S02 B.3 Price Schedule.xlsx

XLSX spreadsheet 53 KB Posted Aug 8, 2024

Attached to: Q403-- MDE 2025 Regions 1-4 Recompete AMENDMENT 00077
Solicitation number: 36C10X25R0001
Issued by: Department of Veterans Affairs Strategic Acquisition Center Frederick

About this file

Written by GovTribe AI · Aug 8, 2024

This document contains a Price Schedule for a federal contract opportunity related to providing medical disability examinations for the Department of Veterans Affairs. It lists various line items for general medical examinations, specialty examinations, ancillary tests, travel reimbursement, and other contract deliverables, along with unit pricing and percentage of Medicare baseline rates. The corresponding federal contract opportunity is a Draft Request for Proposal (RFP) for the recompete of the Medical Disability Examinations (MDE) contract in Regions 1-4, with an Industry Day scheduled for August 13, 2024 and Phase 1 submissions due by August 26, 2024.

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Other files

File	Type	Posted
S06 36C10X25R0001 0006.pdf	PDF	Sep 19, 2024
S06 0006 Government Responses to Vendor Questions.xlsx	XLSX spreadsheet	Sep 19, 2024
S06 36C10X25R0001_0005.docx	DOCX document	Sep 17, 2024
S06 0005 Solicitation Attachment F - Professional Compensation Plans.xlsx	XLSX spreadsheet	Sep 17, 2024
S06 0005 Government Responses to Vendor Questions.xlsx	XLSX spreadsheet	Sep 17, 2024
S06 36C10X25R0001_0004.docx	DOCX document	Sep 16, 2024
S06 0004 MDE Reg 1-4 PWS_Short_Term 9 11 24.docx	DOCX document	Sep 16, 2024
S05 0004 Government Responses to Vendor Questions.xlsx	XLSX spreadsheet	Sep 16, 2024
S05 Government Responses to Vendor Questions_Phase 2.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Solicitation Attachment E - Sample Task Order.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Solicitation Attachment C - Roster of Existing Exam Providers Sample.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Solicition Attachment G - Quality Assurance Plan Template.docx	DOCX document	Sep 11, 2024
S06 0003 MDE Reg 1-4 PWS_Short_Term 9 9 24.docx	DOCX document	Sep 11, 2024
S06 36C10X25R0001_0003.docx	DOCX document	Sep 11, 2024
S06 0003 B.3 Price Schedule 9.3.24.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Solicitation Attachment H - NSP Info.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Attachment AR - Claimant Daily Appointment Log 1.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Attachment X - Monthly Invoice Template.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 0003 Solicitation Attachment F - Professional Compensation Plans.xlsx	XLSX spreadsheet	Sep 11, 2024
S06 Attachment AW - Wage Determinations.xlsx	XLSX spreadsheet	Sep 4, 2024
S06 Attachment X - Monthly Invoice Template.xlsx	XLSX spreadsheet	Sep 4, 2024
S06 Attachment AV - Service Recovery Plan Template.xlsx	XLSX spreadsheet	Sep 4, 2024
S06 36C10X25R0001 0002.pdf	PDF	Sep 4, 2024
S06 Attachment AU - Examination Notification Letter Template (004).docx	DOCX document	Sep 4, 2024
S06 S05 Government Responses to Vendor Questions_0002.xlsx	XLSX spreadsheet	Sep 4, 2024
S06 MDE Reg 1-4 PWS_Short_Term 9.4.24.docx	DOCX document	Sep 4, 2024
S06 B.3 Price Schedule 9.3.24.xlsx	XLSX spreadsheet	Sep 4, 2024
S06 B.3 Price Schedule.xlsx	XLSX spreadsheet	Aug 23, 2024
S06 36C10X25R0001_0001.pdf	PDF	Aug 23, 2024
S06 Attachment Z - Examiner Training Roster_June 2024 Update 08.01.24.xlsx	XLSX spreadsheet	Aug 23, 2024
S06 Solicitation Attachment E - Sample Task Order.xlsx	XLSX spreadsheet	Aug 23, 2024
S05 Government Responses to Vendor Questions.xlsx	XLSX spreadsheet	Aug 23, 2024
S06 B.2 MDE Reg 1-4 PWS.pdf	PDF	Aug 23, 2024
S06 P01 Attachment A.zip	ZIP file	Aug 23, 2024
S02 Solicitation Attachment E - Sample Price Schedule.xlsx	XLSX spreadsheet	Aug 8, 2024
S02 Solicitation Attachment C - Roster of Existing Exam Providers Sample.xlsx	XLSX spreadsheet	Aug 8, 2024
S02 Solicitation Attachment F - Professional Compensation Plans.xlsx	XLSX spreadsheet	Aug 8, 2024
S02 B.2 MDE Reg 1-4 PWS.docx	DOCX document	Aug 8, 2024
S02 Solicitation Attachment D - Self-Certifications of Affiliation.docx	DOCX document	Aug 8, 2024
S02 Solicitation Attachment A - D.1 - PAST PERFORMANCE REFERENCES.pdf	PDF	Aug 8, 2024
S02 B.2 PWS Attachments.zip	ZIP file	Aug 8, 2024
S02 36C10X25R0001_DRAFT.pdf	PDF	Aug 8, 2024
S02 Solicitation Attachment B - D.2 - PPQ.docx	DOCX document	Aug 8, 2024
S02 Solicitation Attachment X - QUESTIONS SPREADSHEET.xlsx	XLSX spreadsheet	Aug 8, 2024

