cir. 2020). “§ 1395ff(b)(3); 42 C.F.R. § 405.966 (a)(2). Redetermination at step one and reconsideration at step two result in reasoned, written decisions.”
Infinity Healthcare Servs., Inc. v. Azar, 349 F. Supp. 3d 587 (S.D. Tex. 2018). “"); 42 C.F.R. § 405.966 (a) ("When filing a request for reconsideration, a party should present evidence and allegations of fact or law related to the issue in dispute and explain why it disagrees with the initial determination, including the redetermination.”
North Carolina Ins. Guar. Ass'n v. Xavier Becerra, 55 F.4th 428 (4th Cir. 2022). “” 42 C.F.R. § 405.966 . Third, if the insurer is not satisfied with the outcome of the reconsideration, it may request a hearing before an Administrative Law Judge (“ALJ”).”
Hospice of East Texas v. Sec'y, US Dep't of Health of Human Servs. (E.D. Tex. 2025). · cites it 2× “§ 1395ff(b)(3); 42 C.F.R. § 405.966 (a)(2)). According to the Secretary, “[t]o the extent the Magistrate Judge concluded that Dr.”
Angel's Touch Inc. v. Cochran (D. Ariz. 2021). “For example, 25 Medicare appeals do not permit the submission of new documentary evidence at the ALJ 26 stage, whereas in the Social Security context, new evidence can be submitted up to five 27 days before the ALJ process.”
Vein & Wellness Grp., LLC v. Becerra (D. Maryland 2022). “” Furthermore, 42 C.F.R. § 405.966 provides, “When filing a request for reconsideration, a party should present evidence and allegations of fact or law related to the issue in dispute and explain why it disagrees with the intitial determination, including the redetermination.”
Integrity Soc. Work Servs., LCSW, LLC v. AZAR (E.D.N.Y 2021). “42 C.F.R. § 405.966 . The QIC conducting the reconsideration must “review[] the evidence and findings upon which the initial determination, including the redetermination, was based, and any additional evidence the parties submit or that the QIC obtains on its own.”
Compass Lab'y Servs., LLC v. Becerra (W.D. Tenn. 2025). “§ 1395ff(b)(3); 42 C.F.R. § 405.966 (a)(2). Each step culminates in written explanations explaining decisions.”
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