36C10X18R0133-A00003006.xlsm
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36C10X18R0133 A00003 ATTACH_AA - Price Proposal Spreadsheet 1 - as of Amend A00003.xlsm
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Price Schedule
| MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | ||||||||||||||||
| REGION 1 (NORTHEAST) | A | |||||||||||||||
| SCHEDULE OF PRICES | ||||||||||||||||
| BASE AND ALL OPTION PERIODS | A | |||||||||||||||
| LINE ITEM | DESCRIPTION | UNIT OF ISSUE | % OF MEDICARE BASELINE RATE | BASE YR UNIT PRICE | OPT YR 1 UNIT PRICE | OPT YR 2 UNIT PRICE | OPT YR 3 UNIT PRICE | OPT YR 4 UNIT PRICE | OPT YR 5 UNIT PRICE | OPT YR 6 UNIT PRICE | OPT YR 7 UNIT PRICE | OPT YR 8 UNIT PRICE | OPT YR 9 UNIT PRICE | A | ||
| 0001 | General Medical Examination | A | ||||||||||||||
| 0001A | General Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body parts | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001AA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001B | General Medical - Pension | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001BA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001C | General Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations) | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CA | Requiring 1-5 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CB | Requiring 6-10 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CC | Requiring 11-15 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CD | Requiring 16 or more DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001D | Aid and Attendance or Housebound | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001DA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001E | Cold Injury Residuals | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001F | General Medical - Comprehensive Medical Examination to include a Gulf War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001FA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001G | General Medical - Comprehensive Medical Examination to include a Prisoner of War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001GA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002 | Musculoskeletal System | A | ||||||||||||||
| 0002A | Osteomyelitis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002B | Arthritis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002C | Amputations | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002D | Shoulder and Arm Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002E | Elbow and Forearm Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002F | Wrist Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002G | Hand and Finger Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002H | Back (Thoracolumbar Spine ) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002I | Neck (Cervical Spine) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002J | Hip and Thigh Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002K | Knee and Lower Leg Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002L | Ankle Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002M | Foot Conditions, Including Flatfoot (Pes Planus) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002N | Bones | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002O | Muscle Injuries | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0003 | Organs of Special Sense / Eye | A | ||||||||||||||
| 0003A | Eye Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004 | Impairment of Auditory Acuity/Ear and Other Sense Organs | A | ||||||||||||||
| 0004A | Hearing Loss and Tinnitus | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004B | Ear (including vestibular & infectious ) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004C | Loss of Sense of Smell and/or Taste (ENT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005 | Infectious Diseases, Immune Disorders and Nutritional Deficiencies | A | ||||||||||||||
| 0005A | Persian Gulf/Afghanistan Infectious Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005B | HIV-Related Illnesses | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005C | Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005D | Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005E | Nutritional Deficiencies | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005F | Chronic Fatigue Syndrome (rheumatological) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006 | Respiratory System | A | ||||||||||||||
| 0006A | Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006B | Respiratory Conditions (other than Tuberculosis and Sleep Apnea) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006C | Tuberculosis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006D | Sleep Apnea | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006E | Sleep Studies (HSAT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006F | Sleep Studies (PSG & ECG) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007 | Cardiovascular System | A | ||||||||||||||
| 0007A | Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007B | Artery and Vein Conditions (Vascular Diseases including Varicose Veins) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007C | Hypertension | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008 | Digestive System | A | ||||||||||||||
| 0008A | Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal Disorders) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008B | Gallbladder and Pancreas Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008C | Intestinal Conditions (other than Surgical or Infectious), including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008D | Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008E | (Hepatitis, Cirrhosis, and other) Liver Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008F | Peritoneal Adhesions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008G | Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008H | Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008I | Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008J | Rectum and Anus Conditions (including Hemorrhoids) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009 | Genitourinary System | A | ||||||||||||||
