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A crisis psychotherapy note documents an encounter where psychotherapy addressed an acute crisis: the precipitating event, urgent assessment, mental status, risk findings, interventions, client response, and disposition. Therapists, psychologists, counselors, and clinical social workers write one after crisis encounters in office, telehealth, or community settings. In the US it supports the time-based crisis codes 90839 and 90840. A typical crisis note runs 250 to 700 words.
Therapists, psychologists, counselors, clinical social workers, crisis clinicians
Treating clinician, crisis and emergency teams, payers, auditors, legal reviewers
250 to 700 words · 15 to 25 minutes by hand (clinical team estimate)
Crisis encounter documentation (compare: progress note, suicide risk assessment, safety plan)
During or immediately after a crisis encounter, in office, by telehealth, or in the community
No mandated format; Medicare defines the service content and time rules, not the note layout
A crisis psychotherapy note is the clinical record entry for an encounter where psychotherapy addressed an acute crisis: substantial distress from a problem serious and complex enough to need attention that day. The name comes from the billing side, not from a documentation standard. The US crisis service codes took effect January 1, 2013, and were developed at the request of the National Association of Social Workers, according to the American Psychiatric Association's contemporaneous coding materials. Clinicians and payers also call it a crisis note, a crisis intervention note, or simply a 90839 note.
Two clarifications matter. First, no law, regulation, or payer policy prescribes a crisis note format. CMS describes what the service itself must involve: an urgent assessment and history of the crisis state, a mental status exam, psychotherapy, mobilization of resources to defuse the crisis and restore safety, and a disposition. Any note that clearly shows that work qualifies; the layout is a convention. Second, a crisis psychotherapy note is not a psychotherapy note in the HIPAA sense. It carries session times, diagnosis, risk findings, and the disposition, exactly the content HIPAA excludes from that specially protected category, so it belongs in the standard clinical record (see the psychotherapy notes authorization page for the difference).
Outpatient therapists, psychologists, counselors, and clinical social workers write one whenever a session became crisis work: an established client arrives in acute distress, a new client presents in crisis, or a routine appointment converts partway through. Medicare recognizes the service from physicians and a broad practitioner list that includes clinical psychologists, clinical social workers, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors, in facility and non-facility settings including homes, and by telehealth when requirements are met. An encounter qualifies by what happened in it, not by how it got on the calendar: a scheduled session that turned into genuine crisis stabilization can qualify, and an unscheduled visit is not automatically a crisis service. When the session stayed planned treatment, write a standard progress note or SOAP note instead. Mobile crisis and community stabilization teams usually document under separate state program codes with their own rules, so this page covers the individual psychotherapy-for-crisis encounter.
The sections mirror what CMS says the service includes: an urgent assessment and history of the crisis state, a mental status exam, psychotherapy, mobilization of resources, and a disposition. Time is the sixth element: record start and stop times or total time, including each segment when the work was split across the day.
Precipitating event and history of the crisis state. What happened, when it escalated, and why it needed attention today: the acute stressor, recent changes, relevant history. Pitfall: recording distress without the why-now. A reviewer should see a problem requiring immediate attention, not a difficult week.
Mental status and presentation. Appearance, speech, affect, thought process, orientation, and judgment, focused on what is relevant to the crisis, with changes across the encounter noted. Pitfall: skipping the mental status exam in the urgency of the moment. It is part of the service Medicare describes, not an optional extra.
Risk assessment. Ideation, intent, plan, access to means, and protective factors as relevant to this crisis, ending in a risk formulation. Pitfall: a bare "denies SI." The formulation is what supports the disposition, so a checkbox leaves the most consequential decision in the note unexplained.
Interventions and resources mobilized. The crisis-focused therapeutic work delivered (de-escalation, grounding, structured problem solving, safety planning) and the supports activated, with consent noted for collateral contacts. Pitfall: a note that reads as monitoring or coordination only. The service is psychotherapy for crisis, so name the therapeutic work.
Client response. How the client's state changed in response to the work, measurable where possible. Pitfall: no recorded response. Contractor reviews repeatedly flag notes with no documented outcome, and a disposition with no recorded response above it looks arbitrary.
Disposition and follow-up. Where the client went and why that was safe: level of care, consultation, a dated next contact, and the escalation instructions given. Pitfall: "will follow up" with no timeframe. The disposition is the part of a crisis note that gets defended later, so give it reasoning and a date.