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Region 1

	LINE ITEM	DESCRIPTION	UNIT OF ISSUE	% OF MEDICARE BASELINE RATE	BASE YR UNIT PRICE	OPT YR 1 UNIT PRICE
	0001	General Medical Examination
	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
	0001AA	Requiring 1-5 DBQs	EA	N/A
	0001AB	Requiring 6-10 DBQs	EA	N/A
	0001AC	Requiring 11-15 DBQs	EA	N/A
	0001AD	Requiring 16 or more DBQs	EA	N/A
	0001B	General Medical - Pension	EA	N/A	N/A	N/A
	0001BA	Requiring 1-5 DBQs	EA	N/A
	0001BB	Requiring 6-10 DBQs	EA	N/A
	0001BC	Requiring 11-15 DBQs	EA	N/A
	0001BD	Requiring 16 or more DBQs	EA	N/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
	0001CA	Requiring 1-5 DBQs	EA	N/A	N/A	N/A
	0001CB	Requiring 6-10 DBQs	EA	N/A	N/A	N/A
	0001CC	Requiring 11-15 DBQs	EA	N/A	N/A	N/A
	0001CD	Requiring 16 or more DBQs	EA	N/A	N/A	N/A
	0001D	Aid and Attendance or Housebound	EA	N/A	N/A	N/A
	0001DA	Requiring 1-5 DBQs	EA	N/A
	0001DB	Requiring 6-10 DBQs	EA	N/A
	0001DC	Requiring 11-15 DBQs	EA	N/A
	0001DD	Requiring 16 or more DBQs	EA	N/A
	0001E	Cold Injury Residuals	EA	N/A
	0001F	General Medical - Comprehensive Medical Examination to include a Gulf War DBQ	EA	N/A	N/A	N/A
	0001FA	Requiring 1-5 DBQs	EA	N/A
	0001FB	Requiring 6-10 DBQs	EA	N/A
	0001FC	Requiring 11-15 DBQs	EA	N/A
	0001FD	Requiring 16 or more DBQs	EA	N/A
	0001G	General Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQ	EA	N/A	N/A	N/A
	0001GA	Requiring 1-5 DBQs	EA	N/A
	0001GB	Requiring 6-10 DBQs	EA	N/A
	0001GC	Requiring 11-15 DBQs	EA	N/A
	0001GD	Requiring 16 or more DBQs	EA	N/A
	0002	Musculoskeletal System
	0002A	Osteomyelitis	EA	N/A
	0002B	Arthritis	EA	N/A
	0002C	Amputations	EA	N/A
	0002D	Shoulder and Arm Conditions	EA	N/A
	0002E	Elbow and Forearm Conditions	EA	N/A
	0002F	Wrist Conditions	EA	N/A
	0002G	Hand and Finger Conditions	EA	N/A
	0002H	Back (Thoracolumbar Spine) Conditions	EA	N/A
	0002I	Neck (Cervical Spine) Conditions	EA	N/A
	0002J	Hip and Thigh Conditions	EA	N/A
	0002K	Knee and Lower Leg Conditions	EA	N/A
	0002L	Ankle Conditions	EA	N/A
	0002M	Foot Conditions, Including Flatfoot (Pes Planus)	EA	N/A
	0002N	Bones	EA	N/A
	0002O	Muscle Injuries	EA	N/A
	0003	Organs of Special Sense / Eye
	0003A	Eye Conditions	EA	N/A
	0004	Impairment of Auditory Acuity/Ear and Other Sense Organs
	0004A	Hearing Loss and Tinnitus	EA	N/A
	0004B	Ear (including vestibular & infectious)	EA	N/A
	0004C	Loss of Sense of Smell and/or Taste (ENT)	EA	N/A
	0004D	Hearing Loss and Tinnitus Conducted with Boothless Audio Technology	EA	N/A
	0005	Infectious Diseases, Immune Disorders and Nutritional Deficiencies
	0005A	Persian Gulf/Afghanistan Infectious Diseases	EA	N/A
	0005B	HIV-Related Illnesses	EA	N/A
	0005C	Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)	EA	N/A
	0005D	Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases	EA	N/A
	0005E	Nutritional Deficiencies	EA	N/A
	0005F	Chronic Fatigue Syndrome
(rheumatological)	EA	N/A
	0006	Respiratory System
	0006A	Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)	EA	N/A
	0006B	Respiratory Conditions (other than Tuberculosis and Sleep Apnea)	EA	N/A
	0006C	Tuberculosis	EA	N/A
	0006D	Sleep Apnea	EA	N/A
	0006E	Sleep Studies (HSAT)	EA	N/A
	0006F	Sleep Studies (PSG & ECG)	EA	N/A
	0007	Cardiovascular System
	0007A	Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)	EA	N/A
	0007B	Artery and Vein Conditions (Vascular Diseases including Varicose Veins)	EA	N/A
	0007C	Hypertension	EA	N/A
	0008	Digestive System
	0008A	Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)	EA	N/A
	0008B	Gallbladder Conditions	EA	N/A
	0008C	Intestinal Conditions DBQ	EA	N/A
	0008D	RESERVED	EA	N/A	N/A	N/A
	0008E	(Hepatitis, Cirrhosis, and other) Liver Conditions	EA	N/A
	0008F	Peritoneal Adhesions	EA	N/A
	0008G	Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders)	EA	N/A
	0008H	RESERVED	EA	N/A	N/A	N/A
	0008I	Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical	EA	N/A
	0008J	Rectum and Anus Conditions
(including Hemorrhoids)	EA	N/A
	0008K	Pancreas Conditions	EA	N/A
	0009	Genitourinary System
	0009A	Kidney Conditions	EA	N/A
	0009B	Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)	EA	N/A
	0009C	Prostate Cancer - Discontinued 12/21/21	EA	N/A
	0009D	Male Reproductive Organ
Conditions	EA	N/A
	0010	Gynecological Conditions and Disorders of the Breast
	0010A	Gynecological Conditions	EA	N/A
	0010B	Breast Conditions and Disorders	EA	N/A
	0011	Hemic and Lymphatic Systems
	0011A	(Hairy Cell and Other B-Cell)
Leukemia	EA	N/A
	0011B	Hematologic and Lymphatic
Conditions, including Leukemia	EA	N/A
	0012	Skin (Derm)
	0012A	Skin Diseases	EA	N/A
	0012B	Scars/Disfigurement	EA	N/A
	0013	Endocrine System
	0013A	Diabetes Mellitus	EA	N/A
	0013B	Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)	EA	N/A
	0013C	Thyroid and Parathyroid
Conditions	EA	N/A
	0014	Neurological Conditions and Convulsive Disorders
	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
	0014B	Parkinson's Disease	EA	N/A
	0014C	Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)	EA	N/A
	0014D	Diabetic Sensory-Motor Peripheral Neuropathy	EA	N/A
	0014E	Narcolepsy	EA	N/A
	0014F	Fibromyalgia	EA	N/A
	0014G	Headaches (including Migraine Headaches)	EA	N/A
	0014H	Multiple Sclerosis (MS)	EA	N/A
