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Charting a crisis session

Overview: When a clinician provides crisis psychotherapy services, the following CPT codes and documentation requirements apply. This guide covers how to bill and document crisis sessions accurately.

CPT Codes

Crisis psychotherapy is billed using two codes:

  • 90839 — Crisis psychotherapy, first 60 minutes. This is the base code for any crisis session lasting at least 30 minutes but typically covering the first full hour.

  • +90840 — Crisis psychotherapy, each additional 30 minutes. This is an add-on code used alongside 90839. Bill one unit for each additional 30-minute block beyond the initial 60 minutes.

  • Example: 105-Minute Crisis Session A session lasting 1 hour and 45 minutes (105 minutes) would be billed as 90839 + 90840 x2 units (60 min + 30 min + 15 min).

  • Important note for clinicians: You will only be able to enter one code in the system. Enter 90839 and our team will add the 90840 units on the back end. Please reach out in these scenarios so that we can ensure the additional codes are added. Yourclinical note must reflect the total time spent — in this example, 105 minutes.

Documentation Requirements

Every crisis note must include the following six elements:

  1. Description of the crisis situation — Provide an urgent assessment and history of the crisis state. What brought the client into crisis? What is the nature and severity of the presenting problem?
  2. Full mental status exam — Document a complete MSE including appearance, behavior, mood, affect, thought process, thought content, perception, cognition, insight, and judgment.
  3. Psychotherapy interventions used — Describe the specific therapeutic interventions you employed to minimize the potential for psychological trauma. This is what distinguishes crisis psychotherapy from a standard evaluation — you must be actively providing psychotherapy, not just assessing.
  4. Mobilization of resources — Document any resources mobilized to defuse the crisis and restore safety. This may include contacting family members, coordinating with emergency services, arranging a higher level of care, or connecting the client with community supports.
  5. Treatment plan — Outline what happens next for the client. Include follow-up appointments, referrals, safety planning, and any changes to the existing treatment plan.
  6. Time documentation — Record the exact number of minutes or start/stop times spent with the client providing crisis psychotherapy. This is essential for supporting the units billed.

Key Reminders

The time documented must reflect face-to-face psychotherapy time with the client in crisis. The session must be truly urgent and crisis-driven — not a routine session that happens to run long. Your note should clearly convey why crisis-level intervention was necessary and what you did therapeutically to address it.