Payment amounts.

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:
(c) General formula. A general formula for calculating the amount of Medicare payment and the patient liability for outpatient mental health services subject to the limitation is 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.

Source

42 CFR § 410.155


Scoping language

Limitation. For services subject to the limitation as specified in paragraph (b) of this section, the percentage of the expenses incurred for such services during a calendar year that is considered incurred expenses under Medicare Part B when determining the amount of payment and deductible under 410.152 and 410.160 of this part, respectively, is as follows:
(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.

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