Ultimate Guide to CPT 90839 & 90840: Avoid Denials Fast
- Sirius solutions global
- 3 days ago
- 10 min read
Mental health providers face unique challenges when billing for crisis services. Unlike routine therapy sessions, crisis psychotherapy demands immediate attention and different coding rules. That is where CPT codes 90839 and 90840 come in.
These codes exist for one specific purpose, billing psychotherapy services during a mental health crisis. They cannot be used for regular appointments or even emotional ones. The rules are strict, the documentation requirements are high and one billing mistake can cause a denial.
This guide walks you through everything you need to know about 90839 and 90840. You will learn when to use them, how to document properly, what Medicare and commercial payers expect and how to avoid the most common billing errors that cost practices thousands in lost revenue.
What Makes Crisis Psychotherapy Different?
Crisis psychotherapy is not just a difficult session. It is an urgent intervention for patients experiencing acute psychological distress that requires immediate clinical attention.
Regular therapy addresses ongoing mental health concerns through scheduled appointments. Crisis intervention responds to situations where a patient's safety or functioning is at immediate risk. The clinical urgency changes everything about how you code and bill.
Medicare and commercial insurers define crisis psychotherapy as services provided when a patient presents with a condition requiring immediate attention to prevent harm. The keyword is "immediate." If the patient could safely wait for a scheduled appointment, it is not a crisis under billing guidelines.
Common crisis situations include:
Active suicidal thoughts with plan or intent
Threats of harm to self or others
Severe decompensation requiring urgent stabilization
Acute psychotic episodes disrupting functioning
Grave disability preventing self-care
Severe trauma response requiring immediate intervention
Each of these scenarios represents a legitimate clinical crisis. Documentation must clearly establish why the situation could not wait and what immediate interventions prevented harm.
Understanding CPT Codes 90839 and 90840
CPT 90839 covers the first 30 to 74 minutes of crisis psychotherapy. The code represents comprehensive assessment and intervention during an acute mental health emergency.
CPT 90840 is an add-on code used for each additional 30 minutes beyond the first 74 minutes. You cannot bill 90840 alone. It always requires 90839 on the same date of service.
Both codes are time-based, which means exact documentation of minutes spent is mandatory. Estimates do not work. Payers audit these codes frequently because of higher reimbursement rates compared to routine therapy.
Here's the quick reference:
CPT 90839: Psychotherapy for crisis, first 60 minutes Actual time range: 30-74 minutes CPT 90840: Each additional 30 minutes Required base code: Must bill with 90839
These are not scheduled appointment codes. You cannot book a patient for "crisis therapy" next Tuesday. The crisis must be happening now, and your clinical documentation must prove it.
When to Use CPT Code 90839
Use 90839 when a patient presents in crisis requiring immediate psychological intervention and you provide between 30 and 74 minutes of face-to-face time.
The service must include four core elements. Miss even one, and you risk a denial.
Required clinical components:
Urgent crisis assessment - Evaluate the immediate threat and severity
Mental status examination - Document current cognitive and emotional state
Psychotherapy intervention - Provide therapeutic techniques to stabilize the patient
Safety planning and resource mobilization - Create concrete steps to prevent harm
You can only bill 90839 once per day, even if the patient calls back hours later in a crisis. If crisis services span midnight, you can bill again for the new date, but documentation must justify separate crisis episodes.
The time does not need to be continuous. If you spend 40 minutes with a patient in crisis, take a 15-minute break, then provide another 30 minutes of crisis intervention the same day, you can add the time together. Just document both time periods clearly.
You cannot bill 90839 with routine psychotherapy codes on the same day. This is a hard stop. If you see a patient for regular therapy and they later have a crisis, you must choose which service to bill. Most practices choose the crisis code because reimbursement is typically higher.
Adding CPT Code 90840 for Extended Sessions
Once you cross 75 minutes of crisis psychotherapy, you add 90840 to capture the additional time.
The magic number is 75 minutes. At 74 minutes, you bill only 90839. At 75 minutes, you bill 90839 plus one unit of 90840.