| 0009A | Kidney Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009B | Urinary Tract (including Bladder and Urethra ) Conditions (excluding Male reproductive System) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009C | Prostate Cancer | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009D | Male Reproductive Organ Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0010 | Gynecological Conditions and Disorders of the Breast | A | ||||||||||||||
| 0010A | Gynecological Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0010B | Breast Conditions and Disorders | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0011 | Hemic and Lymphatic Systems | A | ||||||||||||||
| 0011A | (Hairy Cell and Other B-Cell) Leukemia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0011B | Hematologic and Lymphatic Conditions, including Leukemia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0012 | Skin (Derm) | A | ||||||||||||||
| 0012A | Skin Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0012B | Scars/Disfigurement | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013 | Endocrine System | A | ||||||||||||||
| 0013A | Diabetes Mellitus | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013B | Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013C | Thyroid and Parathyroid Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014 | Neurological Conditions and Convulsive Disorders | A | ||||||||||||||
| 0014A | Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014B | Parkinson's Disease | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014C | Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014D | Diabetic Sensory-Motor Peripheral Neuropathy | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014E | Narcolepsy | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014F | Fibromyalgia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014G | Headaches (including Migraine Headaches) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014H | Multiple Sclerosis (MS) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014I | Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014J | Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014K | Cranial Nerve Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014L | Peripheral Nerve Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014M | Seizure Disorders (epilepsy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015 | Mental Disorders | A | ||||||||||||||
| 0015A | Mental Disorders (other than PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015B | Mental Disorders (other than PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015C | Initial Post Traumatic Stress Disorders (PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015D | Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015E | Review Post Traumatic Stress Disorders (PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015F | Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015G | Eating Disorders | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015H | Eating Disorders - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0016 | Dental and Oral Conditions | A | ||||||||||||||
| 0016A | Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0016B | Temporomandibular Joint (TMJ) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0017 | Ancillary Diagnostic Tests (The percentage proposed listed shall be applied to the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.) | A | ||||||||||||||
| 0017A | Procedures | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017B | Tests | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017C | Laboratory Work | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017D | X-rays | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0018 | Camp Lejeune Contaminated Water (CLCW) Subject Matter Expert (SME) Opinions | A | ||||||||||||||
| 0018A | CLCW SME Opinions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0019 | Record Review Medical File & Medical Opinions | A | ||||||||||||||
| 0019A | Record Review Medical File | |||||||||||||||
| (<1" or <250 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019AA | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (<1" or <250 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019B | Record Review Medical File | |||||||||||||||
| (1"-3" or 250-749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019BB | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (1"-3" or 250-749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019C | Record Review Medical File | |||||||||||||||
| (> 3" or >749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019CC | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (> 3" or >749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0020 | No Shows (If Veteran or Servicemember does not appear for appointment or does not contact vendor within the acceptable timeframe to reschedule but does request a rescheduled appointment, No show is charged on initial appointment but at a lower price since administrative prep work is eventually used by examiner) | A | ||||||||||||||
| 0020A | Complete No Show (Veteran or Servicemember does not appear) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0020B | Partial No Show (Veteran or Servicemember requests to reschedule appointment within less than 24 hours notice) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0021 | Deliverables | A | ||||||||||||||
| 0021A | Detailed PMP (with QAP) and Briefing in accordance with Section 8.6 of the Performance Work Statement (PWS) | Not Separately Priced (NSP) | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021B | Training Plan in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021C | Monthly Status Reports in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021D | Annual Statement of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021E | Quarterly Reports of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0022 | Other | A | ||||||||||||||
| 0022A | Travel Mileage for examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | A | ||
