---
title: Fill Out CMS-20027 Online | Medicare Redetermination Request
description: Complete CMS-20027 online, generate the finished PDF, and mail your Medicare redetermination request with supporting documents.
seotitle: Fill Out CMS-20027 Online | Medicare Redetermination Request
seo-description: Complete CMS-20027 online, generate the finished PDF, and mail your Medicare redetermination request with supporting documents.
group: resources
indexable: true
llms: true
schema: webpage
tags:
  - medicare
  - appeals
  - claims
path: /forms/cms-20027
---
# Fill Out CMS-20027 Online | Medicare Redetermination Request

Complete CMS-20027 online, generate the finished PDF, and mail your Medicare redetermination request with supporting documents.

## How it works
1. **Fill out the form** - Complete the guided fields online.
2. **Add attachments** - Upload any required documents.
3. **Preview the PDF** - Review the final form before mailing.
4. **Mail it** - We print and mail the packet for you.


## Form summary
CMS-20027 is used to request a redetermination (first-level Medicare appeal) for a claim decision.

## What you need
- Beneficiary identifying information
- Claim item or service details
- Reason you disagree with the determination
- Appellant contact details and mailing address
- Signed form (wet signature required)
- Supporting appeal evidence (optional) (optional) — Attach claim notices, medical records, or other documentation supporting your redetermination request.

## Data collected
- Beneficiary name and Medicare number
- Appealed item or service and key determination dates
- Reason for disagreement and supporting details
- Appellant identity and contact information

## Where it gets mailed
You will enter the recipient address during checkout.

## Packet order
- Cover sheet (auto-generated)
- Completed form PDF
- Attachments (in the order you upload)

## Agent summary
This workflow collects beneficiary, appeal, and appellant contact details required to prepare CMS-20027 for mailing.

## For assistants
Use the Forms Draft API to prefill this form and generate a preview PDF.
- Endpoint: `POST /api/forms/cms-20027/drafts`
- Payload: `{ fields: { ... }, attachments: [{ id, label, base64 }] }`
- Required fields: beneficiary_name, medicare_number, item_or_service, medicare_contractor_name, overpayment_involved, disagreement_reason, evidence_to_submit, person_appealing, appellant_name, appellant_street, appellant_city, appellant_state, appellant_zip, appellant_phone
- Attachment IDs: supporting_documents

## LLM field schema
```json
[
  {
    "id": "beneficiary_name",
    "label": "Beneficiary name (first, middle, last)",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "beneficiary-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "medicare_number",
    "label": "Medicare number",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "beneficiary-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "item_or_service",
    "label": "Item or service you are appealing",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "beneficiary-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "service_received_date",
    "label": "Date service or item was received",
    "type": "text",
    "required": false,
    "meta_class": "date",
    "ui_width": null,
    "group_id": "beneficiary-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "initial_determination_notice_date",
    "label": "Date of the initial determination notice",
    "type": "text",
    "required": false,
    "meta_class": "date",
    "ui_width": null,
    "group_id": "beneficiary-info",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "late_filing_reason",
    "label": "Reason for late filing (if submitted after deadline)",
    "type": "textarea",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "medicare_contractor_name",
    "label": "Name of the Medicare contractor that made the determination",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "overpayment_involved",
    "label": "Does this appeal involve an overpayment? (for providers and suppliers only)",
    "type": "radio",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "disagreement_reason",
    "label": "Why you disagree with the determination decision",
    "type": "textarea",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "additional_information",
    "label": "Additional information Medicare should consider",
    "type": "textarea",
    "required": false,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "evidence_to_submit",
    "label": "Will you submit evidence with this appeal?",
    "type": "radio",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appeal-details",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "person_appealing",
    "label": "Who is submitting this appeal?",
    "type": "radio",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_email",
    "label": "Email of person appealing (optional)",
    "type": "text",
    "required": false,
    "meta_class": "email",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_name",
    "label": "Name of person appealing (first, middle, last)",
    "type": "text",
    "required": true,
    "meta_class": "name",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_street",
    "label": "Street address of person appealing",
    "type": "text",
    "required": true,
    "meta_class": null,
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_city",
    "label": "City",
    "type": "text",
    "required": true,
    "meta_class": "city",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_state",
    "label": "State",
    "type": "text",
    "required": true,
    "meta_class": "state",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_zip",
    "label": "ZIP code",
    "type": "text",
    "required": true,
    "meta_class": "zip",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appellant_phone",
    "label": "Telephone number of person appealing",
    "type": "text",
    "required": true,
    "meta_class": "phone",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  },
  {
    "id": "appeal_date",
    "label": "Date of appeal (optional)",
    "type": "text",
    "required": false,
    "meta_class": "date",
    "ui_width": null,
    "group_id": "appellant-contact",
    "choice_group": null,
    "choice_label": null,
    "visibility": null,
    "compound_subfields": null
  }
]
```

## Sources
- [CMS Form Page (CMS-20027)](https://www.cms.gov/medicare/cms-forms/cms-forms/cms-forms-items/cms020385)
- [CMS-20027 PDF](https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms20027.pdf)
- [Medicare Appeals Overview](https://www.medicare.gov/claims-appeals/how-do-i-file-an-appeal)
- [Official instructions](https://www.cms.gov/medicare/cms-forms/cms-forms/cms-forms-items/cms020385)
- [Official PDF](https://www.cms.gov/medicare/cms-forms/cms-forms/downloads/cms20027.pdf)

## Last verified
2026-03-21


## FAQs
- **Who should receive CMS-20027?** Send it to the Medicare Administrative Contractor identified on your Medicare Summary Notice or initial determination notice.
- **Can I include extra evidence?** Yes. You can attach records or documents that support your appeal.
- **Is this the first step in a Medicare appeal?** Yes. Redetermination is the first level of the Medicare claims appeal process.


## Related
- [CMS-20033 - Medicare Reconsideration Request](/forms/cms-20033)
- [CMS-20031 - Transfer of Appeal Rights](/forms/cms-20031)
- [CMS-1490S](/forms/cms-1490s)
- [CMS-20027 Medicare redetermination guide](/health-insurance/cms-20027-medicare-redetermination-guide)
- [CMS-20031 transfer of appeal rights guide](/health-insurance/cms-20031-transfer-of-appeal-rights-guide)
- [Fill out official PDF forms online](/fill-out-official-pdf-forms-online)