Crisis intervention plan not developed (Updated for 2026)

Common Causes for SA23

Denials with code SA23 typically happen for the following specific reasons:

• The provider performed crisis stabilization or intervention services but forgot to document a formal, written crisis safety plan.
• The crisis plan was completed but not submitted or linked to the specific electronic health record (EHR) encounter of the crisis visit.
• The crisis plan lacked required CMS or state-specific elements, such as coping strategies, support contacts, and triggers, rendering it invalid under audit.
• The service was billed under crisis codes (such as CPT 90839 or 90840) but the clinical documentation failed to mention the creation or update of a crisis intervention plan.

How to Prevent SA23 Denials

To avoid receiving this denial in the future, implement these specific checks:

• Implement mandatory templates or EHR prompts for crisis intervention codes to ensure a crisis plan is completed during the encounter.
• Train clinical staff on state and federal documentation guidelines requiring a written, individualized crisis plan for all crisis-level visits.
• Perform regular internal audits of mental health claims to verify that every crisis intervention claim is backed by a signed and dated crisis plan.
• Set up an automated billing scrubber rule that flags crisis codes if a corresponding crisis plan document is missing from the patient's record.

Appeal Letter Template for SA23

If you believe this claim was denied incorrectly, you can use the following template to submit an appeal.

[Your Practice Header]
[Date]

[Payer Name]
[Appeals Department Address]

RE: Appeal for Claim [Claim Number]
Patient: [Patient Name]
ID: [Patient ID]
Date of Service: [Date]
Denial Code: SA23 - Crisis intervention plan not developed

Dear Appeals Department,

I am writing to appeal the denial of the above-referenced claim, which was denied with code SA23: "Crisis intervention plan not developed".

We are appealing the denial for code SA23 regarding the crisis intervention services provided. Per CMS and AMA CPT guidelines for crisis codes 90839 and 90840, the documentation must reflect the mobilization of resources, psychotherapeutic mobilization, and the development of an immediate safety or crisis intervention plan. Upon reviewing the enclosed clinical records, a comprehensive, individualized crisis intervention plan was indeed developed and documented during the encounter on the date of service. This plan outlines specific safety strategies, triggers, and support contacts as required. Because the clinical documentation fully satisfies the service requirements and demonstrates the creation of the crisis plan, we respectfully request that this denial be overturned and the claim be processed for payment.

Attached please find:
1. A copy of the original claim.
2. The relevant medical records supporting the service.
3. [Any other supporting documents].

We respectfully request that you reprocess this claim for payment.

Sincerely,

[Your Name]
[Title]
[Practice Name]