24CRY002_-_Quote_Rate_Sheet.xlsm
XLSM spreadsheet 32 KB Posted
- Attached to
- 24CRY002 - Diagnostic Laboratory Services
- Solicitation number
- 0000031687
- Issued by
- California
About this file
This document is a Bid Rate Sheet for a state and local contract opportunity issued by the California Department of Veterans Affairs (CalVet) for Diagnostic Laboratory Services. The contract requires the submission of a bid percentage of the Medicare rate for various laboratory procedures, with the lowest responsible and responsive bidder being awarded Rank 1 and the next lowest Rank 2. CalVet intends to award up to two contracts, and the contract amount will be determined using a cost allocation formula based on the number of contracts awarded. The contract term is unspecified, but the rates submitted shall remain in effect for the term of the agreement, including any extensions.
The Bid Rate Sheet provides a list of 44 sample Medicare procedures with estimated quantities, average Medicare rates, and a space for the bidder to input their percentage of the Medicare rate. Additionally, there are 5 non-Medicare procedures with estimated quantities and a space for the bidder to input their proposed rate. The basis of award will be the sum of the totals for all 45 items. CalVet states that the usage of the Medicare Fee Schedule is being used as a basis for fair and equitable bidding, and that they do not expressly or by implication guarantee any business, as services are subject to change depending on resident population and need.
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Text version
Sheet1
BID RATE SHEET
Submission of this attachment is mandatory. Proposer shall submit in a clear legible figure a Percentage (%) of MediCare Rate in the space provided below. This form will automatically calculate values based upon the information supplied. Failure to provide the rate shall be cause for rejection of the bid.
*The Centers for Medicare & Medicaid Services-Physician Fee Schedule can be found at:
http://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx
CalVet's usage of the MediCare Fee Schedule is being used as a basis for fair and equitable bidding and to ensure all bidders are placing a bid based upon the same fee schedule. The sample procedures listed below are some of the procedures utilized in prior years but are not an all-inclusive list. The samples will be used to determine a total dollar amount for the Basis of Award.
The State does not expressly or by implication guarantee business, as services are subject to change depending on resident population and need. The numbers are a good faith estimate based on the current circumstances known to CalVet at the time of this bid.
CalVet intends to award up to two contracts. The lowest responsible, responsive Bidder will be the Rank 1 contractor. The next lowest responsible, responsive Bidder will be Rank 2. The contract amount will be determined using a cost allocation formula based on number of contracts awarded. Rate of payment will be the percentage of Medicare noted below based on the County in which services are provided for Medicare Procedures and the Rate specified on non-Medicare Rate Procedures. If awarded an Agreement, the rates submitted below shall remain in effect for the term of the Agreement, including any extension of the term made through a formal amendment.
| Sample Medicare Procedure | SampleCPT Codes | Estimated # Procedures Term of Contract | Average Medicare Rate/ Proc. | % of Medicare | Total | ||||
