CPT 90840 is an add-on code used when a psychotherapy for crisis session lasts beyond 60 minutes. It must be billed in conjunction with CPT 90839, which covers the first 60 minutes of crisis therapy. 1 Crisis psychotherapy is reserved for patients in acute, high-distress situations – for example, those with suicidal intent, severe decompensation or life-threatening psychiatric emergencies. In practice, use 90839 for the initial 60 minutes of crisis intervention and 90840 for each additional 30 minutes beyond that. (If a session is 61–90 minutes, bill 90839+90840; 91–120 minutes, bill 90839+2×90840, etc.) These codes are time-based: document start/stop times or total minutes to justify each unit. 2 By rule, 90840 cannot stand alone and is not used with routine psychotherapy (90832–90838) or psychiatric diagnostic codes (90791/90792). 3
Crisis psychotherapy involves urgent assessment and intervention. Documentation should clearly describe the crisis (e.g. immediate safety risks), a mental status exam, and intensive interventions (mobilizing resources, safety planning, trauma mitigation). 3 Medical necessity hinges on severity (e.g. suicidal ideation, grave disability, or behaviors endangering the patient or others). Notes should detail the time spent and the emergency interventions provided – for example, coordinating hospitalization, calling crisis teams, or adjusting medications – to support billing 90839/90840. (Time is key: CMS allows either start/stop times or total minutes in the record.) 2
CPT 90840 always follows CPT 90839 in the same encounter. Think of 90839 as “crisis therapy, first hour” and 90840 as “each additional 30 min.” The AMA descriptors confirm this: “90839 – Psychotherapy for crisis; first 60 minutes. 90840 – each additional 30 minutes (list separately in addition to code for primary service)”. 4 In other words, if your crisis session goes past one hour, you append 90840 per 30-minute increment. You may bill multiple units of 90840 for very long sessions. Keep in mind that only one 90839 can be billed per date of service (even if work is non-continuous) 5, while 90840 can be billed multiple times as needed. Both codes are standalone psychiatric service codes – they should not be reported on the same day as any other psychotherapy or evaluation codes. 3
Medicare allows a wide range of behavioral health professionals to furnish and bill crisis psychotherapy. Providers include psychiatrists and other physicians (MD/DO), clinical psychologists, licensed clinical social workers (CSWs), clinical nurse specialists (CNSs), nurse practitioners (NPs), physician assistants (PAs), certified nurse-midwives (CNMs), marriage and family therapists (MFTs) and mental health counselors (MHCs). These practitioners may deliver crisis therapy in almost any setting – hospital inpatient or outpatient, clinic, physician office, skilled nursing facility or even a patient’s home. (CMS explicitly lists hospitals, SNFs, offices and home visits as examples.) 3
Billing differences can arise by location and payer. Medicare pays for crisis psychotherapy under the physician fee schedule. It does not restrict crisis codes to psychiatrists only – the above list of providers reflects who “can furnish” these services. Note that for Medicare, if you deliver crisis therapy outside a typical office (for example, in a hospital outpatient department or through certain non-clinic programs), you must use the new HCPCS codes G0017 (first 60 min) and G0018 (each additional 30 min) instead of 90839/90840. These G-codes reimburse at 150% of the non-facility rate for crisis psychotherapy. 3 (If you are in doubt, check the latest CMS Physician Fee Schedule or local billing article.)
Commercial insurers generally mirror Medicare’s allowed provider types for psychotherapy: psychiatrists, psychologists, licensed therapists, etc. Private payers may have narrower rules for which therapist types can bill independently (for example, some states/insurers limit billing privileges for LCSWs or LPCs), so always confirm credentials and network contracts. Most payers allow crisis psychotherapy in any outpatient setting; some may exclude inpatient or ER codes (where different CPTs apply) – again, check the plan’s behavioral health policy or provider manual.