Time thresholds for add-on units:
75 to 104 minutes: 90839 + 90840 (one unit)
105 to 134 minutes: 90839 + 90840 x 2
135 to 164 minutes: 90839 + 90840 x 3
Medicare and most payers follow a midpoint rule for add-on time. You need to reach the midpoint of the next 30-minute block to bill another unit. That midpoint is 15 minutes. So 90 minutes gets one add-on, but you need 105 minutes for a second add-on.
Documentation should state total time spent, not individual segments. Write "Total crisis psychotherapy time: 92 minutes" rather than breaking it into smaller chunks. Payers want one number they can verify.
Time-Based Billing Rules You Must Follow
Getting the time calculation wrong causes more denials than any other mistake with these codes.
If you provide less than 30 minutes of crisis intervention, you cannot use 90839. You would bill a regular psychotherapy code instead, assuming clinical documentation supports it.
Here are real scenarios practices face:
15 minutes of crisis intervention: Bill 90832 or 90833 if appropriate
30 minutes: Bill 90839
45 minutes: Bill 90839
74 minutes: Bill 90839 (do not round up)
75 minutes: Bill 90839 + 90840
89 minutes: Bill 90839 + 90840 (only one add-on)
105 minutes: Bill 90839 + 90840 x 2
Time must be face-to-face or real-time interactive for telehealth. Preparation time, review of records, or consultation with other providers does not count toward the total.
Many practices use start and stop times rather than calculating totals during the session. Write "Crisis therapy start: 2:15 PM, end: 3:42 PM" to create an audit trail. Payers can verify the math.
Documentation Requirements That Prevent Denials
Strong documentation separates clean claims from denials. Payers scrutinize crisis codes because they reimburse higher than routine therapy.
Every crisis psychotherapy note must include:
Clear description of the crisis - What happened, when, and why it requires immediate attention
Mental status exam findings - Current presentation, thought process, risk assessment
Specific interventions used - Techniques applied to stabilize the patient and reduce immediate risk
Safety planning - Concrete steps to prevent harm, including resources mobilized
Treatment plan going forward - Next steps, follow-up arrangements, support system activation
Exact time documentation - Start/stop times or total minutes
Vague documentation kills claims. "Patient was upset and needed extra time" does not justify a crisis code. Compare that to: "Patient presented with active suicidal ideation, specific plan involving overdose, and stated intent to harm self tonight. Immediate crisis intervention provided including safety assessment, lethal means restriction, crisis hotline connection, and emergency contact notification."
The second example establishes medical necessity. The first invites a denial.
Many auditors specifically look for safety planning documentation. If you bill a crisis code without documenting a safety plan, you are asking for trouble. Show exactly what steps were taken to reduce immediate risk.
What You Cannot Bill With Crisis Codes
CPT 90839 and 90840 have Correct Coding Initiative edits that prevent billing with most other mental health codes on the same day.
You cannot bill these codes together:
90832, 90834, 90837 (routine psychotherapy)
90833, 90836, 90838 (psychotherapy with E/M)
90791, 90792 (diagnostic evaluations)
90785 (interactive complexity add-on)
Modifiers won't override these edits. Even modifier 59 or XE won't work because the edits are based on clinical logic, not just timing. You cannot provide crisis therapy and routine therapy on the same day to the same patient.
What happens if a scheduled session turns into a crisis?
You have to choose. Bill either the crisis code (90839) or the scheduled therapy code (90834, etc.). Most practices bill the crisis code because it typically reimburses more and the clinical documentation supports the higher acuity.
Some practices try to bill both by claiming separate sessions. This fails audits. The date of service is the same, and payers view mental health services as a single encounter regardless of gaps in time.
Crisis vs Routine Therapy: Key Differences
Understanding what separates crisis from routine care prevents coding errors and documentation gaps.
