Medicare Claims Processing Manual (Pub. 100-04), Ch. 5 § 100.4
Outpatient Mental Health Treatment Limitation
100.4 - Outpatient Mental Health Treatment Limitation
(Rev. 2736, Issued: 06-28-13, Effective: 10-01-12, Implementation: 10-07-13)
The Outpatient Mental Health Treatment Limitation (the limitation) is not applicable to
CORF services because CORFs do not provide services to treat mental, psychoneurotic
and personality disorders that are subject to the limitation in section 1833(c) of the Act.
For dates of service on or after October 1, 2012, HCPCS code G0409 is the only code
allowed for social work and psychological services furnished in a CORF. This service is
not subject to the limitation because it is not a psychiatric mental health treatment
service.
For additional information on the limitation, see Publication 100-01, Chapter 3, section
30 and Publication 100-02, Chapter 12, sections 50-50.5.