October 30, 2009

Medicare Claims Processing Transmittal 60: Outpatient Mental Health Treatment Limitation

The Centers for Medicare and Medicaid Services released instructions for its Medicare contractors on how to calculate payments for outpatient mental health treatment following the effective date of the Medicare Improvements for Patients and Providers Act of 2008. This document covers how the changes will be applied. Payment for outpatient mental health services will gradually reduce from 2010-2014. Effective January 1, 2014, the limitation will no longer exist and Medicare will pay outpatient mental health services at the same level as other Part B services. Hence, the limitation multiplier will change as follows: 2009 and prior years=62.5% 2010-2011=68.75%; 2012=75%; 2013=81.25%; and, 2014 and onward=100%. This transmittal has initial phase-in instructions and a simple description of the changes.