Client: [initials] Date: Setting: [office/telehealth/home or community] Start/stop time(s), may be non-continuous: Total crisis time (min): Precipitating event & history of crisis state: Mental status & presentation: Risk assessment (ideation, intent, plan, means access, protective factors): Interventions & resources mobilized (consent noted for contacts): Client response: Disposition & follow-up (level of care, next contact, escalation plan): Clinician signature/credentials: Date signed:
Free to use and share, no signup. The PDF includes a one-page cheat sheet with section-by-section pitfalls and a pre-sign checklist; the DOCX is the blank template, ready to adapt.
Scenario: established adult client in outpatient CBT contacts the practice in acute distress after a sudden job loss and is seen the same day for a 65-minute crisis session. All details are fictional.
Client: R.L., 42 · Date: 07/14/2026 · Service: Crisis psychotherapy, in office · Start/stop: 2:10 pm to 3:15 pm (65 minutes, continuous)
Precipitating event and history: Client called the practice at 1:40 pm in acute distress after being terminated from a 12-year position this morning. Reports escalating panic since the meeting, one episode of hyperventilation on the drive over, and repetitive thoughts that the family's finances are ruined. No sleep concerns before today; symptoms of this intensity are new. Spouse drove client to the office and is in the waiting room.
Mental status: Alert and oriented. Grooming appropriate but visibly distressed on arrival: tearful, wringing hands, speech rapid and pressured initially, slowing by mid-session. Affect anxious and constricted, brightening slightly by session end. Thought process organized. No hallucinations or delusions elicited. Judgment and insight intact.
Risk assessment: Client reported passing thoughts this morning that the family "would be better off" without them, which resolved by early afternoon. Denied current suicidal ideation, intent, or plan, and denied any history of self-harm or prior attempts. Access to means reviewed with client and spouse; no concerns identified. Protective factors: engaged spouse, two school-age children, active treatment relationship, previously effective coping skills. Formulation: acute situational crisis with brief passive ideation, now resolved; risk currently low with strong protective factors; outpatient management with supports is appropriate.
Interventions and resources mobilized: Paced breathing practiced in session until physical symptoms settled. Structured review of the precipitating event and immediate financial concerns; cognitive restructuring of catastrophic appraisals using established CBT skills. Safety plan reviewed and updated with client. With client's consent, spouse joined the final 15 minutes to review warning signs, the updated plan, and next steps. Crisis line (988) saved to client's phone.
Client response: Visible de-escalation across the session. Breathing normalized, speech slowed, and client engaged actively in planning. Self-rated distress decreased from 8/10 at arrival to 4/10 at close. Client generated two concrete steps for the next 48 hours and committed to both.
Disposition and follow-up: Client returns home with spouse. Phone check-in scheduled tomorrow at 10:00 am; next appointment 07/17/2026. Client verbalized the safety plan steps and agreed to call or text 988 or go to the nearest emergency department if distress escalates. Risk formulation supports outpatient disposition as documented above.
This sample is fictional and for educational purposes. It does not describe a real patient.
Writing these after every session? BastionGPT drafts complete notes from bullets, dictation, or a transcript.
Generate a note from bulletsA crisis note is read by more people, under more scrutiny, than any other note you write: the colleague taking the next-day check-in, a care coordination handoff, payers, and sometimes attorneys or your licensing board. The disposition and its reasoning are what get examined afterward, so document the risk formulation that led to it, any consultation, and collateral contacts with the consent basis noted. Duty-to-warn and duty-to-protect rules are state law, and they vary: California and Virginia define triggers and protective actions without prescribing note content, while New York expressly requires the reasons for a danger-related disclosure to be "fully documented in the clinical record" (Mental Hygiene Law 33.13). When a threat situation touches your note, consult your attorney or board; state rules vary. If you or a client needs immediate support: call or text 988 (US), 9-8-8 (Canada), or Lifeline 13 11 14 (Australia).
