The 90839 CPT code is psychotherapy for crisis, first 60 minutes. Its add-on, 90840, covers each additional 30 minutes. They are for a patient in high distress with a problem that is typically life threatening or complex and needs immediate attention. The note has to show an urgent assessment, a mental status exam and a disposition, and the time.
One thing most guides leave out. In the 2026 Medicare fee schedule, a 60 minute office session billed as 90837 pays USD 167.00 nationally. The same hour billed as 90839 pays USD 160.32. The crisis code pays less until the session reaches 75 minutes and 90840 applies. A January 2025 HHS report traces the gap back to 2020. Details are below.
Every rule on this page comes from a primary source and is attributed where it appears. Where a rule belongs to one Medicare contractor or to the individual payer, the page says so. The sources are:
- The CMS Psychotherapy for Crisis page, last modified February 25, 2026
- The CMS Medicare NCCI Policy Manual, Chapter XI, revised January 1, 2026
- First Coast Service Options LCD L33252 and billing article A57520, the Medicare contractor for Florida, Puerto Rico and the US Virgin Islands
- The CMS 2026 physician fee schedule relative value file, January release
- The CMS CY 2026 list of Medicare telehealth services
- The HHS ASPE analysis of outpatient crisis services and reimbursement, January 2025
What does CPT code 90839 mean?
CPT code 90839 is "Psychotherapy for crisis; first 60 minutes". The add-on 90840 is "each additional 30 minutes" and is used with 90839, never alone. Both descriptors are from the CMS crisis psychotherapy page. The CMS 2026 relative value file abbreviates them as "Psytx crisis initial 60 min" and "Psytx crisis ea addl 30 min".
| Element | 90839 | 90840 |
|---|---|---|
| Descriptor | Psychotherapy for crisis, first 60 minutes | Each additional 30 minutes |
| Code type | Primary code | Add-on, reported only with 90839 |
| Units per date | One | One per additional 30 minute block |
| Time counted | Total face to face crisis time that date, need not be continuous | Same |
| Medicare global period in the 2026 file | XXX | ZZZ, the add-on indicator |
| Telehealth, CY 2026 Medicare list | Maintain | Maintain |
The code describes the patient's state, not the length of a normal session. A standard 60 minute session that never becomes a crisis is 90837, however hard the material is.
How many minutes do 90839 and 90840 require?
90839 covers the first 30 to 74 minutes of crisis psychotherapy on a date, and is reported once per day. That is the CPT manual instruction as quoted in the ASPE report. 90840 is added for each further 30 minutes. The AAPC Psychiatry Coding Alert puts the first 90840 at minute 75 and the second at minute 105. Under 30 minutes, crisis time is reported with the regular psychotherapy codes, as in the Atrium Health behavioral health coding matrix.
| Total crisis time on the date | What to report |
|---|---|
| Under 30 minutes | Not 90839. Use the psychotherapy code that matches the time, such as 90832 |
| 30 to 74 minutes | 90839 x1 |
| 75 to 104 minutes | 90839 x1 and 90840 x1 |
| 105 to 134 minutes | 90839 x1 and 90840 x2 |
| Each further 30 minutes | One more unit of 90840 |
- The time is total face to face time on the date. A57520 says it does not have to be continuous.
- Time spent on another patient in between does not count. A57520 requires full attention to this patient.
- The patient must be present for all or some of the service. Family time counts when the patient is part of it.
- Record start and stop times for each block, or the total, in the note.
- 90839 is once per date. A second crisis later the same day adds time to the 90839 already billed.
What qualifies as a crisis for 90839?
The definition is the same in the CMS page and in L33252 section VII. Psychotherapy for crisis is "an urgent assessment and history of a crisis state, a mental status exam, and a disposition." The presenting problem "is typically life threatening or complex and requires immediate attention to a patient with high distress."
| Required element | What the record has to show |
|---|---|
| Urgent assessment and history of a crisis state | What happened, when it started, and why it could not wait for a routine visit |
| Mental status exam | A documented MSE in this encounter, not carried forward |
| Psychotherapy | The therapeutic work done during the crisis time |
| Mobilization of resources to defuse the crisis and restore safety | Who was contacted or engaged: family, emergency contact, crisis line, hospital, police where used |
| Interventions to minimize the potential for psychological trauma | What the clinician did to stabilize the patient |
| Disposition | What happens next: home with a safety plan, higher level of care, follow up date |
- Active suicidal or homicidal ideation that requires a safety assessment in the session.
