S06 0003 B.3 Price Schedule 9.3.24.xlsx

53 KB Posted

Attached to
Q403-- MDE 2025 Regions 1-4 Recompete AMENDMENT 00077
Solicitation number
36C10X25R0001
Issued by

About this file

Written by GovTribe AI ·

This document is a price schedule for a recompete of the Medical Disability Examinations (MDE) contract for Regions 1-4. It includes detailed line item descriptions, units of issue, and pricing for a variety of medical examinations and services, including general medical exams, musculoskeletal conditions, mental disorders, dental exams, and travel-related fees. The pricing is structured by region, with four separate pricing tables provided. No specific pricing details are included, as the rates are marked as "N/A". This price schedule appears to be part of a larger Draft Request for Proposal (RFP) under FAR 15 and FAR 12 for the Veterans Benefits Administration (VBA) Medical Disability Examination Office (MDEO). The overall solicitation, which has the number 36C10X25R0001, is a recompete of the multiple award IDIQ contract for MDE services in Regions 1-4. The RFP is scheduled to be released, with an Industry Day event on August 13, 2024 and Phase 1 submissions due by August 26, 2024.

View the file

Other files

File Type Posted
S06 36C10X25R0001 0006.pdf PDF
S06 0006 Government Responses to Vendor Questions.xlsx XLSX spreadsheet
S06 36C10X25R0001_0005.docx DOCX document
S06 0005 Solicitation Attachment F - Professional Compensation Plans.xlsx XLSX spreadsheet
S06 0005 Government Responses to Vendor Questions.xlsx XLSX spreadsheet
S06 36C10X25R0001_0004.docx DOCX document
S06 0004 MDE Reg 1-4 PWS_Short_Term 9 11 24.docx DOCX document
S05 0004 Government Responses to Vendor Questions.xlsx XLSX spreadsheet
S05 Government Responses to Vendor Questions_Phase 2.xlsx XLSX spreadsheet
S06 0003 Solicitation Attachment E - Sample Task Order.xlsx XLSX spreadsheet
S06 0003 Solicitation Attachment C - Roster of Existing Exam Providers Sample.xlsx XLSX spreadsheet
S06 0003 Solicition Attachment G - Quality Assurance Plan Template.docx DOCX document
S06 0003 MDE Reg 1-4 PWS_Short_Term 9 9 24.docx DOCX document
S06 36C10X25R0001_0003.docx DOCX document
S06 0003 Solicitation Attachment H - NSP Info.xlsx XLSX spreadsheet
S06 0003 Attachment AR - Claimant Daily Appointment Log 1.xlsx XLSX spreadsheet
S06 0003 Attachment X - Monthly Invoice Template.xlsx XLSX spreadsheet
S06 0003 Solicitation Attachment F - Professional Compensation Plans.xlsx XLSX spreadsheet
S06 Attachment AW - Wage Determinations.xlsx XLSX spreadsheet
S06 Attachment X - Monthly Invoice Template.xlsx XLSX spreadsheet
S06 Attachment AV - Service Recovery Plan Template.xlsx XLSX spreadsheet
S06 36C10X25R0001 0002.pdf PDF
S06 Attachment AU - Examination Notification Letter Template (004).docx DOCX document
S06 S05 Government Responses to Vendor Questions_0002.xlsx XLSX spreadsheet
S06 MDE Reg 1-4 PWS_Short_Term 9.4.24.docx DOCX document
S06 B.3 Price Schedule 9.3.24.xlsx XLSX spreadsheet
S06 B.3 Price Schedule.xlsx XLSX spreadsheet
S06 36C10X25R0001_0001.pdf PDF
S06 Attachment Z - Examiner Training Roster_June 2024 Update 08.01.24.xlsx XLSX spreadsheet
S06 Solicitation Attachment E - Sample Task Order.xlsx XLSX spreadsheet
S05 Government Responses to Vendor Questions.xlsx XLSX spreadsheet
S06 B.2 MDE Reg 1-4 PWS.pdf PDF
S06 P01 Attachment A.zip ZIP file
S02 Solicitation Attachment E - Sample Price Schedule.xlsx XLSX spreadsheet
S02 B.3 Price Schedule.xlsx XLSX spreadsheet
S02 Solicitation Attachment C - Roster of Existing Exam Providers Sample.xlsx XLSX spreadsheet
S02 Solicitation Attachment F - Professional Compensation Plans.xlsx XLSX spreadsheet
S02 B.2 MDE Reg 1-4 PWS.docx DOCX document
S02 Solicitation Attachment D - Self-Certifications of Affiliation.docx DOCX document
S02 Solicitation Attachment A - D.1 - PAST PERFORMANCE REFERENCES.pdf PDF
S02 B.2 PWS Attachments.zip ZIP file
S02 36C10X25R0001_DRAFT.pdf PDF
S02 Solicitation Attachment B - D.2 - PPQ.docx DOCX document
S02 Solicitation Attachment X - QUESTIONS SPREADSHEET.xlsx XLSX spreadsheet
Show all 44

