Standardized Assessment of Concussion (SAC) 

The Standardized Assessment of Concussion (SAC) is a brief, standardized cognitive screen — orientation, immediate memory, concentration, and delayed recall — used to detect acute concussion-related cognitive impairment at the sideline or in clinic. It takes about 5 minutes, yields a total score out of 30, and is most meaningful when compared against an athlete's own preseason baseline.

What the SAC Measures

The SAC evaluates four discrete cognitive domains in a fixed, scripted sequence:

• Orientation (5 points) — questions about month, date, day of week, year, and time, assessing basic temporal awareness.
• Immediate memory (15 points) — recall of a 5-word list across three learning trials, testing short-term verbal registration and learning.
• Concentration (5 points) — reciting digit strings backward and months of the year in reverse order, testing working memory and attentional control.
• Delayed recall (5 points) — recall of the same 5-word list after a several-minute interval filled with other tasks, testing retention over a short delay.

Together these domains produce a total score, but no single subscore is meant to stand alone diagnostically — the SAC is a screening tool, not a comprehensive neuropsychological battery.

Administration Time

Typical administration runs about 5 minutes, making it practical for sideline use during a game, in an emergency department, or as a quick office check between more detailed evaluations. Its brevity is a deliberate design tradeoff: the SAC sacrifices the depth of a full neuropsych battery for speed and repeatability in acute settings.

Scoring and Interpretation

The SAC total score ranges from 0 to 30 (orientation 5 + immediate memory 15 + concentration 5 + delayed recall 5). There is no single universally accepted "abnormal" cutoff score. Interpretation is instead built around comparison to the individual's own preseason baseline score where one is available — a drop of roughly 1 point or more from an athlete's baseline is commonly treated as a signal warranting closer evaluation, though this is a general clinical convention rather than a validated diagnostic threshold.

A few interpretive cautions matter for accurate clinical use:

• Sensitivity is time-limited. The SAC is most sensitive in the first 24–48 hours after injury. Beyond that window, scores often normalize even when symptoms persist, so a normal SAC score days after injury does not rule out ongoing concussion effects.
• No baseline, less confidence. Without a preseason baseline, a single post-injury SAC score is harder to interpret because normal cognitive performance varies across individuals, education level, and effort.
• It is a screen, not a diagnosis. The SAC supports — but does not replace — clinical judgment, symptom reporting, and, when indicated, more comprehensive testing.

The SAC is commonly embedded within the Sport Concussion Assessment Tool (SCAT5/SCAT6) (opens in a new tab) framework, alongside symptom checklists and balance testing, rather than administered as a fully standalone instrument in sideline settings.

Clinical Use Case

The SAC is designed for rapid triage in situations where a fuller assessment isn't immediately practical: sideline concussion checks during athletic events, emergency department or urgent care evaluation of a recent head injury, and quick in-office rechecks during early follow-up visits. It complements — rather than substitutes for — other components of a concussion evaluation, such as symptom scales like PCSS, balance testing like BESS, and oculomotor/vestibular screening like VOMS or the King-Devick Test.

Because the SAC's sensitivity drops after the acute window, clinics managing patients beyond the first few days typically layer in broader instruments — symptom tracking, sleep and mood screening, and, when recovery is delayed, formal neurocognitive testing — to capture what a brief bedside screen cannot.

CPT Code Considerations

In acute or sideline settings, the SAC is typically bundled into the evaluation and management (E/M) encounter rather than billed as a separate, standalone neurocognitive test. It does not usually fall under the 96116–96146 psychological/neuropsychological testing code family in that context, because it functions as a brief clinical maneuver rather than a formal, time-tracked psychometric battery.

When a SAC-like cognitive screen is instead delivered as part of a structured, technician- or computer-administered outpatient battery, coding may shift toward codes such as 96146 (automated administration and scoring) depending on delivery method, or into the broader technician-administered testing codes (96138/96139) when bundled with other instruments. Actual code selection depends on who administers the test, how it is delivered, and payer-specific policy — see CMS billing and coding guidance for psychological and neuropsychological testing (opens in a new tab) for current requirements. For the codes most relevant to ongoing, between-visit concussion monitoring, see the RTM billing cluster, which covers monitoring activity that occurs after the acute sideline or ED encounter.

Where the SAC Sits in the Kavera Protocol

Within Kavera's Concussion module, the SAC represents the kind of brief, acute-phase cognitive check that typically happens before a patient enters structured between-visit monitoring — it is a starting point, not a substitute for the fuller assessment battery Kavera delivers across visits. Kavera's concussion assessment set is designed to pick up where sideline and ED screens like the SAC leave off, tracking symptom trajectory, mood, sleep, and cognitive-domain performance over the weeks following injury, when SAC-style screens lose sensitivity.

FAQ

Is the SAC the same as SCAT5 or SCAT6?

No. The SAC is one component embedded within the SCAT5/SCAT6 framework, which also includes a symptom checklist, balance testing (BESS), and other elements. The SAC specifically covers orientation, immediate memory, concentration, and delayed recall.

What is a "normal" SAC score?

There is no single universal cutoff for a normal or abnormal SAC score. Interpretation depends heavily on comparison to the individual's own preseason baseline, and a drop of roughly 1 point or more from baseline is commonly used as a signal for further evaluation — but this is a general clinical convention, not a fixed diagnostic threshold.

Can the SAC be used days or weeks after injury?

It can be administered at any point, but its sensitivity is highest in the first 24–48 hours post-injury. Scores often return to baseline beyond that window even when a patient still has symptoms, so a normal SAC score later in recovery should not be treated as proof of full recovery.

Is the SAC billable separately from the office visit?

In most acute or sideline settings, the SAC is bundled into the E/M encounter rather than billed separately under neurocognitive testing codes. Whether a separate code applies depends on how and by whom the test is administered — verify with current CMS and payer guidance rather than assuming a specific code applies.

How does the SAC relate to return-to-play decisions?

The SAC contributes cognitive data used alongside symptom reports, balance testing, and clinical judgment when evaluating recovery, but it is not, by itself, a return-to-play clearance tool. See Return to Play Decision Criteria for how these pieces fit together.

How Kavera Handles This

SAC is a first-visit and re-evaluation tool. Kavera records the 0–30 score and subscales so the acute cognitive screen sits with the rest of the concussion baseline, and later Digit Span and SDMT results are read against it. Self-Serve practices run this with their own staff. On Managed, Juliet Mott's team runs it and bills it under your credentials.