CPT code 90840 is the essential add-on code for extended crisis psychotherapy sessions. When a psychiatric emergency requires more than 60 minutes of intensive intervention, this code allows you to bill for each additional 30-minute increment beyond the base 90839 code. Understanding how to use 90840 correctly ensures you receive fair compensation for prolonged crisis stabilization work.
This guide covers everything you need to know about billing 90840: the relationship with its base code 90839, time calculation rules, unit limits, documentation requirements, and common billing errors to avoid. Whether you are stabilizing a suicidal patient for two hours or managing an acute psychotic episode that requires extended intervention, proper use of 90840 protects your revenue while demonstrating the clinical necessity of your work.
What Is CPT 90840?
CPT 90840 is an add-on code representing each additional 30 minutes of crisis psychotherapy beyond the first 60 minutes covered by 90839. The American Medical Association defines this code as:
Official CPT Definition
"Psychotherapy for crisis; each additional 30 minutes (List separately in addition to code for primary service)" - used when crisis psychotherapy extends beyond the initial 60-minute period, requiring continued intensive intervention to stabilize the patient.
The critical distinction of 90840 is that it cannot stand alone. This is a true add-on code that must always appear on a claim alongside 90839. If you submit 90840 without 90839 on the same date of service, the claim will be denied. Similarly, 90840 cannot be paired with standard psychotherapy codes like 90837.
Think of the crisis code pair this way: 90839 covers the first hour of crisis intervention, and 90840 covers each additional half-hour beyond that. For a 95-minute crisis session, you bill 90839 plus one unit of 90840. For a 130-minute crisis session, you bill 90839 plus two units of 90840.
Add-On Code Requirements
Understanding the rules governing 90840 prevents claim denials and audit problems. Here are the essential requirements:
90840 Billing Rules
Critical Billing Error to Avoid
Never bill 90840 with standard psychotherapy codes (90832, 90834, 90837). If a session starts as routine therapy and escalates to crisis, you must choose: either bill the appropriate standard code for the entire session, or bill 90839/90840 if the crisis component dominated the encounter. You cannot mix crisis and non-crisis codes for the same session.
Time Increments and Unit Calculation
Calculating how many units of 90840 to bill requires understanding the time thresholds. The key is knowing that 90839 covers the first 30 to 74 minutes, and each 90840 unit covers an additional 30-minute block using the midpoint rule.
Time-to-Code Conversion Chart
The Midpoint Rule Explained
Each 30-minute unit uses the midpoint rule: you need at least 16 minutes into the next increment to bill for it. For the first 90840 unit, you need 75 minutes total (60 + 15 = 75, crossing the midpoint). For the second unit, you need 105 minutes (75 + 30 = 105). This pattern continues for each additional unit.
Quick Reference: When to Add Units
Bill 1 Unit of 90840
- ✓Session lasted 75 minutes or more
- ✓Crisis intervention continued beyond initial hour
- ✓Documentation supports ongoing crisis care
- ✓Total time under 105 minutes
Bill 2+ Units of 90840
- ✓Session lasted 105 minutes or more
- ✓Extended stabilization was clinically necessary
- ✓Each additional unit has documented justification
- ✓Add one unit per additional 30-minute block
Maximum Units Per Session
Unlike some add-on codes that have explicit unit limits, CPT 90840 has no formal cap on the number of units you can bill. If clinical necessity requires four hours of continuous crisis intervention, you can bill 90839 plus the appropriate number of 90840 units.
However, practical and payer-imposed limits exist:
- Clinical reasonableness: Payers expect crisis sessions to typically resolve within 2-3 hours. Sessions exceeding this duration require exceptional documentation.
- Payer edits: Some payers have soft limits (often 3-4 units) that trigger manual review or require additional documentation.
- Medical necessity: Each additional unit must be clinically justified. "The session ran long" is not sufficient documentation.
- Alternative disposition: For crises requiring more than 3-4 hours, consider whether the patient should be transitioned to emergency services or inpatient care.
Audit Trigger Warning
Billing 3 or more units of 90840 on a single date of service will often trigger payer review. This does not mean such claims are inappropriate, but your documentation must clearly explain why the patient required over 2 hours of crisis intervention and why a higher level of care was not indicated.
Medicare vs Commercial Rates
Reimbursement for 90840 varies by payer and geographic location. Understanding typical rates helps you evaluate the financial impact of extended crisis sessions:
Medicare Rates (2024 National Average)
Commercial Payer Ranges
These rates reflect the clinical intensity of extended crisis work. A 2-hour crisis session (90839 + 2x 90840) can reimburse $285-500 depending on your payer mix, making accurate billing essential for practice sustainability.