On GovTribe

Work with this file

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Region 1

LINE ITEMDESCRIPTIONUNIT OF ISSUE% OF MEDICARE BASELINE RATEBASE YR UNIT PRICEOPT YR 1 UNIT PRICE
0001General Medical Examination
0001AGeneral Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body partsEAN/AN/AN/A
0001AARequiring 1-5 DBQsEAN/A
0001ABRequiring 6-10 DBQsEAN/A
0001ACRequiring 11-15 DBQsEAN/A
0001ADRequiring 16 or more DBQsEAN/A
0001BGeneral Medical - PensionEAN/AN/AN/A
0001BARequiring 1-5 DBQsEAN/A
0001BBRequiring 6-10 DBQsEAN/A
0001BCRequiring 11-15 DBQsEAN/A
0001BDRequiring 16 or more DBQsEAN/A
0001CGeneral Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations)EAN/AN/AN/A
0001CARequiring 1-5 DBQsEAN/AN/AN/A
0001CBRequiring 6-10 DBQsEAN/AN/AN/A
0001CCRequiring 11-15 DBQsEAN/AN/AN/A
0001CDRequiring 16 or more DBQsEAN/AN/AN/A
0001DAid and Attendance or HouseboundEAN/AN/AN/A
0001DARequiring 1-5 DBQsEAN/A
0001DBRequiring 6-10 DBQsEAN/A
0001DCRequiring 11-15 DBQsEAN/A
0001DDRequiring 16 or more DBQsEAN/A
0001ECold Injury ResidualsEAN/A
0001FGeneral Medical - Comprehensive Medical Examination to include a Gulf War DBQEAN/AN/AN/A
0001FARequiring 1-5 DBQsEAN/A
0001FBRequiring 6-10 DBQsEAN/A
0001FCRequiring 11-15 DBQsEAN/A
0001FDRequiring 16 or more DBQsEAN/A
0001GGeneral Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQEAN/AN/AN/A
0001GARequiring 1-5 DBQsEAN/A
0001GBRequiring 6-10 DBQsEAN/A
0001GCRequiring 11-15 DBQsEAN/A
0001GDRequiring 16 or more DBQsEAN/A
0002Musculoskeletal System
0002AOsteomyelitisEAN/A
0002BArthritisEAN/A
0002CAmputationsEAN/A
0002DShoulder and Arm ConditionsEAN/A
0002EElbow and Forearm ConditionsEAN/A
0002FWrist ConditionsEAN/A
0002GHand and Finger ConditionsEAN/A
0002HBack (Thoracolumbar Spine) ConditionsEAN/A
0002INeck (Cervical Spine) ConditionsEAN/A
0002JHip and Thigh ConditionsEAN/A
0002KKnee and Lower Leg ConditionsEAN/A
0002LAnkle ConditionsEAN/A
0002MFoot Conditions, Including Flatfoot (Pes Planus)EAN/A
0002NBonesEAN/A
0002OMuscle InjuriesEAN/A
0003Organs of Special Sense / Eye
0003AEye ConditionsEAN/A
0004Impairment of Auditory Acuity/Ear and Other Sense Organs
0004AHearing Loss and TinnitusEAN/A
0004BEar (including vestibular & infectious)EAN/A
0004CLoss of Sense of Smell and/or Taste (ENT)EAN/A
0004DHearing Loss and Tinnitus Conducted with Boothless Audio TechnologyEAN/A
0005Infectious Diseases, Immune Disorders and Nutritional Deficiencies
0005APersian Gulf/Afghanistan Infectious DiseasesEAN/A
0005BHIV-Related IllnessesEAN/A
0005CInfectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)EAN/A
0005DSystemic Lupus Erythematosus (SLE) and Other Autoimmune DiseasesEAN/A
0005ENutritional DeficienciesEAN/A
0005FChronic Fatigue Syndrome
(rheumatological)EAN/A
0006Respiratory System
0006ASinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)EAN/A
0006BRespiratory Conditions (other than Tuberculosis and Sleep Apnea)EAN/A
0006CTuberculosisEAN/A
0006DSleep ApneaEAN/A
0006ESleep Studies (HSAT)EAN/A
0006FSleep Studies (PSG & ECG)EAN/A
0007Cardiovascular System
0007AHeart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)EAN/A
0007BArtery and Vein Conditions (Vascular Diseases including Varicose Veins)EAN/A
0007CHypertensionEAN/A
0008Digestive System
0008AEsophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)EAN/A
0008BGallbladder ConditionsEAN/A
0008CIntestinal Conditions DBQEAN/A
0008DRESERVEDEAN/AN/AN/A
0008E(Hepatitis, Cirrhosis, and other) Liver ConditionsEAN/A
0008FPeritoneal AdhesionsEAN/A
0008GStomach and Duodenum Conditions (not including GERD or Esophageal Disorders)EAN/A
0008HRESERVEDEAN/AN/AN/A
0008IHernias (including Abdominal, Inguinal and Femoral Hernias) surgicalEAN/A
0008JRectum and Anus Conditions
(including Hemorrhoids)EAN/A
0008KPancreas ConditionsEAN/A
0009Genitourinary System
0009AKidney ConditionsEAN/A
0009BUrinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)EAN/A
0009CRESERVEDEAN/AN/AN/A
0009DMale Reproductive Organ
ConditionsEAN/A
0010Gynecological Conditions and Disorders of the Breast
0010AGynecological ConditionsEAN/A
0010BBreast Conditions and DisordersEAN/A
0011Hemic and Lymphatic Systems
0011A(Hairy Cell and Other B-Cell)
LeukemiaEAN/A
0011BHematologic and Lymphatic
Conditions, including LeukemiaEAN/A
0012Skin (Derm)
0012ASkin DiseasesEAN/A
0012BScars/DisfigurementEAN/A
0013Endocrine System
0013ADiabetes MellitusEAN/A
0013BEndocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)EAN/A
0013CThyroid and Parathyroid
ConditionsEAN/A
0014Neurological Conditions and Convulsive Disorders
0014ACentral Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS,
Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)EAN/A
0014BParkinson's DiseaseEAN/A
0014CAmyotrophic Lateral Sclerosis (Lou Gehrig's Disease)EAN/A
0014DDiabetic Sensory-Motor Peripheral NeuropathyEAN/A
0014ENarcolepsyEAN/A
