PostalForm
Step 1 of 4Centers for Medicare & Medicaid Services · CMS-20033 · 01/20

CMS-20033 Medicare reconsideration request

PostalForm turns CMS-20033 into an online-native Medicare appeal workflow. You answer one step at a time, generate a clean PDF, attach the required redetermination notice, and mail the completed packet to the address listed in your Medicare appeal materials.

Current step
Beneficiary and claim details
Beneficiary name, Medicare number, and Item or service you want to appeal
This step
7 fields · 5 required

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Step 1

Beneficiary and claim details

Identify the beneficiary, the service or item, and the redetermination notice you are appealing.

5 required

Need more context?

The form is ready to fill now. If you want supporting instructions, mailing notes, or source links, they are below.

What you need+
  • Beneficiary name and Medicare number
  • The item or service being appealed
  • Date of service and date of the redetermination notice
  • Short explanation of why you disagree
  • Mailing address and phone number for the appellant
  • Copy of the redetermination notice
  • Copy of the redetermination notice (required) — CMS says to include a copy of the Medicare Redetermination Notice or Remittance Advice with this request.
  • Supporting evidence or statement (optional) — Attach evidence supporting the appeal, or a statement explaining what evidence you plan to submit and when.
How it works+
  1. Enter the beneficiary and claim details from the Medicare paperwork.
  2. Explain why the redetermination was wrong and add any extra information Medicare should consider.
  3. Choose whether you are submitting evidence and identify who is filing the appeal.
  4. Upload the redetermination notice and any supporting evidence, then mail the completed packet.
Where it gets mailed+

Enter the recipient address during checkout.

Packet order+
  • Cover sheet
  • Completed CMS-20033 form
  • Copy of the redetermination notice
  • Supporting evidence or statement of additional evidence
Common mistakes+
  • Mailing the packet without a copy of the redetermination notice.
  • Leaving out the claim explanation or writing only a very short disagreement statement.
  • Sending the packet to the wrong contractor instead of the QIC address listed in the appeal materials.
  • Skipping supporting evidence when you already have records that back up the appeal.
FAQs+
Can I fill out CMS-20033 online?

You can complete the information online with PostalForm, generate a clean CMS-20033 packet, and mail the finished form with the required attachments.

Do I need to attach the redetermination notice?

Yes. CMS instructs appellants to include a copy of the redetermination notice with the reconsideration request.

Where do I mail CMS-20033?

Mail it to the Qualified Independent Contractor listed in your Medicare appeal materials. The correct mailing address depends on the underlying appeal.

Sources+
Related+
Last verified+

Last Centers for Medicare & Medicaid Services verification: March 31, 2026