Estimate annual Medicare reimbursement for SDOH, care navigation, care management, and complexity coding across your panel. Every value below is editable. Defaults are conservative starting points, so replace each one with your own social-risk prevalence, utilization, and rates.
| Code | Service | Patients / volume iToggle % to enter a share of your panel, or # to enter an exact patient count. Add-on lines use the share of services that exceed the base time. E/M lines use the share of visits eligible for the higher level. | Svcs/yr iAverage billable months or services per enrolled patient per year. Add-on lines inherit this from their base line. | Rate | Annual $ |
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By using this calculator you agree to these terms. Outputs are illustrative estimates based entirely on the values you enter and on Medicare Physician Fee Schedule national non-facility payment amounts. Actual reimbursement varies by locality (GPCI), payer, site of service, beneficiary eligibility, contract terms, and whether each service meets all coverage, consent, and documentation requirements. This tool does not provide billing, coding, legal, financial, or clinical advice, and using it creates no guarantee that any amount will be paid. Confirm all codes and rates against the current CMS final rule and your payer policies before relying on them.
Terms of use. This calculator is provided for general informational purposes only. By accessing or using it, you agree to these terms and to the disclaimer below. You may use the tool to produce estimates for your own planning, but you are responsible for verifying every code, rate, and assumption before acting on any output. You agree not to treat the results as billing guidance or a representation that any service is payable in your setting.
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This Social Determinants of Health (SDOH) Reimbursement Calculator is provided as a tool to assist healthcare providers in estimating potential reimbursements for SDOH-related services based on user-inputted data and default values derived from general industry knowledge and estimates. The accuracy of the calculator's outputs depends on the accuracy and relevance of the inputs provided by the user. The calculator is intended for informational purposes only and should not be considered as providing financial, legal, or professional advice.
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