0014FFibromyalgiaEAN/A
0014GHeadaches (including Migraine Headaches)EAN/A
0014HMultiple Sclerosis (MS)EAN/A
0014IInitial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)EAN/A
0014JReview Evaluation of Residuals of Traumatic Brain Injury (R- TBI)EAN/A
0014KCranial Nerve ConditionsEAN/A
0014LPeripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)EAN/A
0014MSeizure Disorders (epilepsy)EAN/A
0014NSpina BifidaEAN/A
0015Mental Disorders
0015AMental Disorders (other than PTSD)EAN/A
0015BMental Disorders (other than PTSD) - Telehealth examinationEAN/A
0015CInitial Post Traumatic StressDisorders (PTSD)EAN/A
0015DInitial Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015EReview Post Traumatic Stress Disorders (PTSD)EAN/A
0015FReview Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015GEating DisordersEAN/A
0015HEating Disorders - Telehealth
examinationEAN/A
0016Dental and Oral Conditions
0016AOral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)EAN/A
0016BTemporomandibular Joint (TMJ) ConditionsEAN/A
0017Ancillary 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.)
0017AProceduresEA0%0%
0017BTestsEA0%0%0%
0017CLaboratory WorkEA0%0%0%
0017DRadiological ImagingEA0%0%0%
0018Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
0018ASME OpinionsEA (per opinion)N/A
0019Record Review Medical File & Medical Opinions
0019ARESERVEDEAN/AN/AN/A
0019AARESERVEDEAN/AN/AN/A
0019BRESERVEDEAN/AN/AN/A
0019BBRESERVEDEAN/AN/AN/A
0019CRESERVEDEAN/AN/AN/A
0019CCRESERVEDEAN/AN/AN/A
0019DRESERVEDEAN/AN/AN/A
0019EMedical Record ReivewEAN/A
0019FTERA Medical Record ReviewEAN/A
0019GMedical OpinionEAN/A
0020No 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)
0020AComplete No Show (Claimant does not appear)EAN/A
0020BPartial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)EAN/A
0021Deliverables
0021ADetailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)EANSPNSPNSP
0021BTraining Plan in accordance with Section 4.5 of the PWSEANSPNSPNSP
0021CMonthly Status Reports in accordance with Section 4.6 ofthe PWSEANSPNSPNSP
0021DRamp-up Plan in accordance with Section 1.10 of the PWSEANSPNSPNSP
0021EReports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWSEANSPNSPNSP
0021FCompleted DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWSEANSPNSPNSP
0021GIncident Report in accordance with Sections 2 and 4.8 of the PWSEANSPNSPNSP
0021HContractor Portal in accordance with Section 2.3 of the PWSEANSPNSPNSP
0021IVeteran Portal in accordance with Section 2.4 of the PWSEANSPNSPNSP
0021JService Recovery Plan in accordance with Section 3.3 of the PWSEANSPNSPNSP
0021KKickoff Meeting Minutes in accordance with Section 4.3 of the PWSEANSPNSPNSP
0021LQuality Assurance Plan in accordance with Section 4.4 of the PWSEANSPNSPNSP
0021MMonthly Invoice Report in accordance with Section 4.7 of the PWSEANSPNSPNSP
0021NEmergency Plan in accordance
with Section 4.8 of the PWSEANSPNSPNSP
0021OAd-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWSEANSPNSPNSP
0021PResponse to Government Audits in accordance with Section 8.3 of the PWSEANSPNSPNSP
0021QAdministrative Site ReviewsEANSPNSPNSP
0022Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
0022ATravel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/ATBDTBD
0022BTravel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/AN/AN/A
0022BAPhysician AssistantEA (hourly)N/A
0022BBNurse PractitionerEA (hourly)N/A
0022BCPhysician, GeneralistEA (hourly)N/A
0022BDPhysician, OphthalmologyEA (hourly)N/A
0022BEOptometristEA (hourly)N/A
0022BFAudiologistEA (hourly)N/A
0022BGPsychologistEA (hourly)N/A
0022BHPsychiatristEA (hourly)N/A
0022BIPhysician, PhysiatryEA (hourly)N/A
0022BJPhysician, NeurologyEA (hourly)N/A
0022BKSurgeon, NeurologistEA (hourly)N/A
0022BLDentistEA (hourly)N/A
0022BMOtolaryngologistEA (hourly)N/A
0022BNAssistantEA (hourly)N/A
0022BOChaperoneEA (hourly)N/A
0022CTravel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranTBDN/ATBDTBD
0022DClaimant Milage ReimbursementTo be invoiced and paid in accordance with Section 2.12 of the PWS
0022E
0022FCommon Carrier TravelTBDN/ATBDTBD
0022GCommon Carrier Travel (other than automobile)TBDN/ATBDTBD
0023Monitary Incentive
0023AMonitary IncentivesTo be invoiced and paid in accordance with Section 3.5 of the PWS
0024Ramp Up Activities
0024ARamp-up: Initial Contract AwardTBDN/ATBDTBD
0024AAIT Development ActivitiesTBDN/ATBDTBD
0024ABExaminer Network Building ActivitiesTBDN/ATBDTBD
0024BRamp-up: Major Contract ModificationTBDN/ATBDTBD
0024BAIT Development ActivitiesTBDN/ATBDTBD
0024BBExaminer Network Building ActivitiesTBDN/ATBDTBD
0024CRamp-up: Assignment of Additional ESR Workload and Reallocation of WorkTBDN/ATBDTBD
0025Mobile Unit Activities
0025AExaminers CostsEA (hourly)N/A
0025BMobile UnitsEA (daily)N/A
0026Required Assistant, Chaperone and/or Tele PresenterEA (hourly)N/A

