HI 00610.490 Noninpatient Psychiatric Services Limitation Computation

To compute the benefit:

  1. Consider all noninpatient psychiatric reasonable charges up to a maximum of $500, whether or not applied to the deductible.

  2. Multiply by .625.

  3. Subtract any unsatisfied deductible.

  4. Multiply by 8.

Example

In 1982, a patient had psychiatric treatment while not an inpatient and incurred total reasonable charges of $600. The benefit payable is computed as follows: $500 (maximum charges allowable) ×.625=$312.50. Since no part of the deductible has been satisfied for the year, subtract $75, leaving $237.50. The benefit payable is $190 (80 percent of $237.50).


To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0600610490
HI 00610.490 - Noninpatient Psychiatric Services Limitation Computation - 09/15/1989
Batch run: 01/27/2009
Rev:09/15/1989