- Acute decompensation, such as new psychotic symptoms or severe agitation.
- A traumatic event in the last hours or days, with the patient unable to function.
- A situation that requires arranging an emergency evaluation or transport.
- Severe distress where safety cannot be confirmed without immediate work.
These illustrate the definition. Each payer applies it to the note in front of it.
When to use 90839 vs 90837?
Use 90837 for a planned 60 minute psychotherapy session. Use 90839 when the encounter is a crisis under the definition above, with the urgent assessment, mental status exam and disposition in the note. The session length does not decide it. The patient's state does.
| 90837 | 90839 | |
|---|---|---|
| Descriptor | Psychotherapy, 60 minutes with patient | Psychotherapy for crisis, first 60 minutes |
| Time that supports the code | 53 or more minutes | 30 to 74 minutes |
| Add-on for longer time | None in the psychotherapy family | 90840 per additional 30 minutes |
| Required content | Psychotherapy toward treatment plan goals | Urgent assessment, mental status exam, crisis work, disposition |
| Interactive complexity 90785 | Reportable where the criteria are met | Not with crisis codes, per the CMS page |
| CMS 2026 national amount, non facility | USD 167.00 | USD 160.32 |
- A routine session where the patient discloses ideation, and you complete a safety assessment and plan: 90839, if the record meets every element.
- A routine session about a hard topic, with no crisis state: 90837.
- A new patient seen first in crisis: 90839 can be used; 90791 cannot be billed with it the same date.
- A 40 minute crisis contact: 90839, since it is inside 30 to 74 minutes. 90837 would need 53 minutes.
Does 90837 pay more than 90839 in 2026?
Yes, in the office and other non facility settings. The CMS 2026 relative value file gives 90837 5.00 total RVUs non facility and 90839 4.80. At the 2026 conversion factor of 33.4009, that is USD 167.00 against USD 160.32, a gap of USD 6.68 per session before locality adjustment.
| Billed as | Total RVU, non facility | National amount, non facility | Total RVU, facility | National amount, facility |
|---|---|---|---|---|
| 90837 | 5.00 | USD 167.00 | 4.05 | USD 135.27 |
| 90839 | 4.80 | USD 160.32 | 3.88 | USD 129.60 |
| 90839 + 90840 | 7.11 | USD 237.48 | 5.75 | USD 192.06 |
The ASPE report explains how it happened. When the crisis codes were introduced in 2013, Medicare paid them above 90837. When the rate for traditional psychotherapy rose in 2020, the crisis rate stayed the same. Interviewees told ASPE this left "little incentive to use the codes". Some said it can pay better not to bill a crisis as a crisis.
- Code the service that happened. The payment gap is not a reason to bill a crisis as 90837 or a routine hour as 90839.
- A crisis that runs 75 minutes or more, with 90840, pays more than 90837 under Medicare.
- Commercial and Medicaid rates are set by contract and may not show the same gap. Check the fee schedule for each payer.
- Source: CMS PPRRVU2026_Jan_nonQPP, conversion factor 33.4009.
mdhub drafts the note from your session, in your template, for you to review
START FREE TRIAL →Can you bill 90837 and 90839 on the same day?
Not for Medicare. The CMS crisis page says not to bill the crisis codes with 90832 to 90838, 90791, 90792, or 90785 to 90899. If a routine session turns into a crisis, the encounter is reported as crisis psychotherapy for the total crisis time. The AAPC alert reaches the same answer: report only the crisis code.
| Same day pairing | Medicare rule | What to do |
|---|---|---|
| 90839 with 90832, 90834 or 90837 | Do not bill together, per the CMS crisis page | Bill the crisis code for the crisis time |
| 90839 with 90791 or 90792 | Do not bill together; NCCI Chapter XI says 90791 and 90792 are not separately reportable with crisis psychotherapy on the same date | Report 90839; the evaluation goes on another date |
| 90839 with 90785 | Do not bill together, per the CMS crisis page | Leave 90785 off the claim |
| 90839 with 90840 | The add-on is built for this | Add 90840 once the time reaches 75 minutes |
| 90839 with an E/M visit | Not on the CMS do not bill list | Confirm with the payer and document separately identifiable work |
Commercial plans and state Medicaid programs set their own edits. Some accept a routine session and a crisis code on one date with a modifier and separate times. Read the payer's policy before assuming either way.
