Reimbursement Assumptions:

1. The default value for Commercial Facility Reimbursement, Diagnostic Transoral Upper GI Endoscopy under sedation is based on per-visit payment averages from commercial payors obtained from Optum Health in Pediatric (ages 5-18) Hospital Outpatient Departments for claim year 2022 for CPT code 43239.
2. The default value for Commercial Facility Reimbursement, Diagnostic Transnasal Esophagoscopy without sedation is based on per-visit payment averages from commercial payors obtained from Optum Health in Pediatric (ages 5-18) Hospital Outpatient Departments for claim year 2022 for CPT code 43198.
3. The default value for Commercial Facility Reimbursement, Additional Diagnostic or Therapeutic Procedure, uses Colonoscopy reimbursement information as an example is estimated by calculating the difference between the known commercial health plan average reimbursement payment from Optum Health data and published Medicare reimbursement for CPT 43239, which equals 4.5x. That multiple is then applied to the published Medicare average reimbursement value of $1,054 for a diagnostic Colonoscopy, CPT code 45380.
4. The default values for Medicaid Facility Reimbursement, Upper GI Endoscopy under sedation and Diagnostic Transnasal Esophagoscopy without sedation are based on published Medicaid data reporting that CPT codes 43239 and 43198 are reimbursed at the same rate. To account for inter-state variability, one of three example scenarios is used: Option 1 = $1,487, reference state is CO; Option 2 = $867, reference state is NY; Option 3 = $655, reference state is MS. 
5. The default value for Medicaid Facility Reimbursement, Additional Diagnostic or Therapeutic Procedures is estimated by calculating the difference between the known commercial health plan average reimbursement payment from Optum Health data and published Medicare reimbursement for CPT 43239 for the three given scenarios and applying that differential which equals to the estimated commercial reimbursement for a diagnostic Colonoscopy, CPT code 45380. This results in the following: Option 1 = $1,833 ($4,700 x 0.39); Option 2 = $1,081 ($4,700 x 0.23); Option 3 = $799 ($4,700 x 0.17).

General Assumptions: 

1. Assumes that the average reimbursement for a diagnostic TNE will be less than a diagnostic transoral sedated endoscopy using CPT codes 43198 and 43239 respectively.
2. Assumes every TNE conversion is replaced by an additional procedure, using a Colonoscopy as a proxy, CPT code 45380.
3. Assumes that your new TNE patient population might have a different payer mix than your overall payer mix and can be calculated separately.
4. Assumes TNE demand from new patients is 1% of total upper GI endoscopy volume. and uses weighted by user-selected TNE Payer mix.
5. Assumes every TNE conversion is replaced by another procedure on a 1:1 basis.
6. Assumes every sedated to TNE conversion frees up 45 minutes of block time.
7. Annual TNE Conversion revenue is calculated using customer inputs and assumes 15% year over year growth.
8. Annual New Patient Revenue is calculated using customer inputs and assumes 30% year over year growth
9. Assumes TNE demand from new patients is 1% of total upper GI endoscopy volume. and uses weighted by user-selected TNE Payer mix.
10. Assumes every TNE conversion is replaced by another procedure on a 1:1 basis.
11. Assumes every sedated to TNE conversion frees up 45 minutes of block time.
12. Annual TNE Conversion revenue is calculated using customer inputs and assumes 15% year over year growth.
13. Annual New Patient Revenue is calculated using customer inputs and assumes 30% year over year growth