Region 2

LINE ITEMDESCRIPTIONUNIT OF ISSUE% OF MEDICARE BASELINE RATEBASE YR UNIT PRICEOPT YR 1 UNIT PRICE
0001General Medical Examination
0001AGeneral Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body partsEAN/AN/AN/A
0001AARequiring 1-5 DBQsEAN/A
0001ABRequiring 6-10 DBQsEAN/A
0001ACRequiring 11-15 DBQsEAN/A
0001ADRequiring 16 or more DBQsEAN/A
0001BGeneral Medical - PensionEAN/AN/AN/A
0001BARequiring 1-5 DBQsEAN/A
0001BBRequiring 6-10 DBQsEAN/A
0001BCRequiring 11-15 DBQsEAN/A
0001BDRequiring 16 or more DBQsEAN/A
0001CGeneral Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations)EAN/AN/AN/A
0001CARequiring 1-5 DBQsEAN/AN/AN/A
0001CBRequiring 6-10 DBQsEAN/AN/AN/A
0001CCRequiring 11-15 DBQsEAN/AN/AN/A
0001CDRequiring 16 or more DBQsEAN/AN/AN/A
0001DAid and Attendance or HouseboundEAN/AN/AN/A
0001DARequiring 1-5 DBQsEAN/A
0001DBRequiring 6-10 DBQsEAN/A
0001DCRequiring 11-15 DBQsEAN/A
0001DDRequiring 16 or more DBQsEAN/A
0001ECold Injury ResidualsEAN/A
0001FGeneral Medical - Comprehensive Medical Examination to include a Gulf War DBQEAN/AN/AN/A
0001FARequiring 1-5 DBQsEAN/A
0001FBRequiring 6-10 DBQsEAN/A
0001FCRequiring 11-15 DBQsEAN/A
0001FDRequiring 16 or more DBQsEAN/A
0001GGeneral Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQEAN/AN/AN/A
0001GARequiring 1-5 DBQsEAN/A
0001GBRequiring 6-10 DBQsEAN/A
0001GCRequiring 11-15 DBQsEAN/A
0001GDRequiring 16 or more DBQsEAN/A
0002Musculoskeletal System
0002AOsteomyelitisEAN/A
0002BArthritisEAN/A
0002CAmputationsEAN/A
0002DShoulder and Arm ConditionsEAN/A
0002EElbow and Forearm ConditionsEAN/A
0002FWrist ConditionsEAN/A
0002GHand and Finger ConditionsEAN/A
0002HBack (Thoracolumbar Spine) ConditionsEAN/A
0002INeck (Cervical Spine) ConditionsEAN/A
0002JHip and Thigh ConditionsEAN/A
0002KKnee and Lower Leg ConditionsEAN/A
0002LAnkle ConditionsEAN/A
0002MFoot Conditions, Including Flatfoot (Pes Planus)EAN/A
0002NBonesEAN/A
0002OMuscle InjuriesEAN/A
0003Organs of Special Sense / Eye
0003AEye ConditionsEAN/A
0004Impairment of Auditory Acuity/Ear and Other Sense Organs
0004AHearing Loss and TinnitusEAN/A
0004BEar (including vestibular & infectious)EAN/A
0004CLoss of Sense of Smell and/or Taste (ENT)EAN/A
0004DHearing Loss and Tinnitus Conducted with Boothless Audio TechnologyEAN/A
0005Infectious Diseases, Immune Disorders and Nutritional Deficiencies
0005APersian Gulf/Afghanistan Infectious DiseasesEAN/A
0005BHIV-Related IllnessesEAN/A
0005CInfectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)EAN/A
0005DSystemic Lupus Erythematosus (SLE) and Other Autoimmune DiseasesEAN/A
0005ENutritional DeficienciesEAN/A
0005FChronic Fatigue Syndrome
(rheumatological)EAN/A
0006Respiratory System
0006ASinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)EAN/A
0006BRespiratory Conditions (other than Tuberculosis and Sleep Apnea)EAN/A
0006CTuberculosisEAN/A
0006DSleep ApneaEAN/A
0006ESleep Studies (HSAT)EAN/A
0006FSleep Studies (PSG & ECG)EAN/A
0007Cardiovascular System
0007AHeart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)EAN/A
0007BArtery and Vein Conditions (Vascular Diseases including Varicose Veins)EAN/A
0007CHypertensionEAN/A
0008Digestive System
0008AEsophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)EAN/A
0008BGallbladder ConditionsEAN/A
0008CIntestinal Conditions DBQEAN/A
0008DRESERVEDEAN/AN/AN/A
0008E(Hepatitis, Cirrhosis, and other) Liver ConditionsEAN/A
0008FPeritoneal AdhesionsEAN/A
0008GStomach and Duodenum Conditions (not including GERD or Esophageal Disorders)EAN/A
0008HRESERVEDEAN/AN/AN/A
0008IHernias (including Abdominal, Inguinal and Femoral Hernias) surgicalEAN/A
0008JRectum and Anus Conditions
(including Hemorrhoids)EAN/A
0008KPancreas ConditionsEAN/A
0009Genitourinary System
0009AKidney ConditionsEAN/A
0009BUrinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)EAN/A
0009CProstate Cancer - Discontinued 12/21/21EAN/A
0009DMale Reproductive Organ
ConditionsEAN/A
0010Gynecological Conditions and Disorders of the Breast
0010AGynecological ConditionsEAN/A
0010BBreast Conditions and DisordersEAN/A
0011Hemic and Lymphatic Systems
0011A(Hairy Cell and Other B-Cell)
LeukemiaEAN/A
0011BHematologic and Lymphatic
Conditions, including LeukemiaEAN/A
0012Skin (Derm)
0012ASkin DiseasesEAN/A
0012BScars/DisfigurementEAN/A
0013Endocrine System
0013ADiabetes MellitusEAN/A
0013BEndocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)EAN/A
0013CThyroid and Parathyroid
ConditionsEAN/A
0014Neurological Conditions and Convulsive Disorders
0014ACentral Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS,
Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)EAN/A
0014BParkinson's DiseaseEAN/A
0014CAmyotrophic Lateral Sclerosis (Lou Gehrig's Disease)EAN/A
0014DDiabetic Sensory-Motor Peripheral NeuropathyEAN/A
0014ENarcolepsyEAN/A
0014FFibromyalgiaEAN/A
