Crisis services: Supporting accurate documentation and billing

Crisis services provide immediate support for members experiencing acute psychological distress. Because these services involve urgent intervention, documentation must clearly support medical necessity and the care provided.

This overview highlights key considerations for crisis service documentation and billing.

Understanding crisis services

Crisis services are appropriate when a member requires immediate intervention to stabilize symptoms and restore safety.

Examples include:

• Suicidal or homicidal ideation
• Severe emotional distress or loss of control
• Sudden worsening of a mental health or substance use condition

Documentation should clearly explain the crisis, the need for intervention and the actions taken to address the member's immediate needs.

Commonly used crisis service codes

Billing codes may vary by plan. The codes below are examples only and may not be covered under all plans or programs. Please consult your Magellan reimbursement schedule.

• 90839: Crisis psychotherapy (first 30-74 minutes)
  • +90840: Each additional 30 minutes
• H2011: Crisis intervention (15-minute increments)
• H0030: Telephone-based crisis intervention and behavioral health support services (15-minute increments)
• S9484: Crisis intervention services (per hour)
• S9485: Crisis intervention services (per diem)

Documentation and billing considerations

To support accurate billing and medical necessity:

• Describe the member's crisis presentation, including symptoms and risk factors.
• Document the intervention provided, such as assessment, stabilization or safety planning.
• Record actual start and stop times and the service location.
• Include outcomes, referrals and follow-up recommendations, when applicable.

When applicable, include outcomes, referrals, follow-up plans and other treatment recommendations.

Remember that documentation and billing requirements may vary by plan, state or regulatory authority. Refer to Magellan’s provider handbook, the plan or program-specific handbook supplement and contractual requirements for additional guidance.

Pennsylvania HealthChoices providers: See guidance pertaining specifically to the PAHC program.

More information

• Review fraud, waste and abuse policies and Health Insurance Portability and Accountability Act (HIPAA) standard code sets in Section 4 of Magellan's National Provider Network Handbook (PDF).
• For questions about audit or investigation processes, contact the Special Investigations Unit at SIU@MagellanHealth.com or 1-800-755-0850. Anonymous reporting is available.