CPT code 90839 is reserved for one of the most clinically demanding situations in mental health practice: crisis psychotherapy. Unlike standard therapy codes, 90839 requires documented evidence of a psychiatric emergency where the patient poses an immediate risk to themselves or others, or is experiencing such severe symptoms that urgent intervention is medically necessary.
This guide covers everything you need to know about billing 90839 correctly: what constitutes a qualifying crisis, time requirements, documentation standards that prevent denials, and when to add the 90840 extension code for sessions exceeding 60 minutes. Mastering crisis billing protects your revenue while ensuring you are compensated fairly for the intensive clinical work these situations demand.
What Is CPT 90839?
CPT 90839 represents psychotherapy for crisis, covering the first 60 minutes of face-to-face time with a patient experiencing a psychiatric emergency. The American Medical Association defines this code as:
Official CPT Definition
"Psychotherapy for crisis; first 60 minutes" - used for patients in crisis who require urgent assessment and intervention to prevent further psychiatric decompensation, harm to self or others, or to stabilize the patient for appropriate disposition.
The key distinction between 90839 and standard psychotherapy codes (90832, 90834, 90837) lies in the clinical urgency and complexity. Crisis psychotherapy involves:
- Immediate risk assessment for suicidality, homicidality, or grave disability
- Acute symptom stabilization for severe psychiatric presentations
- Safety planning and disposition determination
- Coordination with emergency services when hospitalization is indicated
- Crisis-specific interventions that differ from routine therapeutic techniques
This code is not meant for difficult sessions or emotionally intense conversations that occur during regular treatment. The crisis must represent a significant departure from the patient's baseline functioning and require immediate clinical intervention.
Crisis Definition and Qualifying Situations
Understanding what qualifies as a billable crisis is essential for proper use of 90839. Payers scrutinize these claims carefully, and misuse can result in recoupment, audits, and allegations of upcoding. Below is a clear breakdown of qualifying versus non-qualifying situations:
Qualifies as Crisis (Bill 90839)
- ✓Active suicidal ideation with plan or intent
- ✓Homicidal ideation with identifiable target
- ✓Acute psychotic episode requiring stabilization
- ✓Severe dissociative states with safety concerns
- ✓Acute panic or anxiety with inability to function
- ✓Recent trauma with acute stress response
- ✓Acute substance intoxication with psychiatric symptoms
- ✓Manic episode with dangerous behavior
Does NOT Qualify (Use Standard Codes)
- ✗Passive suicidal ideation without plan or intent
- ✗Emotionally difficult but clinically stable sessions
- ✗Chronic symptoms without acute exacerbation
- ✗Patient requesting urgent appointment for stressors
- ✗Relationship conflicts or life transitions
- ✗Grief reactions without suicidality
- ✗Personality disorder presentations (baseline)
- ✗Sessions that simply ran longer than expected
Audit Alert
Payers frequently audit 90839 claims because of the higher reimbursement rate. If you bill this code more than 5% of the time for any individual patient, expect scrutiny. The clinical picture must clearly support crisis-level intervention, not just a difficult or extended session.
Time Requirements for 90839
CPT 90839 has specific time thresholds that differ from standard psychotherapy codes. Understanding these requirements prevents underbilling and overbilling:
90839 Time Thresholds
Unlike the standard psychotherapy codes where 90837 starts at 53 minutes, crisis psychotherapy has a lower threshold. The minimum time for 90839 is 30 minutes, but you should typically be spending at least 60 minutes to justify the crisis designation and reimbursement level.
Important timing considerations:
- Face-to-face time only: Documentation, phone calls to family members, and coordination with hospitals count as separate services, not toward crisis psychotherapy time
- Start and stop times: Document exact start and stop times in your notes to support the billed duration
- Continuous service: Brief interruptions are acceptable, but extended breaks may require documentation explanation
When to Add CPT 90840
CPT 90840 is the add-on code for crisis psychotherapy beyond the first 60 minutes. This code should only be used in conjunction with 90839 and represents each additional 30-minute increment of crisis care.