Because 90840 is time-based, accurate documentation of session length is crucial. Record either the start/stop time or total minutes of face-to-face contact. 2 For example, if you spend 1 hour 15 minutes directly doing crisis therapy, you would bill 90839 (first 60) plus 90840 once. If a session is 2 hours 10 minutes (130 min), you would bill 90839 plus two units of 90840. (Typically, 90839 covers up to 60 minutes, and each full or partial 30-minute block beyond 60 triggers one 90840.)
Your clinical note should make clear that a crisis evaluation and intervention took place. Key elements include an urgent psychosocial assessment, a full mental status exam, and the interventions used (for example, safety planning, mobilizing caregivers or crisis teams, medication evaluation, de-escalation techniques, etc.). 3 5 The documentation should describe why the situation was emergent (e.g. acute suicidality, severe panic attack, psychotic agitation) and what actions you took. By establishing the crisis context and the medical necessity of an extended session, you justify billing beyond a standard therapy visit. CMS explicitly notes that psychotherapy for crisis “helps reduce a patient’s mental health crisis through an urgent assessment and history of a crisis state, a mental status exam, and a disposition” 3, so detailing those steps in the note is essential.
Standalone service: 90840 is an add-on code. You cannot bill 90840 by itself – it always accompanies 90839. It also cannot be billed on the same day as a psychiatric diagnostic evaluation (90791/90792) or any other psychotherapy/E&M code. 3 In practice, if you provide crisis therapy on a day you also do an E/M or other therapy session, you must decide which service was primary or split them into separate encounters (if allowed).
Modifiers and DOS: Report 90839 and 90840 with the date of service when the crisis therapy occurred. Use modifier -59 or XE/XU/etc. only if another distinct service was done on that day and not related to the crisis therapy. (Do not use interactive complexity 90785 with 90839/90840; CMS specifically says not to pair 90785 with crisis codes.) 1
Group/facility visits: If you are in a hospital or facility setting (inpatient psychiatric unit, ER, partial hospital, etc.), check whether the payer expects a different code or global billing. For example, the CMS rules mentioned above convert certain non-office outpatient crisis visits to G0017/G0018. Many commercial plans do not use G-codes but may bundle crisis therapy under facility fees or observation visits. Always verify with the facility billing office or payer policy.
Coverage and reimbursement: Medicare covers 90839/90840 when documentation supports a true crisis situation. Reimbursement for 90840 will be roughly half of the 90839 rate (since it’s 30 minutes vs 60). Under Medicare, a crisis session in an outpatient non-hospital (office) setting pays at the standard fee schedule; in a hospital-outpatient or similar non-office setting, it pays 150% via the G-codes. 3 Commercial payers vary: many payers set 90840 equal to one-half of the 90839 allowed amount, reflecting the 30 vs 60 minutes. Some private insurers may impose a visit limit (for example, limiting crisis codes to once per month or one per year) so check any utilization management rules.
Commercial payer specifics: Major insurers often publish provider policies listing covered CPTs. For example, Blue Cross NC’s telehealth policy explicitly lists 90840 as allowable (add-on to 90839). 6 Similarly, Blue Cross MI includes 90840 in its telehealth reimbursement guide. 7 These policies confirm that behavioral health providers can bill 90840 (with 90839) for emergency mental health services. Nonetheless, always confirm whether the patient’s plan requires preauthorization for a crisis therapy day or has special claim filing rules.
