September 28, 2026 · AxonCPT Team · CPT, remote assessment, clinical practice

AxonCPT vs. TOVA: Remote vs. In-Office CPT Compared

Disclosure: AxonCPT publishes this comparison and makes a competing product. T.O.V.A. is a product of The TOVA Company and is not affiliated with AxonCPT. TOVA facts below are from the vendor’s own pages, accessed September 2026; verify current specifications and pricing with the vendor before purchasing.

AxonCPT and T.O.V.A. are both continuous performance tests (CPTs), but they sit at opposite ends of the setting question: T.O.V.A. is a hardware-based, in-clinic test with two FDA 510(k) clearances, while AxonCPT is a browser-based, fully remote test with no dedicated hardware. Neither diagnoses ADHD on its own — both supply objective performance data to weigh alongside the interview, history, and rating scales. This guide lines up what each one actually requires, measures, and costs, so you can judge which fits a given patient or practice.

Clinician working at a computer in a clinic office Photo by Vitaly Gariev on Unsplash

AxonCPT vs TOVA at a glance

T.O.V.A. 9 AxonCPT
Setting In-clinic; no remote administration option found on the vendor’s site [1] Fully remote, from an emailed link [6]
Patient device Proprietary USB device and microswitch connected to a Windows or Mac computer; not compatible with Chromebooks, iPads, or Android [1][2] Any browser on a phone, tablet, or desktop; no app or login [6]
Modality Visual and auditory (separate tests) [1] Visual/response-based, reported across five metrics with a Q1–Q4 vigilance breakdown [6]
Test length 21.6 minutes per modality; a 10.8-minute visual version for ages 4–5.5 [1] About 16 minutes [6]
Ages (vendor) Visual 4–80+; auditory 6–29 [1] Not listed on axoncpt.com; ask AxonCPT
Norms Vendor-published normative data (details in the clinical manual) [1] Cohort-matched norms from a 20,000+ reference dataset across 12 age × sex cohorts [6]
FDA 510(k) K170082 (2017) and K173915 (2018), product code LQD [3] Not marketed as FDA-cleared; positioned as objective measurement to supplement clinical judgment [6]
Reports Standard and progress reports through the vendor’s software Instant report at test completion; see the sample report
Published price $1,095 system (includes 5 credits) + $15/credit [4] 2 free tests/month, no card; $49/5 tests; $149/20 tests; $79/month unlimited [6]

The setting difference is the whole decision

T.O.V.A. requires its own USB device and microswitch connected to a Windows or Mac computer, and the vendor states it is not compatible with Chromebooks, iPads, or Android devices [1][2]. We found no remote or at-home administration option on The TOVA Company’s pages, which means every T.O.V.A. test happens in the office [1]. For a telehealth-heavy PMHNP or psychologist, that turns each test into an extra scheduled visit. For more on what that costs in practice, see TOVA test cost for clinicians.

AxonCPT runs in a browser on whatever device the patient already has — phone, tablet, or computer — with no app to install and no login [6]. The clinician sends a link from their account, and the patient completes the roughly 16-minute test at home. That distinction, more than any single metric, is what usually drives the choice between the two: do your patients need to come into the office anyway, or are you trying to remove that step?

Test length, modality, and ages

T.O.V.A. is the only one of the two that publishes a separate auditory CPT (ages 6–29) in addition to its visual test (ages 4–80+) [1]. If an auditory attention measure matters for a specific referral question, T.O.V.A. is one of the few commercial CPTs that offers one; see TOVA vs. Conners CPT 3 for how T.O.V.A. stacks up against the other major in-clinic-turned-online option on modality and evidence. AxonCPT does not publish a separate auditory test.

On length, T.O.V.A.’s visual and auditory tests each run 21.6 minutes — nearly 44 minutes back-to-back if both are given, though most clinicians order one or the other [1]. AxonCPT’s test runs about 16 minutes [6]. T.O.V.A. also publishes a shortened 10.8-minute visual version for ages 4 to 5.5, younger than most remote CPTs typically test [1].

Regulatory status and what it does (and doesn’t) mean

T.O.V.A. carries two FDA 510(k) clearances (K170082 and K173915) under product code LQD [3]. FDA clearance under 510(k) means the manufacturer demonstrated the device is substantially equivalent to an already-cleared predicate device — it does not mean the test has been shown to diagnose ADHD on its own, and clearance summaries for CPTs typically state the intended use as providing objective measurement to aid a broader clinical assessment.

AxonCPT is not marketed as an FDA-cleared device; it describes itself as objective measurement built to supplement clinical judgment [6]. If your institution, payer, or referral partner specifically requires an FDA-cleared instrument, that requirement points toward T.O.V.A. (or another cleared product) rather than AxonCPT.

Try it with your next patient. AxonCPT gives you 2 free tests every month — no card required. Send a link, your patient finishes in ~16 minutes from home, and you get a norm-referenced report instantly. Create your free account →

What does each cost?

