CPT Codes

CPT codes for care management programs

A reference for the code families behind the CMS care management programs: what each code covers, who may furnish the work, and the conditions attached to reporting it.

The Reference

Which code families are covered?

Eight families, covering the CMS care management programs Praventa runs and the platform supports. Each page states the descriptors, the time or eligibility thresholds, and the services that cannot be reported alongside them.

How To Read These

What this reference does and does not do

It describes what each code covers and the conditions on reporting it. It carries no payment rates.

Payment varies by locality, by Medicare Administrative Contractor and by commercial payer, and a rate quoted on a vendor page is frequently out of date by the time it is read. Where a number matters to a decision, it should come from your own fee schedule rather than from a marketing page.

The distinctions that cause the most trouble in practice are not the descriptors themselves but the interactions: which services may be reported in the same month, whose time counts toward which code, and what happens when a patient is enrolled in several programs at once. Each page states those interactions explicitly.

Code descriptors reflect the AMA CPT code set and the CMS HCPCS code set current as of CY2026. Both are revised annually, and Medicare Administrative Contractor and commercial payer policy varies. This page describes what each code covers and the conditions attached to reporting it. It is a reference, not billing advice for a specific claim, and it carries no payment rates.

Talk it through with someone who runs these programs

Praventa operates care management programs with its own clinical team and licenses the same platform to practices running them in-house. Describe your situation and we will tell you which model fits.

Contact Praventa