| 0022B | Travel Time for Performing examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | A | ||
| 0022C | Monetary Incentive may be awarded quarterly in accordance with Section 12.0 of the PWS | Per Quarter | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | A | ||
| 0022D | Veteran Mileage Reimbursement | To be invoiced and paid in accordance with Section 9.2 of the PWS | A | |||||||||||||
| 0023 | ACE Exam Discount Percentage: | |||||||||||||||
| The listed percentage is the discount to be applied in accordance with PWS Section 10.23 and the performance of ACE qualified examinations. | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A |
&F | &A
Sample Task Order
| MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | ||||||||||||||||||
| REGION 1 (NORTHEAST) | a | |||||||||||||||||
| SAMPLE TASK ORDER - SCHEDULE OF PRICES | a | |||||||||||||||||
| LINE ITEM | DESCRIPTION | UNIT OF ISSUE | EST QTY (PER YEAR) | % OF MEDICARE BASELINE RATE | SAMPLE TO BASE YR PRICE | SAMPLE TO YR 1 PRICE | SAMPLE TO YR 2 PRICE | SAMPLE TO YR 3 PRICE | SAMPLE TO YR 4 PRICE | SAMPLE TO YR 5 PRICE | SAMPLE TO YR 6 PRICE | SAMPLE TO YR 7 PRICE | SAMPLE TO YR 8 PRICE | SAMPLE TO YR 9 PRICE | SAMPLE TO TOTAL PRICE | a | ||
| 0001 | General Medical Examination | a | ||||||||||||||||
| 0001A | General Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body parts | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001AA | Requiring 1-5 DBQs | EA | 2,587 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001AB | Requiring 6-10 DBQs | EA | 3,363 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001AC | Requiring 11-15 DBQs | EA | 3,984 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001AD | Requiring 16 or more DBQs | EA | 3,984 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001B | General Medical - Pension | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001BA | Requiring 1-5 DBQs | EA | 68 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001BB | Requiring 6-10 DBQs | EA | 113 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001BC | Requiring 11-15 DBQs | EA | 117 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001BD | Requiring 16 or more DBQs | EA | 117 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001C | General Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations) | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001CA | Requiring 1-5 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001CB | Requiring 6-10 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001CC | Requiring 11-15 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001CD | Requiring 16 or more DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001D | Aid and Attendance or Housebound | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001DA | Requiring 1-5 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001DB | Requiring 6-10 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001DC | Requiring 11-15 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001DD | Requiring 16 or more DBQs | EA | 12 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001E | Cold Injury Residuals | EA | 205 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001F | General Medical - Comprehensive Medical Examination to include a Gulf War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001FA | Requiring 1-5 DBQs | EA | 1337 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001FB | Requiring 6-10 DBQs | EA | 2113 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001FC | Requiring 11-15 DBQs | EA | 2734 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001FD | Requiring 16 or more DBQs | EA | 2734 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001G | General Medical - Comprehensive Medical Examination to include a Prisoner of War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||
| 0001GA | Requiring 1-5 DBQs | EA | 87 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001GB | Requiring 6-10 DBQs | EA | 863 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001GC | Requiring 11-15 DBQs | EA | 1484 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0001GD | Requiring 16 or more DBQs | EA | 1484 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002 | Musculoskeletal System | a | ||||||||||||||||
| 0002A | Osteomyelitis | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002B | Arthritis | EA | 372 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002C | Amputations | EA | 213 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002D | Shoulder and Arm Conditions | EA | 1,811 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002E | Elbow and Forearm Conditions | EA | 1,140 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002F | Wrist Conditions | EA | 644 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002G | Hand and Finger Conditions | EA | 824 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002H | Back (Thoracolumbar Spine ) Conditions | EA | 1,335 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002I | Neck (Cervical Spine) Conditions | EA | 776 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002J | Hip and Thigh Conditions | EA | 1,164 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002K | Knee and Lower Leg Conditions | EA | 3,084 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002L | Ankle Conditions | EA | 1,366 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002M | Foot Conditions, Including Flatfoot (Pes Planus) | EA | 346 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002N | Bones | EA | 105 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0002O | Muscle Injuries | EA | 377 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0003 | Organs of Special Sense / Eye | a | ||||||||||||||||
| 0003A | Eye Conditions | EA | 2,551 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0004 | Impairment of Auditory Acuity/Ear and Other Sense Organs | a | ||||||||||||||||
| 0004A | Hearing Loss and Tinnitus | EA | 814 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0004B | Ear (including vestibular & infectious ) | EA | 4,947 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0004C | Loss of Sense of Smell and/or Taste (ENT) | EA | 82 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005 | Infectious Diseases, Immune Disorders and Nutritional Deficiencies | a | ||||||||||||||||