0014GHeadaches (including Migraine Headaches)EAN/A
0014HMultiple Sclerosis (MS)EAN/A
0014IInitial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)EAN/A
0014JReview Evaluation of Residuals of Traumatic Brain Injury (R- TBI)EAN/A
0014KCranial Nerve ConditionsEAN/A
0014LPeripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)EAN/A
0014MSeizure Disorders (epilepsy)EAN/A
0014NSpina BifidaEAN/A
0015Mental Disorders
0015AMental Disorders (other than PTSD)EAN/A
0015BMental Disorders (other than PTSD) - Telehealth examinationEAN/A
0015CInitial Post Traumatic StressDisorders (PTSD)EAN/A
0015DInitial Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015EReview Post Traumatic Stress Disorders (PTSD)EAN/A
0015FReview Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015GEating DisordersEAN/A
0015HEating Disorders - Telehealth
examinationEAN/A
0016Dental and Oral Conditions
0016AOral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)EAN/A
0016BTemporomandibular Joint (TMJ) ConditionsEAN/A
0017Ancillary 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.)
0017AProceduresEA0%0%
0017BTestsEA0%0%0%
0017CLaboratory WorkEA0%0%0%
0017DRadiological ImagingEA0%0%0%
0018Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
0018ASME OpinionsEA (per opinion)N/A
0019Record Review Medical File & Medical Opinions
0019ARESERVEDEAN/AN/AN/A
0019AARESERVEDEAN/AN/AN/A
0019BRESERVEDEAN/AN/AN/A
0019BBRESERVEDEAN/AN/AN/A
0019CRESERVEDEAN/AN/AN/A
0019CCRESERVEDEAN/AN/AN/A
0019DRESERVEDEAN/AN/AN/A
0019EMedical Record ReivewEAN/A
0019FTERA Medical Record ReviewEAN/A
0019GMedical OpinionEAN/A
0020No 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)
0020AComplete No Show (Claimant does not appear)EAN/A
0020BPartial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)EAN/A
0021Deliverables
0021ADetailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)EANSPNSPNSP
0021BTraining Plan in accordance with Section 4.5 of the PWSEANSPNSPNSP
0021CMonthly Status Reports in accordance with Section 4.6 ofthe PWSEANSPNSPNSP
0021DRamp-up Plan in accordance with Section 1.10 of the PWSEANSPNSPNSP
0021EReports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWSEANSPNSPNSP
0021FCompleted DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWSEANSPNSPNSP
0021GIncident Report in accordance with Sections 2 and 4.8 of the PWSEANSPNSPNSP
0021HContractor Portal in accordance with Section 2.3 of the PWSEANSPNSPNSP
0021IVeteran Portal in accordance with Section 2.4 of the PWSEANSPNSPNSP
0021JService Recovery Plan in accordance with Section 3.3 of the PWSEANSPNSPNSP
0021KKickoff Meeting Minutes in accordance with Section 4.3 of the PWSEANSPNSPNSP
0021LQuality Assurance Plan in accordance with Section 4.4 of the PWSEANSPNSPNSP
0021MMonthly Invoice Report in accordance with Section 4.7 of the PWSEANSPNSPNSP
0021NEmergency Plan in accordance
with Section 4.8 of the PWSEANSPNSPNSP
0021OAd-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWSEANSPNSPNSP
0021PResponse to Government Audits in accordance with Section 8.3 of the PWSEANSPNSPNSP
0021QAdministrative Site ReviewsEAN/ANSPNSP
0022Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
0022ATravel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/ATBDTBD
0022BTravel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/AN/AN/A
0022BAPhysician AssistantEA (hourly)N/A
0022BBNurse PractitionerEA (hourly)N/A
0022BCPhysician, GeneralistEA (hourly)N/A
0022BDPhysician, OphthalmologyEA (hourly)N/A
0022BEOptometristEA (hourly)N/A
0022BFAudiologistEA (hourly)N/A
0022BGPsychologistEA (hourly)N/A
0022BHPsychiatristEA (hourly)N/A
0022BIPhysician, PhysiatryEA (hourly)N/A
0022BJPhysician, NeurologyEA (hourly)N/A
0022BKSurgeon, NeurologistEA (hourly)N/A
0022BLDentistEA (hourly)N/A
0022BMOtolaryngologistEA (hourly)N/A
0022BNAssistantEA (hourly)N/A
0022BOChaperoneEA (hourly)N/A
0022CTravel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranTBDN/ATBDTBD
0022DClaimant Milage ReimbursementTo be invoiced and paid in accordance with Section 2.12 of the PWS
0022E
0022FCommon Carrier TravelTBDN/ATBDTBD
0022GCommon Carrier Travel (other than automobile)TBDN/ATBDTBD
0023Monitary Incentive
0023AMonitary IncentivesTo be invoiced and paid in accordance with Section 3.5 of the PWS
0024Ramp Up Activities
0024ARamp-up: Initial Contract AwardTBDN/ATBDTBD
0024AAIT Development ActivitiesTBDN/ATBDTBD
0024ABExaminer Network Building ActivitiesTBDN/ATBDTBD
0024BRamp-up: Major Contract ModificationTBDN/ATBDTBD
0024BAIT Development ActivitiesTBDN/ATBDTBD
0024BBExaminer Network Building ActivitiesTBDN/ATBDTBD
0024CRamp-up: Assignment of Additional ESR Workload and Reallocation of WorkTBDN/ATBDTBD
0025Mobile Unit Activities
0025AExaminers CostsEA (hourly)N/A
0025BMobile UnitsEA (daily)N/A
0026Required Assistant, Chaperone and/or Tele PresenterEA (hourly)N/A

