Are there any codes you could be using to get higher reimbursement, especially for longer sessions? Let’s look at two underused CPT codes – 90839 and 90840 – that have the possibility of being used for a longer session when your client is going through a crisis.

What are 90839 and 90840?

The Crisis Psychotherapy codes are:

• 90839 Psychotherapy for crisis; first 60 minutes (30–74-minute time range)
• 90840 Psychotherapy for crisis, each additional 30 minutes

When would I use these codes?

These codes can be used when you provide services to a client who is going through a mental health crisis – a client in high distress, and/or one that has complex problems that require immediate attention. Examples might include clients who are suicidal, have disabling anxiety, have just learned of an unwanted pregnancy, or are otherwise experiencing overwhelming psychological symptoms. These services can include:

• providing an urgent assessment and history of a crisis state
• performing a mental status exam and psychotherapy
• mobilizing resources to defuse the crisis and restore safety
• using interventions to minimize the potential for psychological trauma

How does this look on the claim form or superbill?

Example: For a 75–105-minute session, you would have two lines:

Let’s break this down a bit

• While 90839 is defined as the first 60 minutes of the crisis session, it can be used for 30–74-minute sessions.
• For sessions that last 75 minutes or longer, 90840 is added to the 90839 for each additional 30 minutes. That is, using both codes together requires that the session lasts 75 minutes or longer. You may add multiple 90840s for a longer service.
• 90840 is an add-on code that can ONLY be used together with 90839
• These cannot be billed on the same day with other therapy codes
• You may set your own fee for these codes. Each health plan will put a cap on what they will pay, if reimbursed.
• While you will sometimes see this code written as +90840, do not use the plus sign on the claim or superbill. This sign just indicates it is an add-on code.
• Use these CPT codes to report the time you spend with the client furnishing psychotherapy for crisis services, even if the time spent on the date of service isn’t continuous.
• For crisis sessions 16-29 minutes, use the standard CPT code 90832, individual psychotherapy, 30 minutes, which has the range of 16-38 minutes.

Will health plans pay for this code?

In my experience, most plans will pay for these codes. The 90839 typically pays at a similar rate as your 90837 (60-min psychotherapy) code, but the opportunity to add the 90840 for longer sessions may give you a reimbursement advantage. Medicare does pay for these codes, whether provided in-person or via telehealth (click here for more info on Medicare coverage).

Each health plan may set their own limit on how many 90840s they will cover for one day. They may also limit how many times per month or year you can bill these codes. It is recommended that you check to be sure these codes are covered and check your health plan contract to be sure they are included on your fee schedule.

Documenting crisis sessions

When billing crisis codes, document in your notes your clinical handling of the emergency, and the medical necessity for the session, especially if it is a longer session. You’ll need to document:

• why you considered it a crisis
• how you assessed risk, mental status, and medical stability
• substance use assessment, if applicable
• communication you had with any others
• if your session was longer than 74 minutes, why the longer session was needed
• how you stabilized the client, both in-session interventions, and advice given for post-session actions and referrals
• outcome of the session: how did client appear at end, and planned follow-up

_________

References:

CPT code manual: American Medical Association. (2022). CPT 2023 Professional Edition.