Providing emergency care for a patient in crisis can be stressful, and figuring out how to bill for the session afterwards only adds additional strain. Don’t worry: We’re here to help.
Here’s what you need to know about crisis CPT codes, 90839 and 90840.
Want to learn more about CPT codes? Read A Quick Overview of CPT Codes on our blog.
What are 90839 and 90840?
The CPT codes 90839 and 90840 are used for emergency sessions with patients who are in high distress and under complex or life-threatening circumstances that demand immediate attention. Examples of this may include patients who display suicidal intent, disabling anxiety, or other overwhelming psychological symptoms.
It’s important to note that 90840 is an add-on code that must be used in conjunction with 90839. In a crisis scenario, 90839 is billed for the first 60 minutes (though it can be used for 30-74-minute sessions), and 90840 is billed for each additional 30 minutes. Using both of these codes together requires that the session lasts 75 minutes or longer. If you don’t meet the time required to bill one or both of these two crisis codes, you can bill the standard CPT code for the session, such as 90832 (Individual psychotherapy, 30 minutes).
How to handle a crisis
According to the CPT manual, 90839 and 90840 report an urgent assessment, which includes a history of a crisis state, a disposition, and a mental status exam. Treatment should include:
- Psychotherapy
- Mobilization of resources to defuse the crisis and restore safety
- Provision of psychotherapeutic intervention to minimize emotional trauma
Some states have more specific requirements for how therapists should handle a crisis, so make sure you check your local guidelines.
Documenting medical necessity
When billing crisis codes, make sure the following is mentioned in your documentation, and that it’s clear and easy to find:
- A preliminary assessment of risk, mental status, and medical stability
- The need for further evaluation or referral to other mental health services (if applicable)
- Communication with contacts who may have pertinent information for the assessment
- Substance use (if applicable)
- Outcome of the session
While there are many different scenarios that call for crisis intervention, one of the common presentations is suicidal ideation. A great resource is the SAFE-T, though many other resources are available as well.
Billing to insurance
In general, 90839 can only be reported once per day, though the time does not need to be continuous, and depending on the payer, 90840 may have limits on how many times per day it can be reported. You may also be limited by how many times per month or year you can bill these codes, depending on where you provide service. Check your local .
Because 90839 and 90840 are used for crises, you can’t bill these codes in conjunction with the following standard therapy codes:
- 90791 and 90792 (initial evaluations)
- 90832, 90834, and 90837 (psychotherapy)
- 90875 (interactive complexity)
Medicare doesn’t always reimburse crisis situations, and other carriers make their own decisions about whether to cover them. Because of this, APA Practice Organization recommends listing the fee you think is appropriate for the session, with the understanding that it may not be covered by Medicare and that private insurers may limit the amount you can bill.
We’ll cover other codes in future posts, so make sure to subscribe to the TherapyNotes™ blog for more.
Sources: CPT® (Current Procedural Terminology), American Medical Association; More Q&As about the New Psychotherapy Codes, APA Practice Organization; More FAQs on payment for psychotherapy codes, APA Practice Organization; Interactive Complexity, American Academy of Child & Adolescent Psychiatry; Behavioral Health CPT Code Changes for 2013, Anthem Insurance Companies; Most Frequently Used CPT* Codes, National Association of Social Workers; Medical Necessity Criteria, Magellan Health; SAFE-T, Substance Abuse and Mental Health Services Administration
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Psychotherapy CodesCPT® CodeDescriptor90832Psychotherapy, 30 minutes with patient90834Psychotherapy, 45 minutes with patient90837Psychotherapy, 60 minutes with patient90845Psychoanalysis90846Family psychotherapy (without the patient present), 50 minutes90847Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes90849Multiple-family group psychotherapy90853Group psychotherapy (other than of a multiple-family group)
The time for each psychotherapy code is described as time spent with the patient and/or family, and although the time for each code is specific (30, 45, or 60 minutes), the coding manual allows for some flexibility.
When reporting a psychotherapy service, the provider may apply the CPT “Time Rule” and choose the code closest to the actual time of the session:
CPT CodeTotal Duration of Psychotherapy Session9083216–37 minutes9083438–52 minutes9083753 or more minutes90846, 9084726 or more minutes
There are “add-on” codes for specific services that can be provided only in combination with other diagnostic evaluation, psychotherapy, and group psychotherapy services. Add-on codes identify an additional part of the treatment above and beyond the principal service. Both the principal service code and add-on code should be listed on the billing form.
There are psychotherapy services that can be provided via telehealth. See the telehealth services web page.
CPT Code 90839 is a procedure code for licensed mental health providers rendering crisis therapy or psychotherapy for crisis.
Our 90839 billing and coding guide will teach you how to bill for crisis therapy sessions, explain the timeline for 90839 billing, license requirements, and how to bill for extended crisis therapy and telehealth crisis therapy as well.
We’ll also teach you about add-on CPT Code 90840 for each additional 30 minutes beyond the first 90 minutes of crisis therapy treatment (how to bill +90840).
Article Index
If you’d rather skip all of this and get help, consider hiring our mental health insurance billing service (our rates fit your practice size). If you’re brave, read on.