	0014I	Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)	EA	N/A
	0014J	Review Evaluation of Residuals of Traumatic Brain Injury (R- TBI)	EA	N/A
	0014K	Cranial Nerve Conditions	EA	N/A
	0014L	Peripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)	EA	N/A
	0014M	Seizure Disorders (epilepsy)	EA	N/A
	0014N	Spina Bifida	EA	N/A
	0015	Mental Disorders
	0015A	Mental Disorders (other than PTSD)	EA	N/A
	0015B	Mental Disorders (other than PTSD) - Telehealth examination	EA	N/A
	0015C	Initial Post Traumatic StressDisorders (PTSD)	EA	N/A
	0015D	Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015E	Review Post Traumatic Stress Disorders (PTSD)	EA	N/A
	0015F	Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015G	Eating Disorders	EA	N/A
	0015H	Eating Disorders - Telehealth
examination	EA	N/A
	0016	Dental and Oral Conditions
	0016A	Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)	EA	N/A
	0016B	Temporomandibular Joint (TMJ) Conditions	EA	N/A
	0017	Ancillary Diagnostic Tests (The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.)
	0017A	Procedures	EA		0%	0%
	0017B	Tests	EA	0%	0%	0%
	0017C	Laboratory Work	EA	0%	0%	0%
	0017D	Radiological Imaging	EA	0%	0%	0%
	0018	Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
	0018A	SME Opinions	EA (per opinion)	N/A
	0019	Record Review Medical File & Medical Opinions
	0019A	Record Review Medical File
( 1 hour or <250 pgs.)	EA	N/A
	0019AA	Record Review Medical File w/ Medical Opinion
(1 hour or <250 pgs.)	EA	N/A
	0019B	Record Review Medical File
(2 hours or 250-749 pgs.)	EA	N/A
	0019BB	Record Review Medical File w/ Medical Opinion
(2 hours or 250-749 pgs.)	EA	N/A
	0019C	Record Review Medical File
(3 hours or >749 pgs.)	EA	N/A
	0019CC	Record Review Medical File w/ Medical Opinion
(3 hours or >749 pgs.)	EA	N/A
	0019D	Toxic Exposure Risk Activity (TERA) Medical Opinion	EA	N/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)
	0020A	Complete No Show (Claimant does not appear)	EA	N/A
	0020B	Partial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)	EA	N/A
	0021	Deliverables
	0021A	Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)	EA	NSP	NSP	NSP
	0021B	Training Plan in accordance with Section 4.5 of the PWS	EA	NSP	NSP	NSP
	0021C	Monthly Status Reports in accordance with Section 4.6 ofthe PWS	EA	NSP	NSP	NSP
	0021D	Ramp-up Plan in accordance with Section 1.10 of the PWS	EA	NSP	NSP	NSP
	0021E	Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS	EA	NSP	NSP	NSP
	0021F	Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS	EA	NSP	NSP	NSP
	0021G	Incident Report in accordance with Sections 2 and 4.8 of the PWS	EA	NSP	NSP	NSP
	0021H	Contractor Portal in accordance with Section 2.3 of the PWS	EA	NSP	NSP	NSP
	0021I	Veteran Portal in accordance with Section 2.4 of the PWS	EA	NSP	NSP	NSP
	0021J	Service Recovery Plan in accordance with Section 3.3 of the PWS	EA	NSP	NSP	NSP
	0021K	Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS	EA	NSP	NSP	NSP
	0021L	Quality Assurance Plan in accordance with Section 4.4 of the PWS	EA	NSP	NSP	NSP
	0021M	Monthly Invoice Report in accordance with Section 4.7 of the PWS	EA	NSP	NSP	NSP
	0021N	Emergency Plan in accordance
with Section 4.8 of the PWS	EA	NSP	NSP	NSP
	0021O	Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS	EA	NSP	NSP	NSP
	0021P	Response to Government Audits in accordance with Section 8.3 of the PWS	EA	NSP	NSP	NSP
	0021Q	Administrative Site Reviews	EA	N/A
	0022	Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
	0022A	Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022B	Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	N/A	N/A
	0022BA	Physician Assistant	EA (hourly)	N/A
	0022BB	Nurse Practitioner	EA (hourly)	N/A
	0022BC	Physician, Generalist	EA (hourly)	N/A
	0022BD	Physician, Ophthalmology	EA (hourly)	N/A
	0022BE	Optometrist	EA (hourly)	N/A
	0022BF	Audiologist	EA (hourly)	N/A
	0022BG	Psychologist	EA (hourly)	N/A
	0022BH	Psychiatrist	EA (hourly)	N/A
	0022BI	Physician, Physiatry	EA (hourly)	N/A
	0022BJ	Physician, Neurology	EA (hourly)	N/A
	0022BK	Surgeon, Neurologist	EA (hourly)	N/A
	0022BL	Dentist	EA (hourly)	N/A
	0022BM	Otolaryngologist	EA (hourly)	N/A
	0022BN	Assistant	EA (hourly)	N/A
	0022BO	Chaperone	EA (hourly)	N/A
	0022C	Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022D	Claimant Milage Reimbursement	To be invoiced and paid in accordance with Section 2.12 of the PWS
	0022E
	0022F	Common Carrier Travel	NTE (Capped at $3 per mile)	N/A	TBD	TBD
	0022G	Common Carrier Travel (other than automobile)	NTE	N/A	TBD	TBD
	0023	Monitory Incentive
	0023A	Monitary Incentives	To be invoiced and paid in accordance with Section 3.5 of the PWS
	0024	Ramp Up Activities
	0024A	Ramp-up: Initial Contract Award	NTE	N/A	N/A	N/A
	0024AA	IT Development Activities	NTE	N/A	TBD	TBD
	0024AB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024B	Ramp-up: Major Contract Modification	NTE	N/A	N/A	N/A
	0024BA	IT Development Activities	NTE	N/A	TBD	TBD
	0024BB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024C	Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work	NTE	N/A	TBD	TBD
	0025	Ramp Up Activities
	0025A	Examiners Costs	EA (hourly)	N/A
	0025B	Mobile Units	EA (daily)	N/A
	0026	Required Assistant, Chaperone and/or Tele Presenter	EA (hourly)	N/A