Crisis psychotherapy (90839/90840):
Addresses immediate psychological emergency
Patient safety at imminent risk
Requires urgent intervention, cannot wait
Time-based billing starting at 30 minutes
Higher documentation standards
Cannot combine with other therapy codes same day
Routine psychotherapy (90832-90838):
Treats ongoing mental health conditions
Scheduled appointments
Fixed time increments (30, 45, 60 minutes)
Can include E/M services with add-on codes
Standard documentation requirements
Part of established treatment plan
The clinical need drives the code selection. A patient crying about a divorce is not automatically a crisis. A patient with a loaded weapon making threats is. Documentation must support the urgency.
Who Can Bill These Codes and Where
Most licensed mental health professionals can bill 90839 and 90840 when working within their scope of practice.
Eligible providers include:
Psychiatrists (MD, DO)
Psychologists (PhD, PsyD)
Licensed Clinical Social Workers
Licensed Professional Counselors
Licensed Marriage and Family Therapists
Psychiatric Nurse Practitioners
Physician Assistants in psychiatric settings
Clinical Nurse Specialists in mental health
Approved settings:
Medical office or clinic
Hospital (inpatient or outpatient)
Patient's home
Skilled nursing facility
Community mental health center
Telehealth (with proper place of service codes)
Place of service codes matter for reimbursement. Office visits (POS 11) reimburse differently than hospital visits (POS 21 or 23). Some payers increase reimbursement by 50% or more for crisis services provided in non-office settings.
Telehealth billing for crisis codes expanded significantly during the pandemic and many policies remain in effect. Check current payer guidelines for your state.
Medicare Billing for Crisis Psychotherapy
Medicare covers CPT 90839 and 90840 under the Physician Fee Schedule. The codes are paid under fee-for-service Medicare Part B.
Medicare also created two alternative codes:
G0017: First 60 minutes of crisis psychotherapy (non-facility)
G0018: Each additional 30 minutes (non-facility)
These G-codes reimburse higher in non-office settings. When you provide crisis services in a patient's home, skilled nursing facility, or community location, G0017 and G0018 may pay up to 150% of the office rate.
Place of service determines which code set to use. For office-based crisis therapy, use 90839/90840. For home visits or other non-office locations, evaluate whether G0017/G0018 optimize reimbursement.
Medicare requires exact time documentation. Estimates trigger audits. Use start and stop times or document total minutes clearly in the medical record.
Telehealth rules for Medicare change regularly. As of 2025, Medicare continues to cover crisis psychotherapy via telehealth using place of service 02 or 10 with modifier 95. Verify current policies before billing.
Commercial Insurance Considerations
Commercial payers each have their own rules for crisis psychotherapy codes. United Healthcare's requirements differ from Aetna's, which differ from Blue Cross.
Most require pre-authorization for behavioral health services, but crisis codes may be exempt due to the urgent nature. Check contracts. Some plans allow retroactive notification within 24 to 48 hours.
Medical necessity documentation matters even more with commercial payers. They audit crisis codes frequently because of higher costs compared to routine therapy.
Common commercial payer requirements:
Detailed crisis description in clinical notes
Clear statement of imminent risk
Documentation of interventions that prevented harm
Safety plan with specific steps
Total time clearly stated
Proper place of service and modifiers
Some plans require modifier ET (emergency services) when applicable. Others want specific diagnosis codes that support crisis intervention. Review each payer's behavioral health policies.
Many commercial payers do not recognize G0017 and G0018. Stick with 90839 and 90840 unless the payer specifically instructs otherwise.
Telehealth Billing for Crisis Services
Telehealth opened access to crisis psychotherapy for patients who cannot reach an office immediately.
Medicare approved 90839 and 90840 for telehealth services. Use place of service 02 (telehealth provided other than in patient's home) or 10 (patient's home) with modifier 95.
Audio-only telehealth has limited coverage. Most payers require video for psychotherapy codes, though some states mandate audio-only parity for mental health services. Know your state laws.
Telehealth documentation must include:
Platform used (Zoom, Doxy.me, etc.)