Telehealth: Crisis psychotherapy codes are approved for telehealth by Medicare and most insurers. In fact, Medicare has permanently added 90839 and 90840 to its telehealth services list. 8 The CMS FAQ explicitly states you “can furnish these services via telehealth… if you meet all requirements.”. 3 In practice, you would conduct the crisis session by secure video (audio-only may be allowed in some cases or states, but video is standard). When billing Medicare for a virtual crisis visit, use place-of-service 02 (Telehealth) or the normal POS with modifier -95 (real-time audio/visual). Most commercial payers follow suit: they cover virtual psychotherapy at the same rate as in-person, often requiring POS 02 and modifier 95 (or GT) to flag telehealth. For example, state telehealth laws now mandate coverage parity for mental health in many areas. 9
Modifiers: In general, add the usual modifiers for telehealth visits: -95 (synchronous telehealth) on each line or the global modifier as required by the payer. Do NOT use the pharmacy or other modifiers with these codes. Also remember crisis psychotherapy requires a signed note by the provider who performed it, even if done virtually; the provider must be physically present on-screen and engaged for the full time reported.
Parity and coverage: Over a dozen states now require commercial insurers to reimburse tele-mental health at the same rate as in-person. 9 Even in states without specific laws, most large plans (Blue Cross, Aetna, United, etc.) cover video visits for mental health since the pandemic. (Check whether your state or plan has any restrictions on audio-only vs. video – some allow phone-only for crisis, others prefer video.) The key point: 90840 telehealth = same code as in-person, with the usual telehealth billing conventions. The AMA’s telehealth code list confirms 90840 is a CMS-covered telehealth service 4, and HHS telehealth guidance similarly lists it with permanent telehealth coverage. 8
For clinicians and patients, properly using 90840 has significant value. It recognizes that crisis sessions are more intensive and time-consuming than routine therapy. Without an add-on code, providers would be underpaid for extended life-saving work. Billing 90840 lets you recoup the extra time needed for thorough crisis intervention – safety planning, coordination with family or hospitals, de-escalation, etc. For patients, this means you can keep the session going until the immediate danger is addressed, rather than stopping at 60 minutes due to reimbursement concerns. Ultimately, crisis psychotherapy codes encourage comprehensive care: they pay for the full intervention that “helps reduce a patient’s mental health crisis through an urgent assessment… mobilizing resources to defuse the crisis and restore safety”. 3 Used correctly, 90840 (with 90839) supports both patient well-being and clinic sustainability during acute emergencies.
Key Takeaways: CPT 90840 is an add-on code for crisis psychotherapy beyond the first hour. 1 3 It is time-based (each 30 min), requires detailed documentation of crisis interventions, and is reportable via telehealth (permanent coverage). Make sure the patient truly meets crisis criteria and that no other psychiatric/therapy code is billed on the same day. When used appropriately, 90840 ensures fair payment for extended, life-saving therapy and allows patients to receive the care they need in moments of greatest need. 8 3
Sources:
CMS - Billing and Coding: Psychiatry and Psychology Services (A57480) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57480
CMS - Billing and Coding: Psychiatric Diagnostic Evaluation and Psychotherapy Services (A57520) https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleId=57520&ver=33
CMS - Psychotherapy for Crisis https://www.cms.gov/medicare/payment/fee-schedules/physician-fee-schedule/psychotherapy-crisis
AMA - Telehealth Services Covered by Medicare and Included in CPT Code Set https://www.ama-assn.org/system/files/telehealth-services-covered-by-medicare-and-included-in-cpt-code-set.pdf
Headway - How to Use CPT Codes 90839 and 90840: Psychotherapy for Crisis https://headway.co/resources/cpt-code-90839-90840
Blue Cross NC - Telehealth Reimbursement Policy https://www.bluecrossnc.com/content/dam/bcbsnc/pdf/providers/policies-guidelines-codes/policies/commercial/reimbursement/telehealth.pdf
BCBSM - Telehealth for Behavioral Health Providers https://providerinfo.bcbsm.com/documents/billing-claims/telehealth/telehealth-behavioral-health-providers.pdf
Telehealth.HHS.gov - Billing for Telebehavioral Health https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-behavioral-health/billing-for-telebehavioral-health
Fierce Healthcare - Changes in Payer Requirements for Telehealth Since 2019 https://www.fiercehealthcare.com/telehealth/survey-heres-how-telehealth-commercial-payer-laws-have-changed-2019