Region 2

	LINE ITEM	DESCRIPTION	UNIT OF ISSUE	% OF MEDICARE BASELINE RATE	BASE YR UNIT PRICE	OPT YR 1 UNIT PRICE
	0001	General Medical Examination
	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
	0001AA	Requiring 1-5 DBQs	EA	N/A
	0001AB	Requiring 6-10 DBQs	EA	N/A
	0001AC	Requiring 11-15 DBQs	EA	N/A
	0001AD	Requiring 16 or more DBQs	EA	N/A
	0001B	General Medical - Pension	EA	N/A	N/A	N/A
	0001BA	Requiring 1-5 DBQs	EA	N/A
	0001BB	Requiring 6-10 DBQs	EA	N/A
	0001BC	Requiring 11-15 DBQs	EA	N/A
	0001BD	Requiring 16 or more DBQs	EA	N/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
	0001CA	Requiring 1-5 DBQs	EA	N/A	N/A	N/A
	0001CB	Requiring 6-10 DBQs	EA	N/A	N/A	N/A
	0001CC	Requiring 11-15 DBQs	EA	N/A	N/A	N/A
	0001CD	Requiring 16 or more DBQs	EA	N/A	N/A	N/A
	0001D	Aid and Attendance or Housebound	EA	N/A	N/A	N/A
	0001DA	Requiring 1-5 DBQs	EA	N/A
	0001DB	Requiring 6-10 DBQs	EA	N/A
	0001DC	Requiring 11-15 DBQs	EA	N/A
	0001DD	Requiring 16 or more DBQs	EA	N/A
	0001E	Cold Injury Residuals	EA	N/A
	0001F	General Medical - Comprehensive Medical Examination to include a Gulf War DBQ	EA	N/A	N/A	N/A
	0001FA	Requiring 1-5 DBQs	EA	N/A
	0001FB	Requiring 6-10 DBQs	EA	N/A
	0001FC	Requiring 11-15 DBQs	EA	N/A
	0001FD	Requiring 16 or more DBQs	EA	N/A
	0001G	General Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQ	EA	N/A	N/A	N/A
	0001GA	Requiring 1-5 DBQs	EA	N/A
	0001GB	Requiring 6-10 DBQs	EA	N/A
	0001GC	Requiring 11-15 DBQs	EA	N/A
	0001GD	Requiring 16 or more DBQs	EA	N/A
	0002	Musculoskeletal System
	0002A	Osteomyelitis	EA	N/A
	0002B	Arthritis	EA	N/A
	0002C	Amputations	EA	N/A
	0002D	Shoulder and Arm Conditions	EA	N/A
	0002E	Elbow and Forearm Conditions	EA	N/A
	0002F	Wrist Conditions	EA	N/A
	0002G	Hand and Finger Conditions	EA	N/A
	0002H	Back (Thoracolumbar Spine) Conditions	EA	N/A
	0002I	Neck (Cervical Spine) Conditions	EA	N/A
	0002J	Hip and Thigh Conditions	EA	N/A
	0002K	Knee and Lower Leg Conditions	EA	N/A
	0002L	Ankle Conditions	EA	N/A
	0002M	Foot Conditions, Including Flatfoot (Pes Planus)	EA	N/A
	0002N	Bones	EA	N/A
	0002O	Muscle Injuries	EA	N/A
	0003	Organs of Special Sense / Eye
	0003A	Eye Conditions	EA	N/A
	0004	Impairment of Auditory Acuity/Ear and Other Sense Organs
	0004A	Hearing Loss and Tinnitus	EA	N/A
	0004B	Ear (including vestibular & infectious)	EA	N/A
	0004C	Loss of Sense of Smell and/or Taste (ENT)	EA	N/A
	0004D	Hearing Loss and Tinnitus Conducted with Boothless Audio Technology	EA	N/A
	0005	Infectious Diseases, Immune Disorders and Nutritional Deficiencies
	0005A	Persian Gulf/Afghanistan Infectious Diseases	EA	N/A
	0005B	HIV-Related Illnesses	EA	N/A
	0005C	Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)	EA	N/A
	0005D	Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases	EA	N/A
	0005E	Nutritional Deficiencies	EA	N/A
	0005F	Chronic Fatigue Syndrome
(rheumatological)	EA	N/A
	0006	Respiratory System
	0006A	Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)	EA	N/A
	0006B	Respiratory Conditions (other than Tuberculosis and Sleep Apnea)	EA	N/A
	0006C	Tuberculosis	EA	N/A
	0006D	Sleep Apnea	EA	N/A
	0006E	Sleep Studies (HSAT)	EA	N/A
	0006F	Sleep Studies (PSG & ECG)	EA	N/A
	0007	Cardiovascular System
	0007A	Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)	EA	N/A
	0007B	Artery and Vein Conditions (Vascular Diseases including Varicose Veins)	EA	N/A
	0007C	Hypertension	EA	N/A
	0008	Digestive System
	0008A	Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)	EA	N/A
	0008B	Gallbladder Conditions	EA	N/A
	0008C	Intestinal Conditions DBQ	EA	N/A
	0008D	RESERVED	EA	N/A	N/A	N/A
	0008E	(Hepatitis, Cirrhosis, and other) Liver Conditions	EA	N/A
	0008F	Peritoneal Adhesions	EA	N/A
	0008G	Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders)	EA	N/A
	0008H	RESERVED	EA	N/A	N/A	N/A
	0008I	Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical	EA	N/A
	0008J	Rectum and Anus Conditions
(including Hemorrhoids)	EA	N/A
	0008K	Pancreas Conditions	EA	N/A
	0009	Genitourinary System
	0009A	Kidney Conditions	EA	N/A
	0009B	Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)	EA	N/A
	0009C	Prostate Cancer - Discontinued 12/21/21	EA	N/A
	0009D	Male Reproductive Organ
Conditions	EA	N/A
	0010	Gynecological Conditions and Disorders of the Breast
	0010A	Gynecological Conditions	EA	N/A
	0010B	Breast Conditions and Disorders	EA	N/A
	0011	Hemic and Lymphatic Systems
	0011A	(Hairy Cell and Other B-Cell)
Leukemia	EA	N/A
	0011B	Hematologic and Lymphatic
Conditions, including Leukemia	EA	N/A
	0012	Skin (Derm)
	0012A	Skin Diseases	EA	N/A
	0012B	Scars/Disfigurement	EA	N/A
	0013	Endocrine System
	0013A	Diabetes Mellitus	EA	N/A
	0013B	Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)	EA	N/A
	0013C	Thyroid and Parathyroid
Conditions	EA	N/A
	0014	Neurological Conditions and Convulsive Disorders
	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
	0014B	Parkinson's Disease	EA	N/A
	0014C	Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)	EA	N/A
	0014D	Diabetic Sensory-Motor Peripheral Neuropathy	EA	N/A
	0014E	Narcolepsy	EA	N/A
	0014F	Fibromyalgia	EA	N/A
	0014G	Headaches (including Migraine Headaches)	EA	N/A
	0014H	Multiple Sclerosis (MS)	EA	N/A
	0014I	Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)	EA	N/A
	0014J	Review Evaluation of Residuals of Traumatic Brain Injury (R- TBI)	EA	N/A
	0014K	Cranial Nerve Conditions	EA	N/A
	0014L	Peripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)	EA	N/A
	0014M	Seizure Disorders (epilepsy)	EA	N/A
	0014N	Spina Bifida	EA	N/A
	0015	Mental Disorders
	0015A	Mental Disorders (other than PTSD)	EA	N/A
	0015B	Mental Disorders (other than PTSD) - Telehealth examination	EA	N/A
	0015C	Initial Post Traumatic StressDisorders (PTSD)	EA	N/A
	0015D	Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015E	Review Post Traumatic Stress Disorders (PTSD)	EA	N/A
	0015F	Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015G	Eating Disorders	EA	N/A
	0015H	Eating Disorders - Telehealth
examination	EA	N/A
	0016	Dental and Oral Conditions
	0016A	Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)	EA	N/A
	0016B	Temporomandibular Joint (TMJ) Conditions	EA	N/A
	0017	Ancillary Diagnostic Tests (The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.)
	0017A	Procedures	EA		0%	0%
	0017B	Tests	EA	0%	0%	0%
	0017C	Laboratory Work	EA	0%	0%	0%
	0017D	Radiological Imaging	EA	0%	0%	0%
	0018	Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
	0018A	SME Opinions	EA (per opinion)	N/A
	0019	Record Review Medical File & Medical Opinions
	0019A	Record Review Medical File
( 1 hour or <250 pgs.)	EA	N/A
	0019AA	Record Review Medical File w/ Medical Opinion
(1 hour or <250 pgs.)	EA	N/A
	0019B	Record Review Medical File
(2 hours or 250-749 pgs.)	EA	N/A
	0019BB	Record Review Medical File w/ Medical Opinion
(2 hours or 250-749 pgs.)	EA	N/A
	0019C	Record Review Medical File
(3 hours or >749 pgs.)	EA	N/A
	0019CC	Record Review Medical File w/ Medical Opinion
(3 hours or >749 pgs.)	EA	N/A
	0019D	Toxic Exposure Risk Activity (TERA) Medical Opinion	EA	N/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)
	0020A	Complete No Show (Claimant does not appear)	EA	N/A
	0020B	Partial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)	EA	N/A
	0021	Deliverables
	0021A	Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)	EA	NSP	NSP	NSP
	0021B	Training Plan in accordance with Section 4.5 of the PWS	EA	NSP	NSP	NSP
	0021C	Monthly Status Reports in accordance with Section 4.6 ofthe PWS	EA	NSP	NSP	NSP
	0021D	Ramp-up Plan in accordance with Section 1.10 of the PWS	EA	NSP	NSP	NSP
	0021E	Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS	EA	NSP	NSP	NSP
	0021F	Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS	EA	NSP	NSP	NSP
	0021G	Incident Report in accordance with Sections 2 and 4.8 of the PWS	EA	NSP	NSP	NSP
	0021H	Contractor Portal in accordance with Section 2.3 of the PWS	EA	NSP	NSP	NSP
	0021I	Veteran Portal in accordance with Section 2.4 of the PWS	EA	NSP	NSP	NSP
	0021J	Service Recovery Plan in accordance with Section 3.3 of the PWS	EA	NSP	NSP	NSP
	0021K	Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS	EA	NSP	NSP	NSP
	0021L	Quality Assurance Plan in accordance with Section 4.4 of the PWS	EA	NSP	NSP	NSP
	0021M	Monthly Invoice Report in accordance with Section 4.7 of the PWS	EA	NSP	NSP	NSP
	0021N	Emergency Plan in accordance
with Section 4.8 of the PWS	EA	NSP	NSP	NSP
	0021O	Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS	EA	NSP	NSP	NSP
	0021P	Response to Government Audits in accordance with Section 8.3 of the PWS	EA	NSP	NSP	NSP
	0021Q	Administrative Site Reviews	EA	N/A
	0022	Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
	0022A	Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022B	Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	N/A	N/A
	0022BA	Physician Assistant	EA (hourly)	N/A
	0022BB	Nurse Practitioner	EA (hourly)	N/A
	0022BC	Physician, Generalist	EA (hourly)	N/A
	0022BD	Physician, Ophthalmology	EA (hourly)	N/A
	0022BE	Optometrist	EA (hourly)	N/A
	0022BF	Audiologist	EA (hourly)	N/A
	0022BG	Psychologist	EA (hourly)	N/A
	0022BH	Psychiatrist	EA (hourly)	N/A
	0022BI	Physician, Physiatry	EA (hourly)	N/A
	0022BJ	Physician, Neurology	EA (hourly)	N/A
	0022BK	Surgeon, Neurologist	EA (hourly)	N/A
	0022BL	Dentist	EA (hourly)	N/A
	0022BM	Otolaryngologist	EA (hourly)	N/A
	0022BN	Assistant	EA (hourly)	N/A
	0022BO	Chaperone	EA (hourly)	N/A
	0022C	Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022D	Claimant Milage Reimbursement	To be invoiced and paid in accordance with Section 2.12 of the PWS
	0022E
	0022F	Common Carrier Travel	NTE (Capped at $3 per mile)	N/A	TBD	TBD
	0022G	Common Carrier Travel (other than automobile)	NTE	N/A	TBD	TBD
	0023	Monitory Incentive
	0023A	Monitary Incentives	To be invoiced and paid in accordance with Section 3.5 of the PWS
	0024	Ramp Up Activities
	0024A	Ramp-up: Initial Contract Award	NTE	N/A	N/A	N/A
	0024AA	IT Development Activities	NTE	N/A	TBD	TBD
	0024AB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024B	Ramp-up: Major Contract Modification	NTE	N/A	N/A	N/A
	0024BA	IT Development Activities	NTE	N/A	TBD	TBD
	0024BB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024C	Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work	NTE	N/A	TBD	TBD
	0025	Ramp Up Activities
	0025A	Examiners Costs	EA (hourly)	N/A
	0025B	Mobile Units	EA (daily)	N/A
	0026	Required Assistant, Chaperone and/or Tele Presenter	EA (hourly)	N/A