| 1 | Basic Metabolic | 80048 | 1452 | x | $ 11.60 | x | = | $ - 0 | |
| 2 | Comp Metabolic | 80053 | 2163 | x | $ 14.49 | x | = | $ - 0 | |
| 3 | Lipid PaneL | 80061 | 919 | x | $ 18.39 | x | = | $ - 0 | |
| 4 | CBC w/diff | 85025 | 2140 | x | $ 10.66 | x | = | $ - 0 | |
| 5 | Ferritin | 82728 | 245 | x | $ 18.70 | x | = | $ - 0 | |
| 6 | Folate | 82746 | 111 | x | $ 20.17 | x | = | $ - 0 | |
| 7 | Hemoglobin | 83037 | 100 | x | $ 13.32 | x | = | $ - 0 | |
| 8 | Iron, Total | 83540 | 100 | x | $ 8.88 | x | = | $ - 0 | |
| 9 | Tiron (TIBC) | 83550 | 100 | x | $ 10.12 | x | = | $ - 0 | |
| 10 | PSA, Total | 84153 | 420 | x | $ 25.23 | x | = | $ - 0 | |
| 11 | PT/INR | 85610 | 147 | x | $ 5.39 | x | = | $ - 0 | |
| 12 | TSH 3rd Gen | 84443 | 853 | $ 23.05 | x | = | $ - 0 | ||
| 13 | UA w/microscopy | 87086 | 425 | x | $ 11.07 | x | = | $ - 0 | |
| 14 | Vit B12 | 82507 | 535 | x | $ 20.68 | x | = | $ - 0 | |
| 15 | Iron, Profile | 83540 | 244 | x | $ 7.00 | x | = | $ - 0 | |
| 16 | Urine Culture | 87086 | 451 | x | $ 11.07 | x | = | $ - 0 | |
| 17 | Venipuncture | 36418 | 4381 | x | $ 3.00 | x | = | $ - 0 | |
| 18 | Hemoglobin/Hematocrit | 85014 | 139 | $ 3.00 | $ - 0 | ||||
| 19 | Liver Panel | 80076 | 100 | $ 8.20 | $ - 0 | ||||
| 20 | Renal Function Panel | 80069 | 100 | $ 8.70 | $ - 0 | ||||
| 21 | Amylase | 82150 | 50 | $ 6.50 | $ - 0 | ||||
| 22 | Lipase | 83690 | 50 | $ 7.00 | $ - 0 | ||||
| 23 | Immunoglobulin, G, A,M | 82784 | 50 | $ 9.40 | $ - 0 | ||||
| 24 | Lipid Profile | 83721 | 919 | $ 11.00 | $ - 0 | ||||
| 25 | Free T4 | 84439 | 135 | $ 9.00 | $ - 0 | ||||
| 26 | Protein/Creatine ratio, urine PC ratio | 82570 | 100 | $ 6.00 | $ - 0 | ||||
| 27 | Quantiferon Gold (TB test) | 86480 | 171 | $ 62.00 | $ - 0 | ||||
| 28 | Magnesium | 83735 | 353 | $ 7.00 | $ - 0 | ||||
| 29 | Phosphorus | 84100 | 282 | $ 5.00 | $ - 0 | ||||
| 30 | Uric Acid, Serum | 84550 | 204 | $ 5.00 | $ - 0 | ||||
| 31 | Blood Urea Nitrogen (BUN) | 84520 | 50 | $ 4.00 | $ - 0 | ||||
| 32 | Albumin | 82040 | 202 | $ 5.00 | $ - 0 | ||||
| 33 | Covid 19 | 87635 | 400 | $ 52.00 | $ - 0 | ||||
| 34 | Ammonia | 82140 | 106 | $ 15.00 | $ - 0 | ||||
| 35 | Erythrocyte Sedimentation rate | 85652 | 244 | $ 4.00 | $ - 0 | ||||
| 36 | Influenza A+B | 87804 | 300 | $ 17.00 | $ - 0 | ||||
| 37 | Covid, RSV, Influenza | 87637 | 400 | $ 143.00 | $ - 0 | ||||
| 38 | Immunifix Electroph Serum | 82784 | 44 | $ 9.30 | $ - 0 | ||||
| 39 | Reticulocyte Count | 85045 | 50 | $ 4.00 | $ - 0 | ||||
| 40 | C-Reactive Protein | 86141 | 200 | $ 13.00 | $ - 0 | ||||
| 41 | Microalbumin, Creat | 82043 | 93 | $ 6.00 | $ - 0 | ||||
| 42 | Microalbumin, Urine Random | 82570 | 97 | $ 5.20 | $ - 0 | ||||
| 43 | Testosterone, Total | 84402 | 71 | $ 25.00 | $ - 0 | ||||
| 44 | Vit D, 25-OH | 82306 | 699 | $ 30.00 | $ - 0 |
| Non-Medicare Procedure | Estimated Number of Procedures for the Contract Term | Rate Per Service | Total | |||
| 45 | STAT Charge | 30 | x | = | $ - 0 |
Basis of Award (Sum Item totals 1-45): $0.00
| Note: Employee Lab Testing will not be paid as part of this contract. Contractor shall bill as specified in Exhibit A and payment will be processed as part of the Employee Health Program. |
| This Rate Sheet MUST be signed and returned. The quote must be transmitted via email in accordance with solicitation instructions. |
| Company Name: |
| Company Representative's Name (Printed): |
| Company Representative Signature: |
California Department of Veterans Affairs Solicitation Number: 24CRY002
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