Can you bill 90839 and 90840 together?
Yes. That is the only way 90840 is billed. CMS describes 90840 as "each additional 30 minutes" to be used in conjunction with 90839. The 2026 file gives it the add-on global indicator ZZZ. 90840 can be reported more than once on a date. ASPE found that most crisis claims use 90839 alone.
- 90839 on line one, one unit.
- 90840 on line two, with the number of additional 30 minute units.
- The note shows the total time that supports the units.
- Without 90839 on the same claim, 90840 has no primary code and denies.
What are G0017 and G0018?
They are the Medicare codes for crisis psychotherapy outside the office. The CMS page says to use G0017 and G0018 "for services furnished in an applicable site of service". That means any place of service, other than the office, where the non facility rate applies. Billing article A57520 adds that 90839 and 90840 are still reported for the applicable sites.
| Code | 2026 file descriptor | Total RVU, non facility | National amount, non facility |
|---|---|---|---|
| G0017 | Crisis psychotherapy 60m | 6.54 | USD 218.44 |
| G0018 | Crisis psychotherapy add 30m | 3.15 | USD 105.21 |
| 90839 | Psytx crisis initial 60 min | 4.80 | USD 160.32 |
| 90840 | Psytx crisis ea addl 30 min | 2.31 | USD 77.16 |
CMS states that payment for these services is equal to 150 percent of the fee schedule amount for non facility sites. The amounts above are the relative value file figures times the conversion factor. Your contractor's locality amount is the one that pays.
How much does 90839 pay in 2026?
The CMS 2026 relative value file, January release, sets 90839 at 4.80 total RVUs non facility and 3.88 facility: USD 160.32 and USD 129.60 nationally. 90840 adds USD 77.16 non facility per unit.
| Crisis time | Codes | National amount, non facility | National amount, facility |
|---|---|---|---|
| 30 to 74 minutes | 90839 | USD 160.32 | USD 129.60 |
| 75 to 104 minutes | 90839 + 90840 | USD 237.48 | USD 192.06 |
| 105 to 134 minutes | 90839 + 90840 x2 | USD 314.64 | USD 254.51 |
- National amount is total RVU times the 2026 conversion factor of 33.4009.
- Your Medicare contractor applies a locality adjustment, and some non physician practitioners are paid a percentage of the amount.
- Commercial and Medicaid rates are set by contract.
Who can bill 90839?
The CMS crisis page lists the practitioners who can personally furnish these services for Medicare. Some of them can also bill for auxiliary personnel, such as a peer support specialist, incident to their services under general supervision.
- Physicians (MDs and DOs)
- Clinical psychologists
- Clinical social workers
- Clinical nurse specialists
- Nurse practitioners
- Physician assistants
- Certified nurse midwives
- Marriage and family therapists
- Mental health counselors
Is 90839 covered by insurance?
Medicare pays for it under the physician fee schedule. First Coast's article A57520 lists 90839, 90840, G0017 and G0018 among the codes its ICD-10-CM list supports. Medicaid and commercial coverage varies. ASPE notes that the codes are available to public and commercial payers. Its interviewees described uncertainty about which plans pay them, which kept some clinicians from using them.
| Payer type | What to check |
|---|---|
| Medicare | Your contractor's LCD and billing article, and the diagnosis list |
| Medicare Advantage | The plan's own policy and any authorization rule |
| Medicaid | Whether the state program pays 90839, or uses a state crisis code such as H2011 instead |
| Commercial | The plan's behavioral health policy, same day edits and modifier rules |
Can 90839 be billed for telehealth?