Region 3

	LINE ITEM	DESCRIPTION	UNIT OF ISSUE	% OF MEDICARE BASELINE RATE	BASE YR UNIT PRICE	OPT YR 1 UNIT PRICE
	0001	General Medical Examination
	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
	0001AA	Requiring 1-5 DBQs	EA	N/A
	0001AB	Requiring 6-10 DBQs	EA	N/A
	0001AC	Requiring 11-15 DBQs	EA	N/A
	0001AD	Requiring 16 or more DBQs	EA	N/A
	0001B	General Medical - Pension	EA	N/A	N/A	N/A
	0001BA	Requiring 1-5 DBQs	EA	N/A
	0001BB	Requiring 6-10 DBQs	EA	N/A
	0001BC	Requiring 11-15 DBQs	EA	N/A
	0001BD	Requiring 16 or more DBQs	EA	N/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
	0001CA	Requiring 1-5 DBQs	EA	N/A	N/A	N/A
	0001CB	Requiring 6-10 DBQs	EA	N/A	N/A	N/A
	0001CC	Requiring 11-15 DBQs	EA	N/A	N/A	N/A
	0001CD	Requiring 16 or more DBQs	EA	N/A	N/A	N/A
	0001D	Aid and Attendance or Housebound	EA	N/A	N/A	N/A
	0001DA	Requiring 1-5 DBQs	EA	N/A
	0001DB	Requiring 6-10 DBQs	EA	N/A
	0001DC	Requiring 11-15 DBQs	EA	N/A
	0001DD	Requiring 16 or more DBQs	EA	N/A
	0001E	Cold Injury Residuals	EA	N/A
	0001F	General Medical - Comprehensive Medical Examination to include a Gulf War DBQ	EA	N/A	N/A	N/A
	0001FA	Requiring 1-5 DBQs	EA	N/A
	0001FB	Requiring 6-10 DBQs	EA	N/A
	0001FC	Requiring 11-15 DBQs	EA	N/A
	0001FD	Requiring 16 or more DBQs	EA	N/A
	0001G	General Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQ	EA	N/A	N/A	N/A
	0001GA	Requiring 1-5 DBQs	EA	N/A
	0001GB	Requiring 6-10 DBQs	EA	N/A
	0001GC	Requiring 11-15 DBQs	EA	N/A
	0001GD	Requiring 16 or more DBQs	EA	N/A
	0002	Musculoskeletal System
	0002A	Osteomyelitis	EA	N/A
	0002B	Arthritis	EA	N/A
	0002C	Amputations	EA	N/A
	0002D	Shoulder and Arm Conditions	EA	N/A
	0002E	Elbow and Forearm Conditions	EA	N/A
	0002F	Wrist Conditions	EA	N/A
	0002G	Hand and Finger Conditions	EA	N/A
	0002H	Back (Thoracolumbar Spine) Conditions	EA	N/A
	0002I	Neck (Cervical Spine) Conditions	EA	N/A
	0002J	Hip and Thigh Conditions	EA	N/A
	0002K	Knee and Lower Leg Conditions	EA	N/A
	0002L	Ankle Conditions	EA	N/A
	0002M	Foot Conditions, Including Flatfoot (Pes Planus)	EA	N/A
	0002N	Bones	EA	N/A
	0002O	Muscle Injuries	EA	N/A
	0003	Organs of Special Sense / Eye
	0003A	Eye Conditions	EA	N/A
	0004	Impairment of Auditory Acuity/Ear and Other Sense Organs
	0004A	Hearing Loss and Tinnitus	EA	N/A
	0004B	Ear (including vestibular & infectious)	EA	N/A
	0004C	Loss of Sense of Smell and/or Taste (ENT)	EA	N/A
	0004D	Hearing Loss and Tinnitus Conducted with Boothless Audio Technology	EA	N/A
	0005	Infectious Diseases, Immune Disorders and Nutritional Deficiencies
	0005A	Persian Gulf/Afghanistan Infectious Diseases	EA	N/A
	0005B	HIV-Related Illnesses	EA	N/A
	0005C	Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)	EA	N/A
	0005D	Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases	EA	N/A
	0005E	Nutritional Deficiencies	EA	N/A
	0005F	Chronic Fatigue Syndrome
(rheumatological)	EA	N/A
	0006	Respiratory System
	0006A	Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)	EA	N/A
	0006B	Respiratory Conditions (other than Tuberculosis and Sleep Apnea)	EA	N/A
	0006C	Tuberculosis	EA	N/A
	0006D	Sleep Apnea	EA	N/A
	0006E	Sleep Studies (HSAT)	EA	N/A
	0006F	Sleep Studies (PSG & ECG)	EA	N/A
	0007	Cardiovascular System
	0007A	Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)	EA	N/A
	0007B	Artery and Vein Conditions (Vascular Diseases including Varicose Veins)	EA	N/A
	0007C	Hypertension	EA	N/A
	0008	Digestive System
	0008A	Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)	EA	N/A
	0008B	Gallbladder Conditions	EA	N/A
	0008C	Intestinal Conditions DBQ	EA	N/A
	0008D	RESERVED	EA	N/A	N/A	N/A
	0008E	(Hepatitis, Cirrhosis, and other) Liver Conditions	EA	N/A
	0008F	Peritoneal Adhesions	EA	N/A
	0008G	Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders)	EA	N/A
	0008H	RESERVED	EA	N/A	N/A	N/A
	0008I	Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical	EA	N/A
	0008J	Rectum and Anus Conditions
(including Hemorrhoids)	EA	N/A
	0008K	Pancreas Conditions	EA	N/A
	0009	Genitourinary System
	0009A	Kidney Conditions	EA	N/A
	0009B	Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)	EA	N/A
	0009C	Prostate Cancer - Discontinued 12/21/21	EA	N/A
	0009D	Male Reproductive Organ
Conditions	EA	N/A
	0010	Gynecological Conditions and Disorders of the Breast
	0010A	Gynecological Conditions	EA	N/A
	0010B	Breast Conditions and Disorders	EA	N/A
	0011	Hemic and Lymphatic Systems
	0011A	(Hairy Cell and Other B-Cell)
Leukemia	EA	N/A
	0011B	Hematologic and Lymphatic
Conditions, including Leukemia	EA	N/A
	0012	Skin (Derm)
	0012A	Skin Diseases	EA	N/A
	0012B	Scars/Disfigurement	EA	N/A
	0013	Endocrine System
	0013A	Diabetes Mellitus	EA	N/A
	0013B	Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)	EA	N/A
	0013C	Thyroid and Parathyroid
Conditions	EA	N/A
	0014	Neurological Conditions and Convulsive Disorders
	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
	0014B	Parkinson's Disease	EA	N/A
	0014C	Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)	EA	N/A
	0014D	Diabetic Sensory-Motor Peripheral Neuropathy	EA	N/A
	0014E	Narcolepsy	EA	N/A
	0014F	Fibromyalgia	EA	N/A
	0014G	Headaches (including Migraine Headaches)	EA	N/A
	0014H	Multiple Sclerosis (MS)	EA	N/A
	0014I	Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)	EA	N/A