Using published list prices only, no tax, shipping, or bulk discounts, and assuming 50 tests across a practice’s first year:

Product Pricing model Year-one cost at 50 tests Arithmetic
T.O.V.A. 9 $1,095 system + $15/credit [4] $1,770 $1,095 + 45 × $15
AxonCPT 2 free/month; $49/5; $149/20; $79/month unlimited [6] As low as $149–$396 depending on plan mix Varies by plan; see what objective ADHD testing costs clinicians

T.O.V.A. carries a large fixed cost up front that amortizes as volume grows — the marginal cost per test falls to $15 once the system is owned. AxonCPT has no hardware cost and a published per-test or unlimited-subscription price instead. For the full math on TOVA’s cost curve by volume, see TOVA test cost for clinicians.

Does the evidence support either one as a standalone test?

Neither product should be used alone to diagnose ADHD. A 2024 meta-analysis pooling commercially available CPTs, published in the Journal of the American Academy of Child & Adolescent Psychiatry, found pooled sensitivity of 0.75 and specificity of 0.71 for the overall score — below the 0.80/0.80 threshold the authors used as a rough acceptability bar for a standalone diagnostic tool [5]. That review pools across products rather than reporting a T.O.V.A.-specific figure, and we found no dedicated systematic review isolating T.O.V.A.’s standalone accuracy the way one exists for Conners CPT-3 [5]. AxonCPT is a newer entrant with a shorter independent, peer-reviewed research history than an established instrument like T.O.V.A. Both should be read alongside the interview, history, and rating scales — see CPT accuracy for ADHD: what the meta-analyses show for the full evidence picture.

When T.O.V.A. may fit better

  • You need an auditory CPT, or want to evaluate ages down to 4 or up to 80+.
  • You test exclusively in-office and want a dedicated hardware response device.
  • Your institution or payer requires an FDA 510(k)-cleared product.
  • You already own a T.O.V.A. system and the marginal $15/credit fits your volume.

When AxonCPT may fit better

  • Your patients test on whatever device they have — phone, tablet, Chromebook — rather than a dedicated PC.
  • You run a telehealth practice and want to avoid adding an in-person visit just for testing.
  • You retest often during titration and want a published, low per-test price or an unlimited monthly plan.
  • You want a report the moment the patient finishes, with no setup or integration step.

How this looks in practice

A PMHNP running a telehealth ADHD practice might work through the choice this way:

  1. Ask whether the patient can come in. If not, T.O.V.A.’s in-clinic requirement rules it out for that visit.
  2. Check whether an auditory measure or an FDA-cleared instrument is specifically needed for the referral question or the payer.
  3. If neither applies, send the test remotely. With objective ADHD testing with AxonCPT, the patient opens the link and finishes in about 16 minutes at home, and the report — five metrics against age- and sex-matched norms, with a Q1–Q4 vigilance breakdown — is ready as soon as they’re done.
  4. Read the result alongside the interview, history, and rating scales, and document how it informed the plan, regardless of which CPT you used.

Frequently asked questions

Can T.O.V.A. be given remotely? We found no remote administration option on The TOVA Company’s pages; the test requires its USB device connected to a Windows or Mac computer [1][2].

Is AxonCPT FDA-cleared like T.O.V.A.? No. T.O.V.A. carries two FDA 510(k) clearances under product code LQD. AxonCPT is not marketed as FDA-cleared and is positioned as objective measurement to supplement clinical judgment [3][6].

Which test is more accurate for diagnosing ADHD? No published head-to-head study directly compares the two on the same sample. Pooled evidence across commercial CPTs generally shows sensitivity and specificity below the 0.80/0.80 threshold researchers consider acceptable for a standalone tool, which applies to CPTs as a category rather than to either specific product [5].

Does AxonCPT measure auditory attention like T.O.V.A. does? No. AxonCPT does not publish a separate auditory test. If an auditory modality is clinically important for a specific case, T.O.V.A. is one of the few commercial CPTs that offers one [1].

What does a course of testing cost with each? T.O.V.A. requires the $1,095 system plus $15 per test credit thereafter [4]. AxonCPT has no hardware cost: 2 tests are free every month, with paid packs or an unlimited monthly plan for higher volume [6]. See what objective ADHD testing costs clinicians for a full cross-vendor breakdown.

Start testing your patients with AxonCPT

If an in-office hardware system doesn’t fit a telehealth practice, AxonCPT lets patients test from any device they already own, with a published per-test price built for repeat testing during titration. Start with 2 free tests every month, no card required. Create your free AxonCPT account or learn more at axoncpt.com.

References

  1. The TOVA Company. How the T.O.V.A. Works. Accessed September 2026.
  2. The TOVA Company. Computer Requirements. Accessed September 2026.
  3. U.S. Food and Drug Administration. 510(k) Premarket Notification database (K170082, K173915), product code LQD.
  4. The TOVA Company. T.O.V.A. Store. Accessed September 2026.
  5. Arrondo G, Mulraney M, Iturmendi-Sabater I, et al. Systematic Review and Meta-Analysis: Clinical Utility of Continuous Performance Tests for the Identification of Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 2024;63(2):154-171.
  6. AxonCPT. axoncpt.com. Accessed September 2026.