Region 3

LINE ITEMDESCRIPTIONUNIT OF ISSUE% OF MEDICARE BASELINE RATEBASE YR UNIT PRICEOPT YR 1 UNIT PRICE
0001General Medical Examination
0001AGeneral Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body partsEAN/AN/AN/A
0001AARequiring 1-5 DBQsEAN/A
0001ABRequiring 6-10 DBQsEAN/A
0001ACRequiring 11-15 DBQsEAN/A
0001ADRequiring 16 or more DBQsEAN/A
0001BGeneral Medical - PensionEAN/AN/AN/A
0001BARequiring 1-5 DBQsEAN/A
0001BBRequiring 6-10 DBQsEAN/A
0001BCRequiring 11-15 DBQsEAN/A
0001BDRequiring 16 or more DBQsEAN/A
0001CGeneral Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations)EAN/AN/AN/A
0001CARequiring 1-5 DBQsEAN/AN/AN/A
0001CBRequiring 6-10 DBQsEAN/AN/AN/A
0001CCRequiring 11-15 DBQsEAN/AN/AN/A
0001CDRequiring 16 or more DBQsEAN/AN/AN/A
0001DAid and Attendance or HouseboundEAN/AN/AN/A
0001DARequiring 1-5 DBQsEAN/A
0001DBRequiring 6-10 DBQsEAN/A
0001DCRequiring 11-15 DBQsEAN/A
0001DDRequiring 16 or more DBQsEAN/A
0001ECold Injury ResidualsEAN/A
0001FGeneral Medical - Comprehensive Medical Examination to include a Gulf War DBQEAN/AN/AN/A
0001FARequiring 1-5 DBQsEAN/A
0001FBRequiring 6-10 DBQsEAN/A
0001FCRequiring 11-15 DBQsEAN/A
0001FDRequiring 16 or more DBQsEAN/A
0001GGeneral Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQEAN/AN/AN/A
0001GARequiring 1-5 DBQsEAN/A
0001GBRequiring 6-10 DBQsEAN/A
0001GCRequiring 11-15 DBQsEAN/A
0001GDRequiring 16 or more DBQsEAN/A
0002Musculoskeletal System
0002AOsteomyelitisEAN/A
0002BArthritisEAN/A
0002CAmputationsEAN/A
0002DShoulder and Arm ConditionsEAN/A
0002EElbow and Forearm ConditionsEAN/A
0002FWrist ConditionsEAN/A
0002GHand and Finger ConditionsEAN/A
0002HBack (Thoracolumbar Spine) ConditionsEAN/A
0002INeck (Cervical Spine) ConditionsEAN/A
0002JHip and Thigh ConditionsEAN/A
0002KKnee and Lower Leg ConditionsEAN/A
0002LAnkle ConditionsEAN/A
0002MFoot Conditions, Including Flatfoot (Pes Planus)EAN/A
0002NBonesEAN/A
0002OMuscle InjuriesEAN/A
0003Organs of Special Sense / Eye
0003AEye ConditionsEAN/A
0004Impairment of Auditory Acuity/Ear and Other Sense Organs
0004AHearing Loss and TinnitusEAN/A
0004BEar (including vestibular & infectious)EAN/A
0004CLoss of Sense of Smell and/or Taste (ENT)EAN/A
0004DHearing Loss and Tinnitus Conducted with Boothless Audio TechnologyEAN/A
0005Infectious Diseases, Immune Disorders and Nutritional Deficiencies
0005APersian Gulf/Afghanistan Infectious DiseasesEAN/A
0005BHIV-Related IllnessesEAN/A
0005CInfectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)EAN/A
0005DSystemic Lupus Erythematosus (SLE) and Other Autoimmune DiseasesEAN/A
0005ENutritional DeficienciesEAN/A
0005FChronic Fatigue Syndrome
(rheumatological)EAN/A
0006Respiratory System
0006ASinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)EAN/A
0006BRespiratory Conditions (other than Tuberculosis and Sleep Apnea)EAN/A
0006CTuberculosisEAN/A
0006DSleep ApneaEAN/A
0006ESleep Studies (HSAT)EAN/A
0006FSleep Studies (PSG & ECG)EAN/A
0007Cardiovascular System
0007AHeart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)EAN/A
0007BArtery and Vein Conditions (Vascular Diseases including Varicose Veins)EAN/A
0007CHypertensionEAN/A
0008Digestive System
0008AEsophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)EAN/A
0008BGallbladder ConditionsEAN/A
0008CIntestinal Conditions DBQEAN/A
0008DRESERVEDEAN/AN/AN/A
0008E(Hepatitis, Cirrhosis, and other) Liver ConditionsEAN/A
0008FPeritoneal AdhesionsEAN/A
0008GStomach and Duodenum Conditions (not including GERD or Esophageal Disorders)EAN/A
0008HRESERVEDEAN/AN/AN/A
0008IHernias (including Abdominal, Inguinal and Femoral Hernias) surgicalEAN/A
0008JRectum and Anus Conditions
(including Hemorrhoids)EAN/A
0008KPancreas ConditionsEAN/A
0009Genitourinary System
0009AKidney ConditionsEAN/A
0009BUrinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)EAN/A
0009CProstate Cancer - Discontinued 12/21/21EAN/A
0009DMale Reproductive Organ
ConditionsEAN/A
0010Gynecological Conditions and Disorders of the Breast
0010AGynecological ConditionsEAN/A
0010BBreast Conditions and DisordersEAN/A
0011Hemic and Lymphatic Systems
0011A(Hairy Cell and Other B-Cell)
LeukemiaEAN/A
0011BHematologic and Lymphatic
Conditions, including LeukemiaEAN/A
0012Skin (Derm)
0012ASkin DiseasesEAN/A
0012BScars/DisfigurementEAN/A
0013Endocrine System
0013ADiabetes MellitusEAN/A
0013BEndocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)EAN/A
0013CThyroid and Parathyroid
ConditionsEAN/A
0014Neurological Conditions and Convulsive Disorders
0014ACentral Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS,
Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)EAN/A
0014BParkinson's DiseaseEAN/A
0014CAmyotrophic Lateral Sclerosis (Lou Gehrig's Disease)EAN/A
0014DDiabetic Sensory-Motor Peripheral NeuropathyEAN/A
0014ENarcolepsyEAN/A
0014FFibromyalgiaEAN/A