Patient location
Provider location
Confirmation of HIPAA compliance
Same clinical documentation as in-person visits
Technology failures do not change time calculations. If you spend 60 minutes on a crisis call but the connection drops twice, you still bill for the 60 minutes of actual service time.
Parity laws in many states require commercial insurers to reimburse telehealth at the same rate as in-person services. If your state has parity protections, enforce them.
Common Billing Mistakes to Avoid
These errors account for most crisis psychotherapy denials we see practices submit.
Using crisis codes for non-urgent situations. A patient having a bad day is not a crisis. Documentation must prove immediate risk that could not wait.
Billing crisis and routine therapy the same day. You cannot do both. Choose the service that best represents the clinical encounter.
Missing or incomplete time documentation. "Approximately one hour" fails audits. Write exact start and stop times or total minutes.
Weak crisis justification. "Patient needed extra support" does not cut it. Describe the specific risk and why immediate intervention was necessary.
Wrong place of service codes. Billing office POS when services were provided at home costs you money. Use the actual location.
Ignoring modifier requirements. Some payers need modifier 95 for telehealth or ET for emergencies. Check contracts.
Failing to document safety planning. This is non-negotiable for crisis codes. Show exactly what steps prevented harm.
Audit your crisis claims quarterly. Look for patterns in denials and fix documentation gaps before they cost you more revenue.
Reimbursement Insights
Crisis psychotherapy codes reimburse higher than routine therapy because they reflect greater clinical intensity and longer time.
Payment varies based on several factors. Geographic location impacts rates through Medicare's geographic practice cost indices. Provider type matters as physician rates often exceed non-physician rates for the same code.
Setting affects payment significantly. As mentioned, non-facility crisis services can reimburse 50% higher than office-based care under some contracts.
Typical reimbursement factors:
Medicare rates: Set annually by CMS
Commercial rates: Negotiated in contracts
Medicaid rates: Vary by state
Telehealth adjustments: Parity laws may apply
Geographic modifiers: Affect final payment
Accurate billing protects revenue. If you provide 80 minutes of crisis therapy but only bill 90839 because you forgot the add-on code, you lose money. If you bill crisis codes for routine sessions, you risk audits and recoupment.
Best Practices for Clean Claims
Building strong billing processes around crisis codes reduces denials and protects revenue.
Train clinical staff on documentation requirements. Therapists must understand what payers need to see in crisis notes. Template prompts help ensure nothing gets missed.
Use crisis codes only when clinically appropriate. Do not code based on time alone. The clinical situation must justify the code.
Track time precisely. Use EHR timestamps, timers, or manual start/stop documentation. Never estimate.
Audit crisis claims regularly. Review 10-20 claims quarterly. Look for documentation gaps and denial patterns.
Create documentation templates. Include all required elements (crisis description, MSE, interventions, safety plan, time) to prevent omissions.
Verify payer policies. Medicare rules differ from commercial payers. Know what each requires.
Follow up on denials quickly. Most have 30-90 day appeal windows. Do not let revenue disappear.
Why Partner With Sirius Solutions Global
Behavioral health billing is complex. Crisis codes add another layer of rules, documentation requirements, and audit risk.
Sirius Solutions Global specializes in mental health revenue cycle management. We understand the nuances of 90839 and 90840 billing. Our team knows what payers look for in crisis documentation and how to prevent denials before they happen.
We help practices:
Reduce claim denials through expert coding review
Maximize reimbursement with proper code selection
Build documentation templates that satisfy auditors
Navigate payer-specific requirements
Train clinical teams on compliant documentation
Recover revenue from denied claims
Our denial rate for mental health claims averages under 5%, well below the industry standard of 15-20%. We achieve this through detailed knowledge of payer policies, regular audits, and ongoing staff education.
Whether you are a solo practitioner or a large behavioral health group, our scalable solutions adapt to your needs. We handle the billing complexity so you can focus on patient care.
Ready to improve your crisis psychotherapy billing? Contact Sirius Solutions Global today for a free consultation. Let's discuss how we can optimize your revenue cycle and reduce the administrative burden that keeps you from your patients.