Code of Federal Regulations Title 42. Public Health § 42.410.155 Outpatient mental health treatment limitation

(1) For expenses incurred in years before 2010, 62 1/2 percent.

(2) For expenses incurred in 2010 and 2011, 68 3/4 percent.

(3) For expenses incurred in 2012, 75 percent.

(4) For expenses incurred in 2013, 81 1/4 percent.

(5) For expenses incurred in CY 2014 and subsequent years, 100 percent.

(1) Services subject to the limitation. Except as specified in paragraph (b)(2) of this section, services furnished by physicians and other practitioners, whether furnished directly or incident to those practitioners' services, are subject to the limitation if they are furnished in connection with the treatment of a mental, psychoneurotic, or personality disorder (that is, any condition identified by a diagnosis code within the range of 290 through 319) and are furnished to an individual who is not an inpatient of a hospital:

(2) Services not subject to the limitation. Services not subject to the limitation include the following:

(3) Payment amounts. The Medicare payment amount and the patient liability amounts for outpatient mental health services subject to the limitation for each year during which the limitation is phased out are as follows:

(1) Multiply the Medicare approved amount by the percentage of incurred expenses that is recognized as incurred expenses for Medicare payment purposes for the year involved;

(2) Subtract from this amount the amount of any remaining Part B deductible for the patient and year involved;  and,

(3) Multiply this amount by 0.80 (80 percent) to obtain the Medicare payment amount.

(4) Subtract the Medicare payment amount from the Medicare-approved amount to obtain the patient liability amount.