What does the program leave your health center?
Enter your own numbers. The page shows what each patient leaves the center after the SBH license, consultant, supervision and staff time, and how much room each lever has.
Start from
What the center collects per patient
What SBH and the program cost per patient
Overhead
Who delivers the sessions
CMS requires the behavioral health care manager to have formal education or specialized training in behavioral health. The center decides and documents whether each staff member meets that standard; SBH does not.
Wage benchmarks by role
| Role | Median wage | Approx. loaded |
|---|---|---|
| Medical assistant | $21.97 | $31 |
| Social and human service assistant | $22.08 | $32 |
| Community health worker | $24.93 | $36 |
| Mental health and substance abuse social worker | $28.98 | $41 |
| Social workers, all | $29.70 | $42 |
| Health education specialist (bachelor’s) | $30.80 | $44 |
| Registered nurse | $46.90 | $67 |
National medians, May 2025 (BLS Occupational Outlook Handbook). Loaded cost is the wage divided by 0.70, because benefits are about 30% of total compensation (BLS Employer Costs for Employee Compensation, June 2026). Local pay differs, so enter your own. Whether a role meets the CMS education or training standard is the center’s determination.
Who does the monthly RTM review and call
CPT 98980 pays for 20 minutes a month of qualifying staff time reviewing the patient’s monitoring data, plus one live contact. One hour per patient over three months. The center chooses who does it, within the federal, state and policy floors.
What the center needs to see
Full adoption at your center
The pilot is a start. These inputs size the program once your providers are referring, so the year-by-year view on the right shows what you would be scaling into.
Where one patient's collections go
How much room each lever has
Room is the cushion before the center falls to your target margin. Positive means you can move that lever that far; negative means it is already past.
Net per patient across illustrative license levels
Illustrative only. The license is set by an independent fair-market-value assessment, not by the center’s margin.
Over a year, at pilot size
Pilot, then full adoption
The pilot row uses the staffing you chose above; the year rows use dedicated behavioral-health-educated facilitators at the hours set under Full adoption. Years count from go-live and follow SBH's physician-adoption model: providers start referring slowly, then follow colleagues they see referring, so year 1 is small and most of the growth comes in years 2 and 3. "Committed" is license, consultant, supervision, session time and RTM time owed whether or not every claim collects. Staff FTE includes the RTM hour.
How to read this page
- This is an illustrative planning tool, not a quote, a guarantee of results or a billing opinion.
- The license is a planning estimate and SBH’s final license will be set by an independent fair-market-value assessment. The consultant, supervision, staff cost and spare-hours values are also SBH planning assumptions. Replace each with your own figure.
- Overhead and the one-time implementation effort are not in SBH’s planning values. In incremental mode, results are before overhead until you enter the costs the program adds. In loaded mode, the starting overhead share is the national health-center average from HRSA’s UDS guidance (about 7% facility and 25% administration of total cost); replace it with your own Table 8A figure.
- The starting collection of $621 is the Colorado payer mix at 8% uninsured — the qualified partner SBH screens for, and the base case in Pro Forma v94.5. The Colorado average (22% uninsured, $532) is the stress case; enter your own UDS Table 4 share and the page shows your number. The uninsured slider is a straight-line guide between the two.
- Two readings of one number. To the center, any positive result is new money: the patient earned nothing on the waitlist, and the figure shown is after the license, the consultant, supervision and every staff hour. To the independent valuer who sets SBH’s license, the test is different — the 5–15% share the center retains — and that opinion, not this page, settles the fee.
- RTM time. The collection figure includes remote therapeutic monitoring (CPT 98975 once and 98980 in each of three months). 98980 pays for 20 minutes a month of qualifying staff time plus at least one live contact with the patient (a phone call qualifies; messages do not), so one hour per patient over the episode is shown as its own cost. CMS does not require that person to be licensed, but three floors apply and the center decides and documents who meets them: CMS’s education or training standard for the behavioral health care manager, the state’s scope-of-practice rule, and the center’s own policy. From 1 January 2027 RTM also requires an established patient and a separately billed initiating visit; the office visit that starts the program is the natural fit.
- Collections depend on your payer contracts and on meeting each billing code’s requirements. The center bills and decides coding, patients and medical necessity; SBH submits no claims.
- Planning values are from SBH Pro Forma v94.5 (6 November 2026): Waitlist Economics for the license, consultant, supervision, staff hours, 1,760 paid hours per FTE and the Colorado-mix and 8%-uninsured collections; Inputs Global section 16 for the code build; Inputs FQHC for the referral funnel (1,500 panel, 50% presenting, 20% conversion); Physician Adoption for the year-by-year ramp. Code rates are CY2026 national non-facility; CY2027 rates (98975 ≈ $19.70, conversion factor −2.31%, CoCM work RVUs raised) are applied in the next pro forma revision.
- “Presenting with a behavioral health concern” is demand, not Collaborative Care eligibility. SBH’s model uses 50%, from one partner CMO’s estimate; a more conservative reading is 1 in 4 (25%), which halves every volume in the table. Both are estimates until a pilot measures them.
- Not legal or financial advice. Regulatory questions go to your counsel.
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