0014GHeadaches (including Migraine Headaches)EAN/A
0014HMultiple Sclerosis (MS)EAN/A
0014IInitial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)EAN/A
0014JReview Evaluation of Residuals of Traumatic Brain Injury (R- TBI)EAN/A
0014KCranial Nerve ConditionsEAN/A
0014LPeripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)EAN/A
0014MSeizure Disorders (epilepsy)EAN/A
0014NSpina BifidaEAN/A
0015Mental Disorders
0015AMental Disorders (other than PTSD)EAN/A
0015BMental Disorders (other than PTSD) - Telehealth examinationEAN/A
0015CInitial Post Traumatic StressDisorders (PTSD)EAN/A
0015DInitial Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015EReview Post Traumatic Stress Disorders (PTSD)EAN/A
0015FReview Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015GEating DisordersEAN/A
0015HEating Disorders - Telehealth
examinationEAN/A
0016Dental and Oral Conditions
0016AOral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)EAN/A
0016BTemporomandibular Joint (TMJ) ConditionsEAN/A
0017Ancillary 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.)
0017AProceduresEA0%0%
0017BTestsEA0%0%0%
0017CLaboratory WorkEA0%0%0%
0017DRadiological ImagingEA0%0%0%
0018Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
0018ASME OpinionsEA (per opinion)N/A
0019Record Review Medical File & Medical Opinions
0019ARESERVEDEAN/AN/AN/A
0019AARESERVEDEAN/AN/AN/A
0019BRESERVEDEAN/AN/AN/A
0019BBRESERVEDEAN/AN/AN/A
0019CRESERVEDEAN/AN/AN/A
0019CCRESERVEDEAN/AN/AN/A
0019DRESERVEDEAN/AN/AN/A
0019EMedical Record ReivewEAN/A
0019FTERA Medical Record ReviewEAN/A
0019GMedical OpinionEAN/A
0020No 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)
0020AComplete No Show (Claimant does not appear)EAN/A
0020BPartial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)EAN/A
0021Deliverables
0021ADetailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)EANSPNSPNSP
0021BTraining Plan in accordance with Section 4.5 of the PWSEANSPNSPNSP
0021CMonthly Status Reports in accordance with Section 4.6 ofthe PWSEANSPNSPNSP
0021DRamp-up Plan in accordance with Section 1.10 of the PWSEANSPNSPNSP
0021EReports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWSEANSPNSPNSP
0021FCompleted DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWSEANSPNSPNSP
0021GIncident Report in accordance with Sections 2 and 4.8 of the PWSEANSPNSPNSP
0021HContractor Portal in accordance with Section 2.3 of the PWSEANSPNSPNSP
0021IVeteran Portal in accordance with Section 2.4 of the PWSEANSPNSPNSP
0021JService Recovery Plan in accordance with Section 3.3 of the PWSEANSPNSPNSP
0021KKickoff Meeting Minutes in accordance with Section 4.3 of the PWSEANSPNSPNSP
0021LQuality Assurance Plan in accordance with Section 4.4 of the PWSEANSPNSPNSP
0021MMonthly Invoice Report in accordance with Section 4.7 of the PWSEANSPNSPNSP
0021NEmergency Plan in accordance
with Section 4.8 of the PWSEANSPNSPNSP
0021OAd-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWSEANSPNSPNSP
0021PResponse to Government Audits in accordance with Section 8.3 of the PWSEANSPNSPNSP
0021QAdministrative Site ReviewsEAN/ANSPNSP
0022Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
0022ATravel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/ATBDTBD
0022BTravel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/AN/AN/A
0022BAPhysician AssistantEA (hourly)N/A
0022BBNurse PractitionerEA (hourly)N/A
0022BCPhysician, GeneralistEA (hourly)N/A
0022BDPhysician, OphthalmologyEA (hourly)N/A
0022BEOptometristEA (hourly)N/A
0022BFAudiologistEA (hourly)N/A
0022BGPsychologistEA (hourly)N/A
0022BHPsychiatristEA (hourly)N/A
0022BIPhysician, PhysiatryEA (hourly)N/A
0022BJPhysician, NeurologyEA (hourly)N/A
0022BKSurgeon, NeurologistEA (hourly)N/A
0022BLDentistEA (hourly)N/A
0022BMOtolaryngologistEA (hourly)N/A
0022BNAssistantEA (hourly)N/A
0022BOChaperoneEA (hourly)N/A
0022CTravel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranTBDN/ATBDTBD
0022DClaimant Milage ReimbursementTo be invoiced and paid in accordance with Section 2.12 of the PWS
0022E
0022FCommon Carrier TravelTBDN/ATBDTBD
0022GCommon Carrier Travel (other than automobile)TBDN/ATBDTBD
0023Monitary Incentive
0023AMonitary IncentivesTo be invoiced and paid in accordance with Section 3.5 of the PWS
0024Ramp Up Activities
0024ARamp-up: Initial Contract AwardTBDN/ATBDTBD
0024AAIT Development ActivitiesTBDN/ATBDTBD
0024ABExaminer Network Building ActivitiesTBDN/ATBDTBD
0024BRamp-up: Major Contract ModificationTBDN/AN/AN/A
0024BAIT Development ActivitiesTBDN/ATBDTBD
0024BBExaminer Network Building ActivitiesTBDN/ATBDTBD
0024CRamp-up: Assignment of Additional ESR Workload and Reallocation of WorkTBDN/ATBDTBD
0025Mobile Unit Activities
0025AExaminers CostsEA (hourly)N/A
0025BMobile UnitsEA (daily)N/A
0026Required Assistant, Chaperone and/or Tele PresenterEA (hourly)N/A