90840 Billing Rules
- 1. Must accompany 90839: Never bill 90840 alone or with standard psychotherapy codes
- 2. Minimum 16 minutes: Each unit of 90840 requires at least 16 additional minutes beyond the prior threshold
- 3. No maximum units: Bill as many units as clinically justified for prolonged crisis stabilization
- 4. Same documentation standards: Each additional unit needs clinical justification for continued crisis intervention
Example: A patient presents with active suicidal ideation after a relationship breakup. You spend 95 minutes conducting a thorough risk assessment, safety planning, contacting a family member for lethal means restriction, and stabilizing the patient sufficiently to avoid hospitalization. You would bill 90839 + one unit of 90840.
90839 vs Regular Psychotherapy Codes
Understanding when to use 90839 versus standard psychotherapy codes prevents both underbilling (losing revenue for crisis work) and overbilling (risking audits and recoupment):
| Aspect | 90839 (Crisis) | 90837 (Standard 53+ min) |
|---|---|---|
| Clinical Indication | Psychiatric emergency with imminent risk | Routine psychotherapy, stable presentation |
| Minimum Time | 30 minutes (typically 60+) | 53 minutes face-to-face |
| Add-On Code | 90840 for each additional 30 minutes | None available |
| Medicare Rate | $148-185 (varies by locality) | $130-160 (varies by locality) |
| Documentation Focus | Risk assessment, safety plan, disposition | Treatment goals, interventions, progress |
| Expected Frequency | Rare (less than 5% of sessions) | Regular ongoing treatment |
Clinical Decision Point
If a patient presents in distress but you determine after assessment that they are not at imminent risk and can be managed with standard therapeutic intervention, bill the appropriate standard code (90832, 90834, or 90837) based on time spent. The presence of tears, anger, or emotional intensity alone does not constitute a crisis.
Medicare vs Commercial Reimbursement Rates
Crisis psychotherapy commands higher reimbursement than standard therapy codes, reflecting the clinical complexity and intensity of the service. However, rates vary significantly by payer and geographic location:
Medicare Rates (2024 National Average)
Commercial Payer Ranges
Note that some commercial payers have specific requirements for crisis billing, including prior authorization, same-day documentation submission, or mandatory follow-up scheduling. Always verify your contracted rates and requirements before billing.
Documentation Requirements for Crisis Psychotherapy
Documentation for 90839 must clearly support the crisis designation. Insufficient documentation is the primary reason for claim denials and audit failures. Your notes should include:
Crisis Documentation Checklist
Sample Documentation Language
Here is an example of documentation that supports 90839 billing:
Crisis Presentation: Patient arrived at office without appointment, tearful and trembling. Reports taking 8 acetaminophen tablets this morning with intent to "end it all" after discovering spouse's affair. Vomited pills approximately 30 minutes post-ingestion.
Risk Assessment: Active SI with recent attempt. Access to additional medications at home. No identified protective factors initially. High acute risk requiring immediate intervention.
Interventions: Conducted comprehensive suicide risk assessment. Implemented crisis stabilization techniques. Contacted spouse for lethal means restriction. Developed detailed safety plan with 24-hour crisis line numbers. Patient contracted for safety and agreed to voluntary psychiatric evaluation.
Disposition: Transported to ED via family member for medical clearance and psychiatric evaluation. Follow-up scheduled for tomorrow at 9 AM regardless of disposition from ED.