	0014J	Review Evaluation of Residuals of Traumatic Brain Injury (R- TBI)	EA	N/A
	0014K	Cranial Nerve Conditions	EA	N/A
	0014L	Peripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)	EA	N/A
	0014M	Seizure Disorders (epilepsy)	EA	N/A
	0014N	Spina Bifida	EA	N/A
	0015	Mental Disorders
	0015A	Mental Disorders (other than PTSD)	EA	N/A
	0015B	Mental Disorders (other than PTSD) - Telehealth examination	EA	N/A
	0015C	Initial Post Traumatic StressDisorders (PTSD)	EA	N/A
	0015D	Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015E	Review Post Traumatic Stress Disorders (PTSD)	EA	N/A
	0015F	Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015G	Eating Disorders	EA	N/A
	0015H	Eating Disorders - Telehealth
examination	EA	N/A
	0016	Dental and Oral Conditions
	0016A	Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)	EA	N/A
	0016B	Temporomandibular Joint (TMJ) Conditions	EA	N/A
	0017	Ancillary Diagnostic Tests (The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.)
	0017A	Procedures	EA		0%	0%
	0017B	Tests	EA	0%	0%	0%
	0017C	Laboratory Work	EA	0%	0%	0%
	0017D	Radiological Imaging	EA	0%	0%	0%
	0018	Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
	0018A	SME Opinions	EA (per opinion)	N/A
	0019	Record Review Medical File & Medical Opinions
	0019A	Record Review Medical File
( 1 hour or <250 pgs.)	EA	N/A
	0019AA	Record Review Medical File w/ Medical Opinion
(1 hour or <250 pgs.)	EA	N/A
	0019B	Record Review Medical File
(2 hours or 250-749 pgs.)	EA	N/A
	0019BB	Record Review Medical File w/ Medical Opinion
(2 hours or 250-749 pgs.)	EA	N/A
	0019C	Record Review Medical File
(3 hours or >749 pgs.)	EA	N/A
	0019CC	Record Review Medical File w/ Medical Opinion
(3 hours or >749 pgs.)	EA	N/A
	0019D	Toxic Exposure Risk Activity (TERA) Medical Opinion	EA	N/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)
	0020A	Complete No Show (Claimant does not appear)	EA	N/A
	0020B	Partial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)	EA	N/A
	0021	Deliverables
	0021A	Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)	EA	NSP	NSP	NSP
	0021B	Training Plan in accordance with Section 4.5 of the PWS	EA	NSP	NSP	NSP
	0021C	Monthly Status Reports in accordance with Section 4.6 ofthe PWS	EA	NSP	NSP	NSP
	0021D	Ramp-up Plan in accordance with Section 1.10 of the PWS	EA	NSP	NSP	NSP
	0021E	Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS	EA	NSP	NSP	NSP
	0021F	Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS	EA	NSP	NSP	NSP
	0021G	Incident Report in accordance with Sections 2 and 4.8 of the PWS	EA	NSP	NSP	NSP
	0021H	Contractor Portal in accordance with Section 2.3 of the PWS	EA	NSP	NSP	NSP
	0021I	Veteran Portal in accordance with Section 2.4 of the PWS	EA	NSP	NSP	NSP
	0021J	Service Recovery Plan in accordance with Section 3.3 of the PWS	EA	NSP	NSP	NSP
	0021K	Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS	EA	NSP	NSP	NSP
	0021L	Quality Assurance Plan in accordance with Section 4.4 of the PWS	EA	NSP	NSP	NSP
	0021M	Monthly Invoice Report in accordance with Section 4.7 of the PWS	EA	NSP	NSP	NSP
	0021N	Emergency Plan in accordance
with Section 4.8 of the PWS	EA	NSP	NSP	NSP
	0021O	Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS	EA	NSP	NSP	NSP
	0021P	Response to Government Audits in accordance with Section 8.3 of the PWS	EA	NSP	NSP	NSP
	0021Q	Administrative Site Reviews	EA	N/A
	0022	Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
	0022A	Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022B	Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	N/A	N/A
	0022BA	Physician Assistant	EA (hourly)	N/A
	0022BB	Nurse Practitioner	EA (hourly)	N/A
	0022BC	Physician, Generalist	EA (hourly)	N/A
	0022BD	Physician, Ophthalmology	EA (hourly)	N/A
	0022BE	Optometrist	EA (hourly)	N/A
	0022BF	Audiologist	EA (hourly)	N/A
	0022BG	Psychologist	EA (hourly)	N/A
	0022BH	Psychiatrist	EA (hourly)	N/A
	0022BI	Physician, Physiatry	EA (hourly)	N/A
	0022BJ	Physician, Neurology	EA (hourly)	N/A
	0022BK	Surgeon, Neurologist	EA (hourly)	N/A
	0022BL	Dentist	EA (hourly)	N/A
	0022BM	Otolaryngologist	EA (hourly)	N/A
	0022BN	Assistant	EA (hourly)	N/A
	0022BO	Chaperone	EA (hourly)	N/A
	0022C	Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022D	Claimant Milage Reimbursement	To be invoiced and paid in accordance with Section 2.12 of the PWS
	0022E
	0022F	Common Carrier Travel	NTE (Capped at $3 per mile)	N/A	TBD	TBD
	0022G	Common Carrier Travel (other than automobile)	NTE	N/A	TBD	TBD
	0023	Monitory Incentive
	0023A	Monitary Incentives	To be invoiced and paid in accordance with Section 3.5 of the PWS
	0024	Ramp Up Activities
	0024A	Ramp-up: Initial Contract Award	NTE	N/A	N/A	N/A
	0024AA	IT Development Activities	NTE	N/A	TBD	TBD
	0024AB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024B	Ramp-up: Major Contract Modification	NTE	N/A	N/A	N/A
	0024BA	IT Development Activities	NTE	N/A	TBD	TBD
	0024BB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024C	Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work	NTE	N/A	TBD	TBD
	0025	Ramp Up Activities
	0025A	Examiners Costs	EA (hourly)	N/A
	0025B	Mobile Units	EA (daily)	N/A
	0026	Required Assistant, Chaperone and/or Tele Presenter	EA (hourly)	N/A

