Does the calculator give me a dollar reimbursement estimate?

No. It estimates billing volume - how many code units your panel could realistically support each month based on panel size, code-stacking assumptions, and capture rate. Dollar reimbursement depends on payer, plan, and locality-specific fee schedules that the calculator does not model.

What's the difference between panel size and monitored panel?

Panel size is total patient volume. Monitored panel is the subset currently within an active clinical monitoring window who are realistic candidates for RTM or serial cognitive testing.

Can I stack RTM and neurocognitive testing codes for the same patient?

Multiple code categories can apply to the same patient across a month when each element's own documentation and time/day requirements are independently met. Appropriateness for a specific patient and payer is a coding and compliance decision.

Why doesn't this page name specific reimbursement rates?

Rates vary by payer, plan type, and locality, and change annually with CMS rule updates. Check the CMS Physician Fee Schedule or your payer directly for current rates.

Which codes does the calculator cover?

The methodology covers the RTM device/monitoring and treatment management codes (98975, 98978, 98980/98981, 98979) and neurocognitive testing codes (96116/96121, 96132/96133, 96136/96137, 96138/96139, 96146).

Concussion Program Revenue Calculator

What a concussion program is worth inside your existing panel

You already see the patients. The question is how many touchpoints each one gets and whether any of them are documented. This calculator takes the numbers you know and shows what a structured program produces per month.

Planning estimate only. It does not provide billing code guidance, reimbursement advice or payer-specific direction.

The four inputs

1. Post-injury patients per month. New concussion, post-op or cognitive-change patients you see in a typical month. Not your whole panel.

2. Program enrollment. The share who enroll in between-visit monitoring. Patients who recover in a week don't need it. Most practices land between 50% and 70%.

3. Monthly touchpoints per patient. Weekly check-ins, brain training, review, telehealth and re-evaluation. The Kavera protocol produces three to four documented touchpoints per enrolled patient per month.

4. Average value per touchpoint. Your assumption, set from your own fee schedule and payer mix. The calculator does not supply a rate.

How the estimate is built

Enrolled patients = monthly patients × enrollment rate. Monthly touchpoints = enrolled patients × touchpoints per patient. Monthly gross opportunity = touchpoints × your value assumption. Annual = monthly × 12.

The output is gross opportunity under your assumptions, not a reimbursement quote. Payment depends on your payer contracts, locality and the fee schedule for the year you bill.

Where practices underestimate

Two places. First, 98978: most concussion practices already do informal check-ins and bill none of them. Second, treatment-management time (98979, 98980/98981): the review, plan changes and phone calls happen, but nobody logs the minutes. Kavera logs both as they happen.

Get a real number

The calculator is an estimate. The demo runs the program on your actual patient mix and shows what the record looks like. Request demo.

Common questions

Does the calculator give me a reimbursement estimate?

It multiplies your inputs, including your own value-per-touchpoint assumption. It does not supply rates.

Why doesn't this page name reimbursement rates?

They vary by payer, locality and year. See the CMS Physician Fee Schedule for the current national figures and the billing library for each code's requirements.

Can I stack RTM and testing codes for one patient?

They cover different services and can both apply in a course of care where documentation supports each. Whether they do for a given patient is your billing determination.

What counts as a touchpoint?

A documented interaction: check-in, brain training session, dashboard review, telehealth contact, in-office re-evaluation.

Which codes does the program document?

RTM: 98975, 98978, 98979, 98980/98981. Testing: 96116, 96132/96133, 96136–96139, 96146.