---
kind: "section"
citation: "42 C.F.R. § 405.800"
title: "42"
number: "405.800"
heading: "Appeals of CMS or a CMS contractor."
url: "https://uscodex.org/cfr/42/405.800"
---

# §405.800. Appeals of CMS or a CMS contractor.


A CMS contractor's (that is, a carrier, Fiscal Intermediary or Medicare Administrative Contractor (MAC)) determination that a provider or supplier fails to meet the requirements for Medicare billing privileges.

- (a) **Denial of a provider or supplier enrollment application.** If CMS or a CMS contractor denies a provider's or supplier's enrollment application, CMS or the CMS contractor notifies the provider or supplier by certified mail. The notice includes the following:
  - (1) The reason for the denial in sufficient detail to allow the provider or supplier to understand the nature of its deficiencies.
  - (2) **The right to appeal in accordance with part 498 of this chapter.**
  - (3) The address to which the written appeal must be mailed.
- (b) **Revocation of Medicare billing privileges—**
  - (1) **Notice of revocation.** If CMS or a CMS contractor revokes a provider's or supplier's Medicare billing privileges, CMS or a CMS contractor notifies the supplier by certified mail. The notice must include the following:
    - (i) The reason for the revocation in sufficient detail for the provider or supplier to understand the nature of its deficiencies.
    - (ii) **The right to appeal in accordance with part 498 of this chapter.**
    - (iii) The address to which the written appeal must be mailed.
  - (2) **Effective date of revocation.** The effective date of a revocation is as specified in [§ 424.535](/cfr/42/424.535.md) of this chapter.
  - (3) **Payment after revocation.** Medicare does not pay, and the CMS contractor rejects, claims for services submitted with a service date on or after the effective date of a provider's or supplier's revocation.
- (c) **Additional years applied to a reenrollment bar.**
  - (1) If, under [§ 424.535(c)(2)(i)](/cfr/42/424.535.md?p=c-2-i) of this chapter, CMS or a CMS contractor applies additional years to a provider's or supplier's existing reenrollment bar, CMS or the CMS contractor notifies the provider or supplier by certified mail. The notice includes the following:
    - (i) The reason for the application of additional years in sufficient detail to allow the provider or supplier to understand the nature of the action.
    - (ii) **The right to appeal in accordance with part 498 of this chapter.**
    - (iii) The address to which the written appeal must be mailed.
  - (2) [Paragraph (c)(1)](#c-1) of this section applies only to the years added to the existing reenrollment bar under [§ 424.535(c)(2)(i)](/cfr/42/424.535.md?p=c-2-i) of this chapter and not to the original length of the reenrollment bar, which is not subject to appeal.
- (d) **Scope of supplier.** For purposes of this subpart, the term “supplier” includes all of the following:
  - (1) The individuals and entities that qualify as suppliers under [§ 400.202](/cfr/42/400.202.md) of this chapter.
  - (2) **Physical therapists in private practice.**
  - (3) **Occupational therapists in private practice.**
  - (4) **Speech-language pathologists.**

## Notes

### Amendments

[77 FR 29028, May 16, 2012, as amended at 84 FR 47852, Sept. 10, 2019; 88 FR 79523, Nov. 16, 2023; 90 FR 55603, Dec, 2, 2025]

### Authority

Authority: Secs. 1102, 1866(j), and 1871 of the Social Security Act (42 U.S.C. 1302, 1395cc(j), and 1395hh).

### Source

Source: 77 FR 29028, May 16, 2012, unless otherwise noted.

### Authority

Authority: 42 U.S.C. 263a, 405(a), 1302, 1320b-12, 1395x, 1395y(a), 1395ff, 1395hh, 1395kk, 1395rr, and 1395ww(k).

### Amendments

[77 FR 29028, May 16, 2012, as amended at 84 FR 47852, Sept. 10, 2019; 88 FR 79523, Nov. 16, 2023; 90 FR 55603, Dec, 2, 2025]