90839 and 90840 are on the CMS CY 2026 Final List of Medicare Telehealth Services with a status of Maintain. The CMS crisis page also says these services can be furnished by telehealth if all requirements are met. ASPE found the telehealth share of 90839 claims rose from 2020 across Medicaid, Medicare and commercial data.
- Use the place of service and modifier the payer requires for telehealth.
- Document the patient's location, since disposition and resource mobilization depend on it.
- Commercial and Medicaid telehealth rules are set by each plan and by state law.
Can 90785 be added to 90839?
No, for Medicare. The CMS crisis page lists 90785 to 90899 among the codes not to bill with crisis psychotherapy. The add-on 90840 is the one code in that range CMS pairs with 90839. ASPE heard from clinicians who bill a crisis as 90834 or 90837 plus 90785 instead. ASPE also found the interactive complexity criteria were unevenly understood.
What must a 90839 progress note document?
The note carries the claim. It has to show the definition was met and the time behind the units. The list follows the CMS definition and A57520's time rules.
| Requirement | Source | In the note |
|---|---|---|
| Crisis state and why it needed immediate attention | CMS page, L33252 section VII | Presenting problem, onset, risk level |
| Urgent assessment and history | CMS page, L33252 section VII | Assessment findings, including risk assessment |
| Mental status exam | CMS page, L33252 section VII | A current MSE for this encounter |
| Psychotherapy and interventions | CMS page, L33252 section VII | What the clinician did to stabilize the patient |
| Resources mobilized | CMS page, L33252 section VII | Who was contacted and what was arranged |
| Disposition | CMS page, L33252 section VII | Where the patient went next and the follow up |
| Total face to face time | A57520 | Start and stop times or total minutes, across blocks |
| Patient present for all or some | A57520 | Who attended and for which part |
| Full attention to this patient | A57520 | No other patient seen during the counted time |
ASPE quotes a social worker who uses the codes only "when we could very clearly say in the notes: 'This is what's happening, we do not want to argue about this.'" That is the standard to write to.
What does a 90839 note look like?
A short example for a fictional patient, written to the elements above. Names and details are invented.
| Field | Entry |
|---|---|
| Patient | R., age 34, major depressive disorder, recurrent, in weekly outpatient therapy |
| Crisis state | Disclosed suicidal ideation with intent this week after a job loss; unable to confirm safety at session start |
| Time | 2:00 pm to 3:20 pm face to face, 80 minutes; 90839 x1, 90840 x1 |
| Mental status exam | Alert, oriented x3; depressed mood, constricted affect; linear thought process; no psychotic features; judgment impaired by current distress |
| Assessment | Structured suicide risk assessment completed; acute risk judged high at start, moderate after intervention |
| Interventions | De-escalation, collaborative safety plan, means safety counseling, problem solving for the next 72 hours |
| Resources mobilized | Spouse joined by phone with consent; agreed to stay with patient tonight; 988 and clinic after hours line reviewed |
| Disposition | Home with spouse and written safety plan; follow up session in 2 days; criteria for emergency evaluation reviewed |
A reviewer can see the crisis state, the MSE, the work done, who was mobilized, the disposition and the minutes behind two units.
How often is 90839 billed?
Rarely. The ASPE report analyzed Medicaid, Medicare and commercial claims from 2018 to 2022.
| Finding | ASPE result |
|---|---|
| Enrollees with a 90839 claim in a year | Less than 1 percent, in each payer, every year |
| Trend | Use rose from 2018 to 2020 and fell from 2020 to 2022 |
| Mean episode length, Medicaid | 66 to 69 minutes |
| Mean episode length, Medicare | 73 to 77 minutes |
| Mean episode length, commercial | 71 to 76 minutes |
| Claims in an emergency department | 6 to 10 percent, steady across the period |
| Commercial claims in an office | 76 percent in 2018, 50 percent in 2022 |
| Patients with an existing provider relationship, 2022 | 43 percent Medicaid, 36 percent Medicare, 46 percent commercial |
The barriers ASPE heard were lack of knowledge of the codes, limited training, inconsistent payer policies and pay that did not reflect the work. Its interviewees also noted a difference by practice size. A large group or agency might have staff who can step in when a client is in crisis. A therapist in a solo or small practice often does not have time outside scheduled appointments.