| 0005A | Persian Gulf/Afghanistan Infectious Diseases | EA | 10 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005B | HIV-Related Illnesses | EA | 10 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005C | Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis) | EA | 160 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005D | Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005E | Nutritional Deficiencies | EA | 103 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0005F | Chronic Fatigue Syndrome (rheumatological) | EA | 98 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006 | Respiratory System | a | ||||||||||||||||
| 0006A | Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT) | EA | 1,811 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006B | Respiratory Conditions (other than Tuberculosis and Sleep Apnea) | EA | 755 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006C | Tuberculosis | EA | 41 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006D | Sleep Apnea | EA | 182 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006E | Sleep Studies (HSAT) | EA | 250 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0006F | Sleep Studies (PSG & ECG) | EA | 200 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0007 | Cardiovascular System | a | ||||||||||||||||
| 0007A | Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery) | EA | 1,138 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0007B | Artery and Vein Conditions (Vascular Diseases including Varicose Veins) | EA | 213 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0007C | Hypertension | EA | 968 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008 | Digestive System | a | ||||||||||||||||
| 0008A | Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal Disorders) | EA | 745 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008B | Gallbladder and Pancreas Conditions | EA | 72 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008C | Intestinal Conditions (other than Surgical or Infectious), including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis | EA | 403 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008D | Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy) | EA | 46 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008E | (Hepatitis, Cirrhosis, and other) Liver Conditions | EA | 506 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008F | Peritoneal Adhesions | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008G | Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders) | EA | 263 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008H | Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) | EA | 55 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008I | Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical | EA | 419 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0008J | Rectum and Anus Conditions (including Hemorrhoids) | EA | 424 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0009 | Genitourinary System | a | ||||||||||||||||
| 0009A | Kidney Conditions | EA | 341 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0009B | Urinary Tract (including Bladder and Urethra ) Conditions (excluding Male reproductive System) | EA | 243 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0009C | Prostate Cancer | EA | 217 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0009D | Male Reproductive Organ Conditions | EA | 952 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0010 | Gynecological Conditions and Disorders of the Breast | 0 | a | |||||||||||||||
| 0010A | Gynecological Conditions | EA | 245 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0010B | Breast Conditions and Disorders | EA | 82 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0011 | Hemic and Lymphatic Systems | 0 | a | |||||||||||||||
| 0011A | (Hairy Cell and Other B-Cell) Leukemia | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0011B | Hematologic and Lymphatic Conditions, including Leukemia | EA | 193 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0012 | Skin (Derm) | a | ||||||||||||||||
| 0012A | Skin Diseases | EA | 1,496 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0012B | Scars/Disfigurement | EA | 1,479 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0013 | Endocrine System | a | ||||||||||||||||
| 0013A | Diabetes Mellitus | EA | 695 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0013B | Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus) | EA | 125 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0013C | Thyroid and Parathyroid Conditions | EA | 124 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014 | Neurological Conditions and Convulsive Disorders | a | ||||||||||||||||
| 0014A | Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS) | EA | 188 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014B | Parkinson's Disease | EA | 36 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014C | Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) | EA | 25 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014D | Diabetic Sensory-Motor Peripheral Neuropathy | EA | 486 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014E | Narcolepsy | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014F | Fibromyalgia | EA | 77 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014G | Headaches (including Migraine Headaches) | EA | 1,472 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014H | Multiple Sclerosis (MS) | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014I | Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) | EA | 2,794 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014J | Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) | EA | 658 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014K | Cranial Nerve Conditions | EA | 77 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014L | Peripheral Nerve Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) | EA | 2,407 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0014M | Seizure Disorders (epilepsy) | EA | 56 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015 | Mental Disorders | a | ||||||||||||||||