Region 4

	LINE ITEM	DESCRIPTION	UNIT OF ISSUE	% OF MEDICARE BASELINE RATE	BASE YR UNIT PRICE	OPT YR 1 UNIT PRICE
	0001	General Medical Examination
	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
	0001AA	Requiring 1-5 DBQs	EA	N/A
	0001AB	Requiring 6-10 DBQs	EA	N/A
	0001AC	Requiring 11-15 DBQs	EA	N/A
	0001AD	Requiring 16 or more DBQs	EA	N/A
	0001B	General Medical - Pension	EA	N/A	N/A	N/A
	0001BA	Requiring 1-5 DBQs	EA	N/A
	0001BB	Requiring 6-10 DBQs	EA	N/A
	0001BC	Requiring 11-15 DBQs	EA	N/A
	0001BD	Requiring 16 or more DBQs	EA	N/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
	0001CA	Requiring 1-5 DBQs	EA	N/A	N/A	N/A
	0001CB	Requiring 6-10 DBQs	EA	N/A	N/A	N/A
	0001CC	Requiring 11-15 DBQs	EA	N/A	N/A	N/A
	0001CD	Requiring 16 or more DBQs	EA	N/A	N/A	N/A
	0001D	Aid and Attendance or Housebound	EA	N/A	N/A	N/A
	0001DA	Requiring 1-5 DBQs	EA	N/A
	0001DB	Requiring 6-10 DBQs	EA	N/A
	0001DC	Requiring 11-15 DBQs	EA	N/A
	0001DD	Requiring 16 or more DBQs	EA	N/A
	0001E	Cold Injury Residuals	EA	N/A
	0001F	General Medical - Comprehensive Medical Examination to include a Gulf War DBQ	EA	N/A	N/A	N/A
	0001FA	Requiring 1-5 DBQs	EA	N/A
	0001FB	Requiring 6-10 DBQs	EA	N/A
	0001FC	Requiring 11-15 DBQs	EA	N/A
	0001FD	Requiring 16 or more DBQs	EA	N/A
	0001G	General Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQ	EA	N/A	N/A	N/A
	0001GA	Requiring 1-5 DBQs	EA	N/A
	0001GB	Requiring 6-10 DBQs	EA	N/A
	0001GC	Requiring 11-15 DBQs	EA	N/A
	0001GD	Requiring 16 or more DBQs	EA	N/A
	0002	Musculoskeletal System
	0002A	Osteomyelitis	EA	N/A
	0002B	Arthritis	EA	N/A
	0002C	Amputations	EA	N/A
	0002D	Shoulder and Arm Conditions	EA	N/A
	0002E	Elbow and Forearm Conditions	EA	N/A
	0002F	Wrist Conditions	EA	N/A
	0002G	Hand and Finger Conditions	EA	N/A
	0002H	Back (Thoracolumbar Spine) Conditions	EA	N/A
	0002I	Neck (Cervical Spine) Conditions	EA	N/A
	0002J	Hip and Thigh Conditions	EA	N/A
	0002K	Knee and Lower Leg Conditions	EA	N/A
	0002L	Ankle Conditions	EA	N/A
	0002M	Foot Conditions, Including Flatfoot (Pes Planus)	EA	N/A
	0002N	Bones	EA	N/A
	0002O	Muscle Injuries	EA	N/A
	0003	Organs of Special Sense / Eye
	0003A	Eye Conditions	EA	N/A
	0004	Impairment of Auditory Acuity/Ear and Other Sense Organs
	0004A	Hearing Loss and Tinnitus	EA	N/A
	0004B	Ear (including vestibular & infectious)	EA	N/A
	0004C	Loss of Sense of Smell and/or Taste (ENT)	EA	N/A
	0004D	Hearing Loss and Tinnitus Conducted with Boothless Audio Technology	EA	N/A
	0005	Infectious Diseases, Immune Disorders and Nutritional Deficiencies
	0005A	Persian Gulf/Afghanistan Infectious Diseases	EA	N/A
	0005B	HIV-Related Illnesses	EA	N/A
	0005C	Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)	EA	N/A
	0005D	Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases	EA	N/A
	0005E	Nutritional Deficiencies	EA	N/A
	0005F	Chronic Fatigue Syndrome
(rheumatological)	EA	N/A
	0006	Respiratory System
	0006A	Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)	EA	N/A
	0006B	Respiratory Conditions (other than Tuberculosis and Sleep Apnea)	EA	N/A
	0006C	Tuberculosis	EA	N/A
	0006D	Sleep Apnea	EA	N/A
	0006E	Sleep Studies (HSAT)	EA	N/A
	0006F	Sleep Studies (PSG & ECG)	EA	N/A
	0007	Cardiovascular System
	0007A	Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)	EA	N/A
	0007B	Artery and Vein Conditions (Vascular Diseases including Varicose Veins)	EA	N/A
	0007C	Hypertension	EA	N/A
	0008	Digestive System
	0008A	Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)	EA	N/A
	0008B	Gallbladder Conditions	EA	N/A
	0008C	Intestinal Conditions DBQ	EA	N/A
	0008D	RESERVED	EA	N/A	N/A	N/A
	0008E	(Hepatitis, Cirrhosis, and other) Liver Conditions	EA	N/A
	0008F	Peritoneal Adhesions	EA	N/A
	0008G	Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders)	EA	N/A
	0008H	RESERVED	EA	N/A	N/A	N/A
	0008I	Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical	EA	N/A
	0008J	Rectum and Anus Conditions
(including Hemorrhoids)	EA	N/A
	0008K	Pancreas Conditions	EA	N/A
	0009	Genitourinary System
	0009A	Kidney Conditions	EA	N/A
	0009B	Urinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)	EA	N/A
	0009C	Prostate Cancer - Discontinued 12/21/21	EA	N/A
	0009D	Male Reproductive Organ
Conditions	EA	N/A
	0010	Gynecological Conditions and Disorders of the Breast
	0010A	Gynecological Conditions	EA	N/A
	0010B	Breast Conditions and Disorders	EA	N/A
	0011	Hemic and Lymphatic Systems
	0011A	(Hairy Cell and Other B-Cell)
Leukemia	EA	N/A
	0011B	Hematologic and Lymphatic
Conditions, including Leukemia	EA	N/A
	0012	Skin (Derm)
	0012A	Skin Diseases	EA	N/A
	0012B	Scars/Disfigurement	EA	N/A
	0013	Endocrine System
	0013A	Diabetes Mellitus	EA	N/A
	0013B	Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)	EA	N/A
	0013C	Thyroid and Parathyroid
Conditions	EA	N/A
	0014	Neurological Conditions and Convulsive Disorders
	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
	0014B	Parkinson's Disease	EA	N/A
	0014C	Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease)	EA	N/A
	0014D	Diabetic Sensory-Motor Peripheral Neuropathy	EA	N/A
	0014E	Narcolepsy	EA	N/A
	0014F	Fibromyalgia	EA	N/A
	0014G	Headaches (including Migraine Headaches)	EA	N/A
	0014H	Multiple Sclerosis (MS)	EA	N/A
	0014I	Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)	EA	N/A