Time: 2:15 PM to 3:50 PM (95 minutes face-to-face crisis psychotherapy)
Payer-Specific Rules and Requirements
Different payers have varying requirements for crisis psychotherapy billing. Here are key considerations for major payer types:
Medicare
- No prior authorization required for crisis services
- Documentation must clearly distinguish crisis from routine care
- Frequency limits may apply if crisis codes are used repeatedly for the same patient
- Medical necessity is reviewed retrospectively through audits
Medicaid (varies by state)
- Some states require crisis designation on facility or provider enrollment
- May require same-day documentation submission
- Often has lower reimbursement rates than Medicare
- Some states bundle crisis services into per diem rates
Commercial Payers
- United Healthcare: Generally follows CMS guidelines, no prior auth for crisis
- Aetna: May require notification within 24 hours for crisis services
- Cigna: Accepts 90839 with appropriate documentation, watch for frequency edits
- Blue Cross Blue Shield: Varies by state, verify local LCD requirements
Verification Tip
Before billing crisis codes to a new payer, call provider services to verify: (1) whether the code is covered, (2) any prior authorization requirements, (3) documentation submission timelines, and (4) any frequency limitations. Document this verification in your files.
Common Denial Reasons and How to Prevent Them
Crisis psychotherapy claims face higher scrutiny than standard therapy codes. Understanding common denial reasons helps you prevent revenue loss:
1. Insufficient Documentation of Crisis
Problem: Notes describe a difficult session but lack clear evidence of psychiatric emergency.
Prevention: Always document the specific imminent risk (SI, HI, psychosis, etc.) and why standard intervention was insufficient.
2. Missing Time Documentation
Problem: No start/stop times or total time documented in the note.
Prevention: Record exact start and stop times for every crisis session. Include total face-to-face minutes.
3. Frequency Edits
Problem: Multiple 90839 claims for the same patient trigger automated review.
Prevention: If a patient has repeated crises, document why each episode represents a new acute presentation, not ongoing crisis.
4. Billing 90840 Without 90839
Problem: Add-on code submitted alone or with standard therapy code.
Prevention: Always pair 90840 with 90839 on the same date of service. Never use 90840 with 90832, 90834, or 90837.
5. Missing Safety Plan Documentation
Problem: Crisis claimed but no safety planning documented.
Prevention: Include safety plan details or explanation of why safety planning was deferred (e.g., patient hospitalized).
Real-World Billing Scenarios
These scenarios illustrate proper code selection for various clinical presentations:
Scenario 1: Clear Crisis (Bill 90839)
A patient calls stating they are standing on a bridge and considering jumping. You conduct a 75-minute phone session, keeping them talking while emergency services are dispatched, then continue crisis stabilization until EMS arrives.
Billing: 90839 + 90840 (75 minutes of crisis psychotherapy). Document the active suicidal behavior, interventions to maintain safety, and coordination with emergency services.
Scenario 2: Escalated But Not Crisis (Bill 90837)
During a regular session, your patient becomes very upset learning their insurance is changing. They cry for most of the 60-minute session and express hopelessness about finding a new therapist. No suicidal ideation, plan, or intent expressed.
Billing: 90837 (standard 53+ minute psychotherapy). Emotional distress without imminent risk does not qualify as crisis. Document the clinical content and therapeutic interventions.
Scenario 3: Acute Psychosis (Bill 90839)
An established patient with schizophrenia arrives for their appointment clearly decompensated, responding to internal stimuli, and expressing paranoid delusions about being poisoned. You spend 90 minutes conducting a thorough assessment, reality testing, coordinating with their psychiatrist, and arranging voluntary hospitalization.
Billing: 90839 + 90840 (90 minutes). Document the acute psychotic symptoms, deviation from baseline, safety concerns, and disposition to hospital.
Scenario 4: Chronic Suicidality (Bill 90837)
A patient with borderline personality disorder reports passive suicidal thoughts, as they have for the past six months. They deny plan, intent, or means. Mental status is at baseline. You spend 55 minutes conducting therapy focusing on distress tolerance.
Billing: 90837 (standard psychotherapy). Chronic suicidality at baseline without acute exacerbation does not qualify as crisis. Billing 90839 here would be inappropriate.
Frequently Asked Questions
Can I bill 90839 for a telehealth crisis session?
