CMS Pub. 100-04, ch. 12, § 210

Regardless of the actual expenses a beneficiary incurs in connection with the treatment of

mental, psychoneurotic, and personality disorders while the beneficiary is not an inpatient

of a hospital at the time such expenses are incurred, the amount of those expenses that

may be recognized for Part B deductible and payment purposes is limited to 62.5 percent

of the Medicare approved amount for those services. This limitation is called the

outpatient mental health treatment limitation (the limitation). The 62.5 percent limitation

has been in place since the inception of the Medicare Part B program and it will remain

effective at this percentage amount until January 1, 2010. However, effective January 1,

2010, through January 1, 2014, the limitation will be phased out as follows:

• January 1, 2010 - December 31, 2011, the limitation percentage is 68.75%.

(Medicare pays 55% and the patient pays 45%).

• January 1, 2012 - December 31, 2012, the limitation percentage is 75%.

(Medicare pays 60% and the patient pays 40%).

• January 1, 2013 - December 31, 2013, the limitation percentage is 81.25%.

(Medicare pays 65% and the patient pays 35%).

• January 1, 2014 - onward, the limitation percentage is 100%.

(Medicare pays 80% and the patient pays 20%).

For additional details concerning computation of the limitation, please see the examples

under section 210.1 E.