	0014J	Review Evaluation of Residuals of Traumatic Brain Injury (R- TBI)	EA	N/A
	0014K	Cranial Nerve Conditions	EA	N/A
	0014L	Peripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)	EA	N/A
	0014M	Seizure Disorders (epilepsy)	EA	N/A
	0014N	Spina Bifida	EA	N/A
	0015	Mental Disorders
	0015A	Mental Disorders (other than PTSD)	EA	N/A
	0015B	Mental Disorders (other than PTSD) - Telehealth examination	EA	N/A
	0015C	Initial Post Traumatic StressDisorders (PTSD)	EA	N/A
	0015D	Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015E	Review Post Traumatic Stress Disorders (PTSD)	EA	N/A
	0015F	Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination	EA	N/A
	0015G	Eating Disorders	EA	N/A
	0015H	Eating Disorders - Telehealth
examination	EA	N/A
	0016	Dental and Oral Conditions
	0016A	Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)	EA	N/A
	0016B	Temporomandibular Joint (TMJ) Conditions	EA	N/A
	0017	Ancillary Diagnostic Tests (The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.)
	0017A	Procedures	EA		0%	0%
	0017B	Tests	EA	0%	0%	0%
	0017C	Laboratory Work	EA	0%	0%	0%
	0017D	Radiological Imaging	EA	0%	0%	0%
	0018	Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
	0018A	SME Opinions	EA (per opinion)	N/A
	0019	Record Review Medical File & Medical Opinions
	0019A	Record Review Medical File
( 1 hour or <250 pgs.)	EA	N/A
	0019AA	Record Review Medical File w/ Medical Opinion
(1 hour or <250 pgs.)	EA	N/A
	0019B	Record Review Medical File
(2 hours or 250-749 pgs.)	EA	N/A
	0019BB	Record Review Medical File w/ Medical Opinion
(2 hours or 250-749 pgs.)	EA	N/A
	0019C	Record Review Medical File
(3 hours or >749 pgs.)	EA	N/A
	0019CC	Record Review Medical File w/ Medical Opinion
(3 hours or >749 pgs.)	EA	N/A
	0019D	Toxic Exposure Risk Activity (TERA) Medical Opinion	EA	N/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)
	0020A	Complete No Show (Claimant does not appear)	EA	N/A
	0020B	Partial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)	EA	N/A
	0021	Deliverables
	0021A	Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)	EA	NSP	NSP	NSP
	0021B	Training Plan in accordance with Section 4.5 of the PWS	EA	NSP	NSP	NSP
	0021C	Monthly Status Reports in accordance with Section 4.6 ofthe PWS	EA	NSP	NSP	NSP
	0021D	Ramp-up Plan in accordance with Section 1.10 of the PWS	EA	NSP	NSP	NSP
	0021E	Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS	EA	NSP	NSP	NSP
	0021F	Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS	EA	NSP	NSP	NSP
	0021G	Incident Report in accordance with Sections 2 and 4.8 of the PWS	EA	NSP	NSP	NSP
	0021H	Contractor Portal in accordance with Section 2.3 of the PWS	EA	NSP	NSP	NSP
	0021I	Veteran Portal in accordance with Section 2.4 of the PWS	EA	NSP	NSP	NSP
	0021J	Service Recovery Plan in accordance with Section 3.3 of the PWS	EA	NSP	NSP	NSP
	0021K	Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS	EA	NSP	NSP	NSP
	0021L	Quality Assurance Plan in accordance with Section 4.4 of the PWS	EA	NSP	NSP	NSP
	0021M	Monthly Invoice Report in accordance with Section 4.7 of the PWS	EA	NSP	NSP	NSP
	0021N	Emergency Plan in accordance
with Section 4.8 of the PWS	EA	NSP	NSP	NSP
	0021O	Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS	EA	NSP	NSP	NSP
	0021P	Response to Government Audits in accordance with Section 8.3 of the PWS	EA	NSP	NSP	NSP
	0021Q	Administrative Site Reviews	EA	N/A
	0022	Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
	0022A	Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022B	Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	N/A	N/A
	0022BA	Physician Assistant	EA (hourly)	N/A
	0022BB	Nurse Practitioner	EA (hourly)	N/A
	0022BC	Physician, Generalist	EA (hourly)	N/A
	0022BD	Physician, Ophthalmology	EA (hourly)	N/A
	0022BE	Optometrist	EA (hourly)	N/A
	0022BF	Audiologist	EA (hourly)	N/A
	0022BG	Psychologist	EA (hourly)	N/A
	0022BH	Psychiatrist	EA (hourly)	N/A
	0022BI	Physician, Physiatry	EA (hourly)	N/A
	0022BJ	Physician, Neurology	EA (hourly)	N/A
	0022BK	Surgeon, Neurologist	EA (hourly)	N/A
	0022BL	Dentist	EA (hourly)	N/A
	0022BM	Otolaryngologist	EA (hourly)	N/A
	0022BN	Assistant	EA (hourly)	N/A
	0022BO	Chaperone	EA (hourly)	N/A
	0022C	Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran	NTE	N/A	TBD	TBD
	0022D	Claimant Milage Reimbursement	To be invoiced and paid in accordance with Section 2.12 of the PWS
	0022E
	0022F	Common Carrier Travel	NTE (Capped at $3 per mile)	N/A	TBD	TBD
	0022G	Common Carrier Travel (other than automobile)	NTE	N/A	TBD	TBD
	0023	Monitory Incentive
	0023A	Monitary Incentives	To be invoiced and paid in accordance with Section 3.5 of the PWS
	0024	Ramp Up Activities
	0024A	Ramp-up: Initial Contract Award	NTE	N/A	N/A	N/A
	0024AA	IT Development Activities	NTE	N/A	TBD	TBD
	0024AB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024B	Ramp-up: Major Contract Modification	NTE	N/A	N/A	N/A
	0024BA	IT Development Activities	NTE	N/A	TBD	TBD
	0024BB	Examiner Network Building Activities	NTE	N/A	TBD	TBD
	0024C	Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work	NTE	N/A	TBD	TBD
	0025	Ramp Up Activities
	0025A	Examiners Costs	EA (hourly)	N/A
	0025B	Mobile Units	EA (daily)	N/A
	0026	Required Assistant, Chaperone and/or Tele Presenter	EA (hourly)	N/A

File details come from the government source that posted it. Updated Sep 18, 2026.