Documentation Requirements for Extended Crisis
Each unit of 90840 requires specific documentation justifying why continued crisis intervention was necessary. Generic statements about session length will not survive audit scrutiny. Your documentation must address:
Extended Crisis Documentation Checklist
Sample Documentation for 90840
Here is an example of documentation that supports billing 90839 plus two units of 90840 (approximately 2-hour session):
Session Time: 1:30 PM to 3:45 PM (135 minutes face-to-face crisis psychotherapy)
Initial Presentation (1:30-2:30 PM): Patient presented with acute suicidal crisis following job termination this morning. Reported specific plan to overdose on benzodiazepines stockpiled at home. Expressed intent to act tonight. Initial risk assessment indicated high acute risk. Conducted thorough evaluation of plan details, access to means, and timeline. Patient ambivalent about safety.
Extended Intervention (2:30-3:15 PM): Crisis stabilization techniques did not immediately reduce risk level. Patient continued to express intent despite initial interventions. Contacted spouse for emergency means restriction. Spouse confirmed removal of medications from home. Continued safety planning with patient, who remained resistant. Evaluated capacity for voluntary hospitalization decision.
Final Stabilization (3:15-3:45 PM): Following confirmation of means restriction, patient showed reduced immediate intent. Developed comprehensive safety plan with 24-hour check-ins. Patient ultimately contracted for safety and agreed to return tomorrow for follow-up. Risk level reduced from high to moderate with intensive outpatient safety structure.
Rationale for Extended Session: Patient required over 2 hours of continuous crisis intervention due to initial resistance to safety planning, need to coordinate real-time means restriction with family member, and time required to achieve sufficient stabilization to avoid hospitalization. Shorter intervention would have left patient at unacceptable risk level.
Payer-Specific Rules
Different payers have varying requirements for extended crisis billing. Here are key considerations:
Medicare
- No prior authorization required for 90840 units
- No formal unit limit, but sessions exceeding 3 units may trigger medical review
- Documentation must clearly support medical necessity for each unit
- Time must be recorded in exact minutes, not estimates
Medicaid
- Rules vary significantly by state
- Some states cap at 2-3 units of 90840 per session
- May require same-day documentation submission
- Some states bundle crisis services into per diem or case rates
Commercial Payers
- United Healthcare: Generally follows CMS guidelines, may require medical records for 3+ units
- Aetna: Accepts multiple units with supporting documentation, no explicit cap
- Cigna: Monitors for frequency patterns, may require clinical review for extended sessions
- Blue Cross Blue Shield: Varies by state, some plans have soft caps requiring appeals for additional units
Verification Recommendation
Before billing multiple units of 90840 to a new payer, verify their specific policies by calling provider services. Ask about: (1) maximum units per session, (2) documentation requirements, (3) whether multiple units trigger automatic review, and (4) any notification or authorization requirements for extended crisis sessions.
Common Denial Reasons and Prevention
Understanding why 90840 claims get denied helps you prevent revenue loss:
1. Missing Base Code 90839
Problem: 90840 submitted alone or with standard therapy codes.
Prevention: Always verify 90839 appears on the claim before adding 90840 units. Never pair 90840 with 90832, 90834, or 90837.
2. Time Documentation Insufficient
Problem: Notes state "approximately 90 minutes" or lack specific times.
Prevention: Record exact start and stop times. "Session: 2:15 PM to 3:50 PM (95 minutes)" is defensible. "About an hour and a half" is not.
3. Lack of Clinical Justification
Problem: Documentation does not explain why crisis required extended time.
Prevention: Explicitly document why stabilization took longer than 60 minutes. Describe what changed during the extended period and why earlier termination was not clinically appropriate.
4. Time Calculation Errors
Problem: Billing 2 units for 85 minutes or 1 unit for 70 minutes.
Prevention: Review time thresholds before billing. First unit of 90840 requires minimum 75 minutes. Second unit requires minimum 105 minutes.
5. Frequency Pattern Flags
Problem: Same patient billed with 90840 multiple times per month.
Prevention: If a patient requires frequent extended crisis sessions, document why treatment plan adjustments or higher level of care have not been implemented. Each episode must represent a distinct acute crisis.
Real-World Billing Scenarios
These scenarios illustrate proper 90840 billing decisions:
Scenario 1: Suicidal Patient Requiring Means Restriction (95 min)
A patient arrives reporting suicidal ideation with a plan to use a firearm at home. You spend 60 minutes on initial assessment and crisis intervention, then an additional 35 minutes coordinating with the patient's spouse to remove firearms from the home, creating a detailed safety plan, and ensuring the patient is stable enough to leave safely.
Billing: 90839 + one unit of 90840. The 95 minutes exceeds the 75-minute threshold for one add-on unit but falls below 105 minutes for two units.
Scenario 2: Acute Psychotic Episode with Family Coordination (140 min)
An established patient with bipolar disorder presents in acute manic psychosis. You spend 2 hours and 20 minutes conducting reality testing, managing agitation, coordinating with the patient's psychiatrist for emergency medication adjustment, arranging for family supervision, and ultimately achieving sufficient stabilization to avoid hospitalization.
