Overview: CPT 90839 is the code for psychotherapy for crisis – first 60 minutes. It is used when a patient is in an acute mental health crisis requiring immediate intervention (e.g. imminent risk of harm, suicidal intent, acute psychosis, or other life-threatening distress). These sessions involve an urgent assessment of the crisis, a focused mental status exam, and safety planning or resource mobilization to defuse the crisis. In short, 90839 is not for routine therapy or scheduled visits – it is reserved for emergencies. Medicare specifically notes that 90839/90840 “help reduce a patient’s mental health crisis” and are appropriate for “patients in high distress with life-threatening, complex problems that require immediate attention”. 1 Documentation should clearly justify the emergent nature of the encounter (see Documentation below).
Eligible Providers & Settings: A wide range of licensed behavioral health professionals can furnish and bill crisis psychotherapy. Medicare allows physicians (MD, DO) and certain non-physician practitioners to provide 90839/90840 within their scope of practice, including psychologists (CP), clinical social workers (CSW), clinical nurse specialists (CNS), nurse practitioners (NP), physician assistants (PA), certified nurse-midwives (CNM), marriage-and-family therapists (MFT), and mental health counselors (MHC). In private practice or small clinic settings, licensed therapists (LCSWs, LMFTs, LPCs, etc.) and psychiatrists can bill these codes if state law permits. The services can be provided in any setting – hospital, outpatient office, patient home, skilled nursing facility, etc. Medicare covers 90839/90840 in all settings (professional fee schedule) and even pays 150% of the non-facility rate when furnished outside the office 1 (using HCPCS G0017/G0018 for billing as described below). These services may also be provided and billed via telehealth if you meet the usual requirements. 2
Time & Documentation: Code 90839 is timed (first 60 minutes) and 90840 is the add-on for each additional 30 minutes of crisis therapy. Report 90839 for the first hour of face-to-face care; add 90840 for every 30-minute block beyond that on the same date. (For example, a 90-minute crisis session is billed as 90839 + 90840.) Importantly, Medicare guidance allows you to total multiple segments on the same day for time if the patient returns to the crisis management process – “even if the time spent on the date of service isn’t continuous”. Always record start/end times or total minutes on the claim, as with other time-based codes. Documentation is critical: chart notes must explicitly describe the crisis and your interventions. The record should document the nature and severity of the crisis (precipitating events, risk to self/others, safety concerns, level of distress) and your clinical response (urgent history taking, mental status exam findings, interventions used, safety plan, disposition). Medicare’s “what’s covered” list for crisis codes includes “urgent assessment and history of a crisis state,” a mental status exam, mobilizing resources to defuse the crisis, and steps to minimize trauma – your documentation should reflect these elements. As always, note the medical necessity (why immediate therapy was needed) to support the code choice. 1
Billing Rules & Payer Considerations: 90839/90840 are stand-alone psychotherapy codes. They should not be reported with a psychiatric evaluation (90791/90792) or routine psychotherapy codes (90832–90838), or with most other mental health procedure codes. In practice, you choose either to bill the crisis session (90839/90840) or an evaluation code, not both on the same service. For Medicare Part B, bill 90839 alone (plus any 90840 units) for the first session. If continuing to manage the crisis beyond 60 minutes, append 90840 as needed. No interactive-complexity code (90785) or family therapy codes should be billed with 90839/90840 (Medicare guidance explicitly prohibits using 90785 or any 90832-38 code with crisis codes). 1
Medicare: CPT 90839/90840 are covered under the Physician Fee Schedule. The beneficiary’s home counts as an outpatient site, so if you treat the patient at home (or at a facility other than your office) use HCPCS G0017 for the first 60 minutes and G0018 for each additional 30 minutes instead of 90839/90840[. (These HCPCS codes pay 150% of the non-facility PFS rate.) In the office or clinic, simply use 90839/90840 with the appropriate place of service. Medicare pays all psychotherapy in every setting; there is no site restriction. (If you incidentally employ auxiliary staff under supervision—e.g. peer support—Medicare allows “incident to” billing under certain conditions, but that’s advanced practice detail.) 1
Commercial Insurance: Private payers generally recognize 90839/90840 similarly, but policies can vary. Most insurers require that the service meet clinical criteria for crisis intervention. Be sure to check individual plan policies (some may use terms like “crisis intervention” or have dedicated processes). Many commercial carriers will also require documentation showing the emergency nature. Some payers reimburse crisis services at a higher rate or use special modifiers. For example, one UnitedHealthcare fee schedule shows 90839 reimbursed at a base rate and a much higher rate when billed with a crisis-intervention modifier “ET”. 3 (If your local plan uses such modifiers or codes, follow their guidance.) In general, commercial insurers that cover outpatient psychotherapy will cover 90839/90840 if billed correctly. Also keep in mind parity laws in many states: by law mental health services via telehealth and in-person should be reimbursed equivalently, so don’t assume telehealth pays less. Always verify coverage specifics for your state and payers.
