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Billing and coding

How to use CPT codes 90839 and 90840: Psychotherapy for crisis

Text on an abstract background reads "90839 90840"

CPT codes 90839 and 90840 both reflect treatment for a crisis, but represent different time frames.

Your work as a therapist isn’t limited to routine therapy sessions. If a client is experiencing thoughts of self-harm or suicidal ideation, for example, you may be tasked with assessing and diffusing the crisis. You may provide psychotherapy as an intervention, but in these emergent scenarios, your work will probably be more extensive and intense.

Understanding the ins and outs of how to bill insurance when supporting a client through a crisis can help ensure you get reimbursed for the valuable work you do. Read on to learn more about two important codes you should be familiar with when it comes to a client in crisis.

When to use a crisis code

It may be difficult to determine whether a crisis code is appropriate. Typically, the presenting problem is life threatening or complex and requires immediate attention to a client experiencing significant distress. Examples include: 

  • Suicidal intent
  • Grave disability
  • Disabling symptoms
  • Decompensation that risks the client’s ability to remain at the current level of care

Use these CPT codes to report the time you spend with the patient furnishing psychotherapy for crisis services, even if the time spent on the date of service isn’t continuous.

CPT code 90839 description

When you’re providing a higher level of care, you should bill your services accordingly. If you assess and treat a client in crisis, you may use CPT (Current Procedural Terminology) code 90389, or psychotherapy for crisis.

Psychotherapy for crisis codes can be used when you conduct an urgent assessment and history of a crisis state, a mental status exam, and a disposition. The treatment for 90389 includes psychotherapy, mobilization of resources to defuse the crisis and restore safety, and implementation of psychotherapeutic interventions to minimize the potential for psychological trauma.

This code, specifically, is used for the 30–74 minutes of crisis therapy. It can’t be used in conjunction with other psychotherapy codes, but you may add on code 90840 if your work extends beyond 74 minutes.

CPT code 90840 description

CPT code 90840 is an add-on code which can only be used in conjunction with 90839 when a psychotherapy for crisis session exceeds 74 minutes. 90840 can’t be used independently and can only be billed with 90839. A unit of 90840 may be added for each additional 30 minutes.

When using CPT code 90840, no additional documentation is required beyond specifying the total time spent in session on the date of service.

It’s important to use the code that most accurately reflects the time you spent with the patient to treat their condition, and ensure that documentation for the session supports the chosen code. 

Documentation requirements for psychotherapy for crisis

Your documentation should include all of the following:

  • Description of crisis situation (urgent assessment & history of crisis state)
  • Full mental status exam
  • Psychotherapy interventions used to minimize the potential for psychological trauma
  • Document any mobilization of resources to defuse crisis and restore safety
  • Treatment plan (what happens next for the client)
  • Exact number of minutes or start/stop times spent doing with the client providing psychotherapy for crisis

CPT code 90839 and 90840 time frames

CPT codes 90839 and 90840 reflect the same service, but different time frames. These codes are used to report the total duration of face to face time spent with the patient or family, even if the time spent on the date of service isn’t continuous. The provider must devote immediate attention to the patient for the entire amount of time.

  • 90839 is billed for the first 30–74 minutes.
  • 90840 is billed for each additional 30 minutes over 74 minutes. The client needs to be seen for a minimum of 15 additional minutes for the time to round up to the next unit of 90840.

Here are some examples of coding that correlates with different amounts of face-to-face time providing crisis services:

10 minute session: neither code can be used

30 minutes: 90839 (minimum time for this code)

74 minutes: 90839 (maximum time for this code to be used alone)

75 minutes: 90839, +90840 (minimum time for 90840 add on code)

104 minutes (1h + 30m +14m): 90839, +90840 (maximum time before an addition unit of 90840 is used)

105 minutes (1h + 30m +15m): 90839, +90840, +90840 (minimum time for an additional 90840 add on code)

CPT code 90839 and 90840 reimbursement rates

Because you’ll probably spend more time and energy assessing and treating a client in crisis, you’ll likely be reimbursed at a higher rate. Reimbursement rates for sessions billed with 90839 and 90840 will vary depending on the plan, your contract, your location, and your license type.

This document is intended for educational purposes only. It is designed to facilitate compliance with payer requirements and applicable law, but please note that the applicable laws and requirements vary from payer to payer and state to state. Please check with your legal counsel or state licensing board for specific requirements.

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