Why do 90839 claims get denied?
| Denial cause | How it happens | Fix |
|---|---|---|
| Billed with 90837 the same day | Routine session and crisis both billed | Report the crisis code for the total crisis time |
| Under 30 minutes | Short crisis contact billed as 90839 | Use the time matched psychotherapy code |
| 90840 without enough time | Add-on billed at 60 to 74 minutes | 90840 starts at 75 minutes |
| 90840 alone | Add-on billed on a date without 90839 | Bill 90839 on the same claim |
| 90785 attached | Interactive complexity added to the crisis code | Remove it; CMS lists 90785 as not billable with crisis codes |
| Missing MSE or disposition | Note reads like a routine session | Document every element of the definition |
| No time | Note has no minutes | Record start and stop times or total time |
| Wrong site code | Home or other non facility visit billed as 90839 to Medicare | Check whether G0017 and G0018 apply |
| Payer does not cover the code | State Medicaid or plan uses its own crisis code | Verify the payer's crisis codes before billing |
What should you check before a 90839 claim goes out?
- The note shows a crisis state, an urgent assessment, an MSE and a disposition.
- Total crisis time is 30 minutes or more, with times in the note.
- 90839 appears once for the date.
- 90840 units match the time: one from minute 75, two from minute 105.
- No 90832 to 90838, 90791, 90792 or 90785 on the same date for Medicare.
- The place of service is right, and G0017 and G0018 are used where they apply.
- Telehealth claims carry the payer's place of service and modifier.
- The diagnosis is on the payer's covered list.
- The payer covers 90839, or the state's crisis code is used instead.
- Resources mobilized and follow up are documented.
90839 CPT code FAQ
What does CPT code 90839 mean?
Psychotherapy for crisis, first 60 minutes. It covers an urgent assessment and history of a crisis state, a mental status exam, psychotherapy, mobilizing resources and a disposition.
How many minutes is 90839?
90839 covers the first 30 to 74 minutes of crisis psychotherapy on a date, once per day. Under 30 minutes, use the regular psychotherapy code that matches the time.
When do you add 90840?
From minute 75. One unit of 90840 covers 75 to 104 minutes, two units 105 to 134, and each further 30 minutes adds a unit.
Can you bill 90839 and 90840 together?
Yes. 90840 is an add-on and is only billed with 90839 on the same date.
Can you bill 90837 and 90839 on the same day?
Not for Medicare. CMS says not to bill crisis codes with 90832 to 90838. Report the crisis code for the total crisis time. Other payers set their own edits.
When should you use 90839 instead of 90837?
When the patient is in a crisis state and the note shows the urgent assessment, mental status exam and disposition. A planned 60 minute session is 90837.
Does 90839 pay more than 90837?
Not in 2026 for Medicare in the office. 90837 is USD 167.00 and 90839 is USD 160.32 nationally, non facility. With 90840 from minute 75, the crisis claim pays more.
Is 90839 covered by insurance?
Medicare pays for it under the physician fee schedule. Medicaid and commercial coverage varies by plan and state, so verify before billing.
Can 90839 be billed for telehealth?
Yes for Medicare. 90839 and 90840 are on the CY 2026 Medicare telehealth list with status Maintain.
Can 90785 be billed with 90839?
Not for Medicare. The CMS crisis page lists 90785 to 90899 among codes not to bill with crisis psychotherapy, apart from the add-on 90840.
What are G0017 and G0018?
Medicare codes for crisis psychotherapy in non facility places of service other than the office, such as the patient's home. G0018 is the add-on for each 30 minutes.
Who can bill 90839?
For Medicare: physicians, clinical psychologists, clinical social workers, nurse practitioners, clinical nurse specialists, physician assistants, certified nurse midwives, marriage and family therapists and mental health counselors.
For the other psychotherapy codes, see our pages on 90837, 90834, 90832, 90791 and 90846, and our guide to psychotherapy notes.
Streamline Your Practice
The 90839 CPT code pays when the note proves the crisis and the minutes. mdhub drafts the note from your session in your template for you to review. Start a free trial, or book a demo if your clinic has 10 or more clinicians.