Yes, 90839 can be billed for telehealth crisis sessions with the appropriate place of service code (usually 02 for telehealth) and modifier (95 or GT depending on payer requirements). The same documentation standards apply. Note that some crisis situations, particularly those involving active suicidal behavior or psychosis, may require transitioning to in-person care or emergency services.
How often can I bill 90839 for the same patient?
There is no hard limit, but frequent crisis billing for one patient will trigger payer scrutiny. If you find yourself billing crisis codes more than once or twice per month for the same patient, consider whether: (1) the patient needs a higher level of care, (2) you are documenting appropriately to distinguish true crises from difficult sessions, or (3) the treatment plan needs revision. Repeated crises should prompt clinical review.
Can I bill 90839 and an E/M code on the same day?
Generally, no. Crisis psychotherapy codes are comprehensive and include the assessment component. Billing a separate E/M code (like 99213 or 99214) for the same encounter would typically be considered unbundling. The exception is if you provide a distinct, separately identifiable service, such as a medical evaluation for a concurrent physical complaint unrelated to the psychiatric crisis, with modifier 25.
What if the crisis resolves quickly and I only spend 35 minutes?
You can still bill 90839 for sessions as short as 30 minutes if the clinical presentation genuinely constituted a crisis. However, very brief crisis sessions may face greater scrutiny because true psychiatric emergencies typically require extended assessment and stabilization. If your documentation supports that you rapidly assessed and stabilized an acute crisis, the claim should be defensible.
Should I use 90839 or 90837 if a crisis emerges during a scheduled session?
If a scheduled therapy session transforms into a crisis requiring crisis-level intervention, you should bill 90839. The code is based on the nature of the service provided, not whether the appointment was scheduled. Document the transition clearly: "Scheduled session for ongoing treatment of depression. During session, patient disclosed active suicidal plan, and remainder of session was devoted to crisis intervention and safety planning."
Can LCSWs and LPCs bill 90839, or only psychologists and psychiatrists?
Licensed clinical social workers (LCSWs), licensed professional counselors (LPCs), and other qualified mental health professionals can bill 90839 if they are credentialed with the payer and operating within their scope of practice. Check your state licensing board regulations and individual payer contracts. Some payers may restrict crisis codes to certain provider types or require supervision for certain licensure levels.
How do I document if the patient refuses hospitalization?
Document the refusal thoroughly: (1) your recommendation for hospitalization and the clinical reasoning, (2) your explanation to the patient of risks and benefits, (3) the patient's stated reasons for refusal, (4) their capacity to make this decision, (5) the enhanced safety plan and crisis resources provided, and (6) your follow-up plan. If the patient lacks capacity, document your actions regarding involuntary commitment procedures per your state law.
Key Takeaways: CPT 90839 Crisis Psychotherapy
- 1.Only use 90839 for genuine psychiatric emergencies with imminent risk, not emotionally intense regular sessions.
- 2.Document exact start and stop times, risk assessment findings, safety planning, and disposition for every crisis claim.
- 3.Add 90840 for each 30-minute increment beyond the first 60 minutes of crisis intervention.
- 4.Expect payer scrutiny if crisis codes exceed 5% of your claims for any individual patient.
- 5.Use crisis codes to capture appropriate reimbursement for intensive clinical work, but never as a substitute for proper treatment planning.
Crisis psychotherapy represents some of the most demanding work in mental health practice. When you provide these intensive services, you deserve appropriate compensation. By understanding the clinical requirements, documenting thoroughly, and billing correctly, you protect both your patients and your practice.
TheraFocus helps therapists manage crisis documentation with built-in risk assessment templates, automatic time tracking, and billing code suggestions based on session content. Our platform ensures you capture the clinical detail needed to support crisis claims while focusing on what matters most: helping your patients through their most difficult moments.
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The TheraFocus team is dedicated to empowering therapy practices with cutting-edge technology, expert guidance, and actionable insights on practice management, compliance, and clinical excellence.