Billing: 90839 + three units of 90840. At 140 minutes, you exceed the 135-minute threshold for three add-on units. Document thoroughly why the extended time was necessary to avoid hospitalization.
Scenario 3: Crisis That Resolves Quickly (55 min)
A patient calls in crisis with suicidal thoughts. You conduct an emergency session lasting 55 minutes. Risk assessment reveals passive ideation without plan, intent, or means. The patient stabilizes well with standard crisis intervention.
Billing: 90839 only. The 55-minute session qualifies for the base crisis code but does not reach the 75-minute threshold for 90840. No add-on code is billed.
Scenario 4: Session Incorrectly Calculated (70 min)
A therapist spends 70 minutes with a patient in crisis and considers billing 90840 because the session exceeded one hour.
Correct Billing: 90839 only. At 70 minutes, you have not reached the 75-minute threshold for the first unit of 90840. The session is 5 minutes short. Billing 90840 here would be overcoding.
Frequently Asked Questions
Can I bill 90840 for telehealth crisis sessions?
Yes, 90840 can be billed for telehealth crisis sessions using the same rules as in-person encounters. Apply the appropriate place of service code (02 for telehealth) and any required modifiers (95 or GT depending on payer). The time thresholds and documentation requirements remain identical. However, be prepared to explain in documentation why the crisis could be managed via telehealth rather than requiring in-person intervention or emergency services.
Is there a maximum number of 90840 units I can bill?
CPT guidelines do not specify a maximum, but practical limits apply. Most payers will scrutinize claims with more than 2-3 units of 90840 (sessions exceeding 2 hours). For very prolonged crises, consider whether the patient should be transitioned to emergency department care, crisis stabilization unit, or inpatient hospitalization. Your documentation must justify why extended outpatient crisis intervention remained appropriate.
Can I bill 90840 with 90785 (interactive complexity)?
Yes, you can add 90785 to crisis psychotherapy when interactive complexity factors are present, such as involvement of third parties, use of play equipment or interpreters, or managing emotional barriers to communication. Bill 90839 + 90840 (as needed) + 90785. Document the specific complexity factors that applied to the session.
What if my session is exactly 75 minutes?
At exactly 75 minutes, you can bill one unit of 90840. The threshold for the first add-on unit is 75 minutes (60 minutes for 90839 plus 15 minutes, which crosses the midpoint of the first 30-minute increment). Document your exact start and stop times carefully, as a 74-minute session would not qualify for the add-on.
Can I split crisis codes across two clinicians?
If two clinicians provide crisis care to the same patient on the same date, billing becomes complex. Generally, each clinician should bill for their own time if they are providing distinct services. However, if one clinician provides the base service and another provides additional time, coordination with your billing department is essential. Some payers may require modifier 77 (repeat procedure by another physician) or other specific billing arrangements.
Does documentation time count toward 90840?
No. Only face-to-face time with the patient counts toward crisis psychotherapy billing. Documentation, phone calls to family members, coordination with hospitals or psychiatrists, and other non-face-to-face activities are not included in the time calculation. If you spend 80 minutes with a patient and 30 minutes on documentation, you bill based on the 80 face-to-face minutes only.
What if a crisis session spans midnight?
If a crisis session begins before midnight and continues into the next calendar day, you typically bill all time on the date of service when the session began. Document the unusual circumstances clearly. Some payers may have specific rules about sessions spanning midnight, so verify with your major payers if this situation arises regularly in your practice (such as in emergency or crisis center settings).
Key Takeaways: CPT 90840 Crisis Add-On Billing
- 1.Always bill 90840 with 90839. This add-on code cannot stand alone or pair with standard psychotherapy codes.
- 2.Each unit of 90840 represents 30 additional minutes. The first unit requires at least 75 total minutes (crossing the midpoint).
- 3.Document exact start and stop times for every crisis session. Estimates and approximations invite denials.
- 4.Justify extended time clinically. Explain why the patient could not be stabilized sooner and why a higher level of care was not needed.
- 5.No formal unit cap exists, but sessions exceeding 2 hours will face increased scrutiny. Document thoroughly.
Extended crisis sessions represent some of the most clinically demanding and emotionally draining work in mental health practice. When you spend two or more hours stabilizing a patient in acute psychiatric distress, you deserve fair compensation for that intensive care. Proper use of 90840 ensures you capture the revenue you have earned while maintaining documentation that demonstrates the medical necessity of your work.
TheraFocus helps therapists track crisis session time automatically, calculate appropriate billing codes based on documented duration, and generate audit-ready documentation that supports extended crisis claims. Our platform prompts you for the clinical details that justify 90840 billing while ensuring you never leave revenue on the table for the critical work you do during psychiatric emergencies.
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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.