Telehealth Use: CPT 90839/90840 are approved for telehealth under Medicare and most private plans. 2 You may conduct crisis psychotherapy via secure two-way video (or even audio-only, which remains allowed for behavioral health until at least late 2025). When billing Medicare for telehealth, use the same CPT codes with place of service 02 (or 10 if the patient is at home) and modifier 95 (or as required by payer). Effective 2024, CMS distinguishes POS 10 for “telehealth in patient’s home” 4 – this pays the non-facility rate. (If the patient is at another site – e.g. a clinic or school – use POS 02.) Commercial insurers often mimic this approach; if in doubt, call the payer to confirm whether they want modifier 95 or a special telehealth place of service. Notably, recent CMS policy has no COVID-era in-person requirement for mental health telehealth – you do not need a prior face-to-face visit before providing 90839 via telehealth. 4 Simply ensure you have the patient’s location and consent for telehealth documented. In short, crisis therapy can be delivered remotely just as in-person, and should be reimbursed at the same rate (parity statutes typically cover behavioral health).
Comparison to Routine Psychotherapy (90832/90834/90837): The standard individual psychotherapy codes (90832: 30 min, 90834: 45 min, 90837: 60 min) are for non-crisis treatment. They require medical necessity for treatment of a psychiatric disorder but are intended for routine therapy sessions. By contrast, 90839 is for emergency or crisis situations only. You should use 90839 instead of 90837/34/32 when the session’s focus is crisis management, not routine care. (Indeed, CMS rules explicitly forbid billing 90839/90840 on the same day as 90832–90838.) In practical terms, if a session is precipitated by a genuine crisis (e.g. following a suicide attempt, panic attack with risk of harm, acute trauma, etc.), code 90839/90840 applies. If it is just a regularly scheduled therapy visit (even if the patient mentions distress), use the standard psychotherapy codes. Crisis sessions often take longer (beyond the usual 45–60 min), so 90840 allows for additional time. Remember also that 90839 inherently includes clinical complexity (e.g. family involved, safety planning), so you would not bill the interactive complexity add-on (90785) or multiple psychotherapy codes together in a crisis encounter. 1
Key Takeaways & Value: For clinicians, using 90839/90840 properly ensures that the intense work of crisis intervention is reimbursed appropriately. This code reflects the high level of skill and time required (initial 60 min plus any extension) and recognizes that crisis therapy differs from a routine session. It typically reimburses at a higher rate (especially in non-facility settings at 150% under Medicare) 1 and can improve a practice’s ability to respond to acute needs. For patients, authorized crisis therapy means access to timely, comprehensive care when they are at greatest risk. By documenting and billing 90839 when indicated, providers help ensure that emergent psychiatric needs are met quickly – often averting hospitalization or greater harm.
In summary, 90839 is the designated code for the first hour of a crisis psychotherapy session (with 90840 for each additional half-hour). It may be billed by qualified mental health professionals in any setting (including by telehealth) when the clinical situation is urgent. Strict documentation of the crisis and adherence to payer rules (e.g. not combining with other therapy codes) are essential. When used correctly, this code allows small and private practices to deliver and be paid for critical emergency behavioral health services, fulfilling both patient care and practice sustainability needs. 1
Sources:
CMS - Psychotherapy for Crisis (Medicare Fee Schedule Guidance) https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/psychotherapy-crisis
Telehealth.HHS.gov - Billing for Telebehavioral Health Services https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/billing-for-telebehavioral-health
UHC Provider - Behavioral Health Value-Based Payments 2025 Base Fee Schedule (Rocky Mountain Health Plans) https://www.uhcprovider.com/content/dam/provider/docs/public/commplan/co/behavior-health/CO-Value-based-fee-schedule-2025.pdf
CMS - MLN901705: Telehealth & Remote Patient Monitoring https://www.cms.gov/files/document/mln901705-telehealth-remote-patient-monitoring.pdf