For Medicare, the crisis codes are time based and the time rules are specific. 90839 covers the first 60 minutes and 90840 each additional 30, and contractor guidance counts the total face-to-face crisis time on the date of service even when it is not continuous, with the patient present for all or some of it and the clinician's full attention on the crisis while time is counted. Since January 1, 2024, crisis psychotherapy furnished at an applicable site of service (anywhere the non-facility rate applies other than an office, such as a client's home) bills Medicare's G0017 and G0018 at 150 percent of the non-facility rate under the Consolidated Appropriations Act, 2023. Do not bill the crisis codes on the same date as a psychiatric diagnostic evaluation or standard psychotherapy, and remember that a diagnosis, panic, or an unscheduled appointment by itself does not establish the service (CMS, Psychotherapy for Crisis). The format is a convention; the content and the time are the requirement. Crisis work also usually changes the treatment plan, so close the loop there once the client is stable.
Crisis-specific audit data is thin: no national dataset publishes a 90839-only denial rate. The broader psychotherapy findings are blunt. Medicare's 2024 reporting-period data for outpatient psychiatric services put improper payments at 16.1 percent ($254.5 million), with insufficient documentation driving 78.3 percent of them, and a national OIG audit of psychotherapy claims estimated $580 million in improper payments, with undocumented time a leading cause. The BastionGPT Clinical Advisory Board sees the same errors most often in crisis note reviews:
BastionGPT is specifically trained, tuned, and clinically tested on crisis psychotherapy notes.
See how clinicians use it day to day on the AI therapy notes page.
Many BastionGPT users report saving more than 90 minutes per day on documentation.
HIPAA-compliant with a signed BAA on every plan. Your data is never used to train models. BastionGPT drafts, you review and sign.
Most run 250 to 700 words, noticeably longer than a routine progress note, because the note carries an urgent assessment, a risk formulation, interventions, the client's response, and a reasoned disposition. Length is not the goal: a reviewer should be able to reconstruct what the crisis was, what you did, and why the disposition was safe.
No. No regulation or payer policy prescribes headings, a named template, or a SOAP-style layout for crisis work. Medicare defines the service content instead: an urgent assessment and history of the crisis state, a mental status exam, psychotherapy, resource mobilization, and a disposition. Any note that clearly shows that work qualifies; the format is a convention.
They are time-based codes, so the record must make the crisis time countable. Medicare contractor guidance counts the total face-to-face time on the date of service even when it is not continuous, and the patient may be present for all or some of it, but the clinician must give the crisis full attention while time is counted. A clear total time can be sufficient; start and stop times are the safest habit. 90839 covers the first 60 minutes and 90840 each additional 30.
Yes. Nothing in Medicare policy makes a scheduled appointment ineligible, and an unscheduled visit is not automatically a crisis. What controls is the work: whether the presentation met the immediate-attention criteria and the session became crisis psychotherapy with assessment and disposition work. When a routine session converts partway through, count only the crisis time.
No. CMS instructs practitioners not to report the crisis codes on the same date as a psychiatric diagnostic evaluation (90791, 90792) or standard psychotherapy (90832 through 90838). 90840 also never stands alone; it is an add-on to 90839. When a session becomes a crisis, bill the crisis service the time supports rather than stacking codes.
Medicare codes for crisis psychotherapy furnished at an applicable site of service: anywhere the non-facility rate applies other than an office, such as a client's home. Congress created the category in the Consolidated Appropriations Act, 2023, and since January 1, 2024 these codes pay 150 percent of the non-facility rate. In an office or facility you keep using 90839 and 90840, so picking the code that matches the site matters.
No. HIPAA's specially protected psychotherapy-notes category excludes exactly what a crisis note must contain: session times, diagnosis, symptoms, treatment plan, and progress. A crisis psychotherapy note belongs in the standard clinical record, where payers and other treating providers can rely on it. Keep private process reflections in separately maintained psychotherapy notes with their own authorization rules.
Not as a universal rule: no national 90839 requirement makes a standalone safety plan mandatory, so document the safety planning you actually did in the note itself. Since January 1, 2025, Medicare also recognizes structured safety-planning interventions as a separate service, G0560, billed in 20-minute increments and distinct from the crisis psychotherapy itself.
Yes. Give it bullets or a dictation from the encounter, and it drafts a structured crisis note with the precipitant, mental status, risk assessment, interventions, response, and disposition for your review. BastionGPT is HIPAA-compliant with a signed BAA on every plan, and your data is never used to train models.
The compliance claims on this page trace to these authorities, last verified July 2026:
Educational content, not legal or billing advice. Sample notes are fictional. Follow your organization's policies and your board, payer, and jurisdiction requirements.