CPT Code 90840: Under psychotherapy for crisis services and procedures

What is CPT code 90840?

CPT code 90840 is an add-on code used to provide additional time during psychotherapy for a crisis. It represents each additional 30 minutes of face-to-face psychotherapy following the initial 60 minutes, which is billed using CPT 90839. This code applies when healthcare providers (such as psychiatrists, licensed therapists, clinical psychologists, or other qualified healthcare professionals) deliver immediate, unscheduled, and medically necessary intervention services in response to a patient’s behavioral or psychological emergency.

Psychotherapy services under this code are designed to support patients in acute distress, often due to suicidal ideation, severe anxiety, psychotic episodes, or mental health crises triggered by physical illness or trauma. Providers use this code to reflect extended care that involves intense clinical decision making and behavioral observations to stabilize the patient and determine a safe disposition.

What is psychotherapy for crisis?

Psychotherapy for crisis is an urgent assessment and intervention provided during a psychiatric or psychological emergency. It includes a health-focused clinical interview, mental status exam, risk assessment, and crisis stabilization efforts. This service is delivered when a patient presents with severe emotional distress requiring immediate clinical attention, typically outside scheduled sessions. Its goal is to reduce imminent risk, restore safety, and initiate a treatment plan that may include follow-up services or referrals.

CPT code 90840 documentation requirements

Thorough documentation supports medical necessity and ensures compliance with current procedural terminology and National Correct Coding Initiative (NCCI) guidelines.

Clear indication of crisis state

Clearly describe the nature of the psychiatric emergency, such as suicidal ideation, homicidal threats, panic attacks, or other acute mental illnesses. Documentation must demonstrate that the crisis required immediate attention and unscheduled response.

Clinical interventions provided

Record all clinical actions taken during the session, including de-escalation techniques, urgent assessment, safety evaluations, and mental status exam findings. Include any behavioral observations that influenced your clinical decision-making.

Time spent (additional 30+ minutes)

Document the exact amount of time spent beyond the first 60 minutes of psychotherapy for crisis. CPT 90840 accounts for each additional 30-minute increment of continuous, face-to-face time with the patient present. Time must be clearly stated and uninterrupted.

Disposition plan or safety plan

Note the patient’s disposition at the end of the session. This may include hospitalization, referral to outpatient care, initiation of a treatment plan, or family psychotherapy involvement. Include safety planning details to support the necessity and outcome of the intervention.

Communication with support systems

Document any communications made with emergency services, family members, or treatment team members involved in coordinating care. These efforts reinforce the complexity of the encounter and validate coding practices.

CPT Code 90840 billing guidelines

Correct use of CPT 90840 depends on its pairing with CPT 90839 and compliance with payer policies for crisis care services.

Use only with CPT 90839

CPT 90840 is an add-on code and cannot be billed alone. It must always accompany 90839, which represents the first 60 minutes of psychotherapy for crisis. This structure reflects the progressive intensity of time in crisis intervention services.

Time must be continuous and face-to-face

The time reported must be continuous and with the patient physically present. Time spent coordinating care, reviewing history, or consulting with others does not count toward the time requirement unless it is done face-to-face with the patient.

Bill multiple units for extended time

Multiple units of CPT 90840 may be billed for prolonged sessions. For example, a 120-minute crisis encounter would be billed as 90839 (first 60 minutes) + 90840 x 2 (for 61–120 minutes). Clearly document time intervals for each unit billed.

Modifier use for same date services

If an evaluation and management (E/M) service or another mental health service is provided on the same date, use appropriate modifiers (e.g., Modifier 25) to indicate distinct and separately identifiable services. Ensure accurate billing by clearly separating services in documentation.

Immediate, unscheduled, and medically necessary

Crisis services must be immediate, unscheduled, and clinically justified. Documentation must support the medical necessity of providing urgent care beyond routine or planned psychotherapy sessions.

Other Relevant CPT Codes

• 90839 – Psychotherapy for crisis, first 60 minutes
• 90791 – Psychiatric diagnostic evaluation (without medical services)
• 90792 – Psychiatric diagnostic evaluation (with medical services)
• 90832–90838 – Psychotherapy services (standard duration, not crisis-specific)