CPT Code 90839 Definition
90839 is defined as Psychotherapy for crisis, first 60 minute.
Along with add-on code 90840 it falls into a subgroup of crisis psychotherapy procedure codes.
CPT Code 90839 License Level Requirements:
Therapy for crisis can be billed by:
- Licensed Clinical Social Workers (LCSW)
- Licensed Professional Counselors (LPC)
- Licensed Marriage Family Therapist (LMFT)
- Clinical Psychologists (PsyD PhD)
- Psychiatrists (MD)
90839 Time Requirement
90839 is a crisis procedure code but also has a time requirement. If the session falls short of the 60 minute time requirement you can bill a routine procedure code, such as 90834 or 90832 depending on the time elapsed.
Make sure to document the time spent to ensure you can bill this code.
CPT Code 90839 Time Length: 60-90 Minutes
How do you bill more than 90 minutes of crisis therapy? Use Add-on code 90840.
CPT Code 90840 Description:
90840 Add-On service code describes an billing an additional 30 minutes of crisis therapy services rendered after the first 90 minutes of treatment.
CPT Code 90840 Time Length:
Each additional 30 minutes of crisis psychotherapy after the first 90 minutes of services.
90839 Reimbursement Rate 2022: $157.66
CPT Code 90840 Reimbursement Rate 2022: $78.64
(Source)
2020 Medicare 90840 Reimbursement Rate: $70.74
(Source)
CPT Code 90839 Billing Checklist:
- Telehealth Session?
- Use POS 02 + 95 or GT Telehealth Modifier
- Over 90 Minutes?
- Use +90840
- After Hours?
- Use 99050 or 99051
CPT Code 90839 Reimbursement
CPT Code 90839 typically pays slightly more than CPT code 90837 for a 60 minute individual psychotherapy session. 90840 pays a similar rate per time period, about half of what 90839 allows.
Medicare has published CPT Code 90839 Reimbursement Rates for 2020 as:
CPT Code 90839 – Therapy for Crisis – Medicare Reimbursement: $157.66
— 60 to 90 minute session for crisis therapy services
CPT Code 90840 – Extended Therapy for Crisis – Medicare Reimbursement: $78.64
— Over 90 minute crisis therapy session
CPT Code 99050 – Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed
Not Covered by Medicare. This code is for commercial insurance companies and may be approved on a case by case basis.
CPT Code 99051 – Services provided in the office during regularly scheduled evening, weekend, or holiday office hours.
Not Covered by Medicare. This code is for commercial insurance companies and may be approved on a case by case basis.
Crisis Therapy Billing Recommendations
We know many providers are not perfectly billing their crisis therapy sessions. If you would like help doing so, reach out to our mental health insurance billing service for assistance.
CPT Code 90839 Billing Recommendations:
- Use the appropriate diagnosis and add multiple diagnoses.
- Use specified diagnoses (instead of general Dx).
- Perform services for 2 hours and bill 90839 + 90840
- If your services are performed out of normal business hours, use add-on CPT code 99050. If they’re during scheduled holiday, weekend, or evening hours use CPT addon code 99051.
- Crisis sessions are not scheduled so perform an authorization phone call within 24 business hours after the session has been performed. (We do this for you.)
90839 vs 90840 for an Extended Crisis Session
90840 is an add-on code that can be billed for longer crisis sessions. In order to bill 90840, the session must be 30 minutes longer (90 minutes in this case).
If you are going to bill CPT code 90840, use 90839 as the primary CPT code. Your billing will look like 90839 +90840.
After Hours Crisis Therapy Billing Guide
Make sure to code all your claims accurately.
Question: Did you perform crisis therapy outside of normal business hours? Make sure to add CPT Code 99050.
If you’re performing crisis therapy during a holiday, weekend, or evening hours that are scheduled, use CPT Code 99051.
Crisis therapy sessions are never known about before the fact, obviously; they are performed in crisis.
Telehealth Crisis Therapy Recommendations
In 2020, telehealth therapy has become the norm. Ensure you are billing crisis via telehealth with the appropriate place of service codes and modifiers.
Use Place of Service code 02 and Telehealth CPT Code Modifiers 95 or GT, depending on the insurance company and it’s guidelines. Your billing service will take care of this for you.
90839 Requirements & Documentation
The situation must require prompt attention to a highly distressed patient. This means it is especially important to document the medical necessity of the situation. Make sure to document the risk, any referrals to other services, and communication with other contacts.
Does 90839 Require Authorization?
Usually CPT code 90839 does not require prior authorization. Due to the nature of a crisis psychotherapy session, it’s often simply not practical to call the insurance and ask if they’ll pay for this code. Unfortunately, not all insurance companies will reimburse this, Medicare in particular is known for not reimbursing crisis codes. There may also be limits to the amount of times it can be bill within a certain time period.
In these cases, it is still a good idea to call the insurance company to determine if it is better to bill 90839 or for a routine service, i.e. 90837. Our billing service can do this for you.
How Do I Bill CPT 90839?
Just like other CPT codes, it should go in the 24(c) location of a CMS 1500. If applicable, 90840 should be billed on the same claim.