| 0015A | Mental Disorders (other than PTSD) | EA | 1,344 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015B | Mental Disorders (other than PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015C | Initial Post Traumatic Stress Disorders (PTSD) | EA | 2,535 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015D | Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015E | Review Post Traumatic Stress Disorders (PTSD) | EA | 6,934 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015F | Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015G | Eating Disorders | EA | 54 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0015H | Eating Disorders - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0016 | Dental and Oral Conditions | a | ||||||||||||||||
| 0016A | Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions) | EA | 1,733 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0016B | Temporomandibular Joint (TMJ) Conditions | EA | 188 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0017 | Ancillary Diagnostic Tests (The percentage proposed listed shall be applied to the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.) | a | ||||||||||||||||
| 0017A | Procedures (@ $200 Sample Medicare National Baseline Rate) | EA | 1,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0017B | Tests (@ $200 Sample Medicare National Baseline Rate) | EA | 2,000 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0017C | Laboratory Work (@ $50 Sample Medicare National Baseline Rate) | EA | 4,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0017D | X-rays (@ $50 Sample Medicare National Baseline Rate) | EA | 3,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0018 | Camp Lejeune Contaminated Water (CLCW) Subject Matter Expert (SME) Opinions | a | ||||||||||||||||
| 0018A | CLCW SME Opinions | EA | 200 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0019 | Record Review Medical File & Medical Opinions | a | ||||||||||||||||
| 0019A | Record Review Medical File | |||||||||||||||||
| (<1" or <250 pgs) | EA | 1,451 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0019AA | Record Review Medical File w/ Medical Opinion | |||||||||||||||||
| (<1" or <250 pgs) | EA | 478 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0019B | Record Review Medical File | |||||||||||||||||
| (1"-3" or 250-749 pgs) | EA | 3,207 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0019BB | Record Review Medical File w/ Medical Opinion | |||||||||||||||||
| (1"-3" or 250-749 pgs) | EA | 1,058 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0019C | Record Review Medical File | |||||||||||||||||
| (> 3" or >749 pgs) | EA | 3,149 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0019CC | Record Review Medical File w/ Medical Opinion | |||||||||||||||||
| (> 3" or >749 pgs) | EA | 1,039 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||
| 0020 | No Shows (If Veteran or Servicemember does not appear for appointment or does not contact vendor within the acceptable timeframe to reschedule but does request a rescheduled appointment, No show is charged on initial appointment but at a lower price since administrative prep work is eventually used by examiner) | a | ||||||||||||||||
| 0020A | Complete No Show (Veteran or Servicemember does not appear) | EA | 5,083 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0020B | Partial No Show (Veteran or Servicemember requests to reschedule appointment within less than 24 hours notice) | EA | 660 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||
| 0021 | Deliverables | a | ||||||||||||||||
| 0021A | Detailed PMP (with QAP) and Briefing in accordance with Section 8.6 of the Performance Work Statement (PWS) | Not Separately Priced (NSP) | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||
| 0021B | Training Plan in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||
| 0021C | Monthly Status Reports in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||
| 0021D | Annual Statement of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||
| 0021E | Quarterly Reports of ADA & OSHA Compliance in accordance with Section 8.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||
| 0022 | Other | a | ||||||||||||||||
| 0022A | Travel Mileage for examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | a | ||
| 0022B | Travel Time for Performing examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | a | ||
| 0022C | Monetary Incentive may be awarded quarterly in accordance with Section 12.0 of the PWS | Per Quarter | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | a | ||
| 0022D | Veteran Mileage Reimbursement | To be invoiced and paid in accordance with Section 9.2 of the PWS | a | |||||||||||||||
| 0023 | ACE Exam Discount Percentage: | |||||||||||||||||
| The listed percentage is the discount to be applied in accordance with PWS Section 10.23 and the performance of ACE qualified examinations. | EA | $2,000,000 in ACE Eligible Exams Performed Annually | N/A | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $2,000,000 | $20,000,000.00 | a | |||
| TOTAL PRICE -- SAMPLE TASK ORDER -- MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | ||||||||||||||||||
| REGION 1 (NORTHEAST): | SAMPLE TO BASE YR PRICE | SAMPLE TO YR 1 PRICE | SAMPLE TO YR 2 PRICE | SAMPLE TO YR 3 PRICE | SAMPLE TO YR 4 PRICE | SAMPLE TO YR 5 PRICE | SAMPLE TO YR 6 PRICE | SAMPLE TO YR 7 PRICE | SAMPLE TO YR 8 PRICE | SAMPLE TO YR 9 PRICE | SAMPLE TO TOTAL PRICE | a | ||||||
| $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $2,000,000.00 | $20,000,000.00 | a |
&F | &A
Regions
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 1 (NORTHEAST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 2 (SOUTHEAST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 3 (MIDWEST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 4 (PACIFIC)
File details come from the government source that posted it. Updated .