(Medicare General Information, Eligibility, and Entitlement)

30 - Outpatient Mental Health Treatment Limitation  (Rev. 60, Issued: 10- 30-09, Effective: 01 -01-10, Implementation: 01- 04-10)  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.  The 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 the outpatient mental health treatment limitation, please see the Medicare Claims Processing Manual, Publication 100- 04, chapter 9, section 60 and chapter 12, section 210.  40 - Limitation on Physical Therapy, Occupational Therapy and Speech -Language Pathology Services  (Rev. 28; Issued:  08- 12-05; Effective/Implementation:  09 -12-05)  Coverage of outpatient physical therapy, occupational therapy, and speech- language pathology services under Part B has been limited in some years.  For descriptions of these limitations see Pub 100 -04, Chapter 5, 10.2.  Transmittals Issued for this Chapter  Rev #  Issue Date  Subject  Impl Date  CR#  R12307GI   10/19/2023  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2024  01/02/2023  13365  R11641GI  10/13/2022  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2023  01/03/2023  12903  R11136GI  11/30/2021  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2022  01/03/2022  12507  R10880GI  08/06/2021  Internet Only Manual Updates to Pub. 100 -01, 100- 02, and 100- 04 to Implement Consolidated Appropriations Act Changes and Correct Errors and Omissions (SNF)  11/08/2021  12009  R10469GI  11/20/2020  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year (CY) 2021  01/04/2021  12024   11/22/2019  Update to Medicare Deductible, Coinsurance and Premium Rates for 2020  01/06/2020  11542  R119GI  11/02/2018  Update to Medicare Deductible, Coinsurance and Premium Rates for 2019  01/07/2019  11025  R111GI  12/08/2017  Update to Medicare Deductible, Coinsurance and Premium Rates for 2018  01/02/2018  10405  R103GI  12/02/2016  Update to Medicare Deductible, Coinsurance and Premium Rates for 2017  01/03/2017  9902  R96GI  11/25/2015  Update to Medicare Deductible, Coinsurance and Premium Rates for 2016  01/04/2016  9410  R89GI  11/21/2014  Update to Medicare Deductible, Coinsurance and Premium Rates for 2015  01/05/2015  8982  R82GI  11/15/2013  Update to Medicare Deductible, Coinsurance and Premium Rates for 2014  01/06/2014  8527  R81GI  12/07/2012  Update to Medicare Deductible, Coinsurance and Premium Rates for 2013  01/07/2013  8052  R80GI  10/26/2012  Manual Updates to Clarify SNF Claims Processing  04/01/2013  8044  R74GI  12/16/2011  Update to Medicare Deductible, Coinsurance and Premium Rates for 2011  01/03/2012  7567  R72GI  11/18/2011  Update to Medicare Deductible, Coinsurance and Premium Rates for 2011  Rescinded and replaced by Transmittal 74  01/03/2012  7567  R65GI  11/19/2010  Update to Medicare Deductible, Coinsurance and Premium Rates for 2011  01/03/2011  7224  R61GI  11/13/2009  Update to Medicare Deductible, Coinsurance and Premium Rates for 2010  01/04/2010  6690  R60GI  10/30/2009  Outpatient Mental Health Treatment Limitation  01/04/2010  6686  R56GI  11/17/2008  Update to Medicare Deductible, Coinsurance and Premium Rates for 2009  01/05/2009  6258  R55GI  11/07/2008  Update to Medicare Deductible, Coinsurance and Premium Rates for 2009 -  Rescinded and replaced by Transmittal 56  01/05/2009  6258  R49GI  12/14/2007  Update to Medicare Deductible, Coinsurance and Premium Rates for 2008  01/07/2008  5830  R41GI  10/27/2006  Update to Medicare Deductible, Coinsurance and Premium Rates for 2007  01/02/2007  5345  R31GI  11/04/2005  Update to Medicare Deductible, Coinsurance and Premium Rates for 2006  01/03/2006  4132  R28GI  08/12/2005  Conforming Changes for Change Request 3648 to Pub. 100 -01 09/12/2005  3912  R18GI  03/04/2005  Billing for Blood and Blood Products Under the Hospital Outpatient Prospective Payment System (OPPS)  07/05/2005  3681  R12GI  10/22/2004  New Policy and Refinements on Billing Noncovered Charges to Fiscal Intermediaries (FIs)  04/04/2005  3416  R11GI  10/22/2004  Manual Revision Regarding Waiver of Annual Deductible and Coinsurance for Both ASC Facility, and ASC/Hospital Outpatient Department Physician Services  11/22/2004  3471  R10GI  09/10/2004  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year 2005  01/03/2005  3463  R09GI  09/03/2004  Update to Medicare Deductible, Coinsurance and Premium Rates for Calendar Year 2005  01/03/2005  3463  R03GI  03/12/2004  New Part B Annual Deductible  01/03/2005  3121  R01GI  09/11/2002  Initial Publication of Manual  NA NA  Back to top of Chapter