Region 4

LINE ITEMDESCRIPTIONUNIT OF ISSUE% OF MEDICARE BASELINE RATEBASE YR UNIT PRICEOPT YR 1 UNIT PRICE
0001General Medical Examination
0001AGeneral Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body partsEAN/AN/AN/A
0001AARequiring 1-5 DBQsEAN/A
0001ABRequiring 6-10 DBQsEAN/A
0001ACRequiring 11-15 DBQsEAN/A
0001ADRequiring 16 or more DBQsEAN/A
0001BGeneral Medical - PensionEAN/AN/AN/A
0001BARequiring 1-5 DBQsEAN/A
0001BBRequiring 6-10 DBQsEAN/A
0001BCRequiring 11-15 DBQsEAN/A
0001BDRequiring 16 or more DBQsEAN/A
0001CGeneral Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations)EAN/AN/AN/A
0001CARequiring 1-5 DBQsEAN/AN/AN/A
0001CBRequiring 6-10 DBQsEAN/AN/AN/A
0001CCRequiring 11-15 DBQsEAN/AN/AN/A
0001CDRequiring 16 or more DBQsEAN/AN/AN/A
0001DAid and Attendance or HouseboundEAN/AN/AN/A
0001DARequiring 1-5 DBQsEAN/A
0001DBRequiring 6-10 DBQsEAN/A
0001DCRequiring 11-15 DBQsEAN/A
0001DDRequiring 16 or more DBQsEAN/A
0001ECold Injury ResidualsEAN/A
0001FGeneral Medical - Comprehensive Medical Examination to include a Gulf War DBQEAN/AN/AN/A
0001FARequiring 1-5 DBQsEAN/A
0001FBRequiring 6-10 DBQsEAN/A
0001FCRequiring 11-15 DBQsEAN/A
0001FDRequiring 16 or more DBQsEAN/A
0001GGeneral Medical - Comprehensive Medical Examination to include a
Prisoner of War DBQEAN/AN/AN/A
0001GARequiring 1-5 DBQsEAN/A
0001GBRequiring 6-10 DBQsEAN/A
0001GCRequiring 11-15 DBQsEAN/A
0001GDRequiring 16 or more DBQsEAN/A
0002Musculoskeletal System
0002AOsteomyelitisEAN/A
0002BArthritisEAN/A
0002CAmputationsEAN/A
0002DShoulder and Arm ConditionsEAN/A
0002EElbow and Forearm ConditionsEAN/A
0002FWrist ConditionsEAN/A
0002GHand and Finger ConditionsEAN/A
0002HBack (Thoracolumbar Spine) ConditionsEAN/A
0002INeck (Cervical Spine) ConditionsEAN/A
0002JHip and Thigh ConditionsEAN/A
0002KKnee and Lower Leg ConditionsEAN/A
0002LAnkle ConditionsEAN/A
0002MFoot Conditions, Including Flatfoot (Pes Planus)EAN/A
0002NBonesEAN/A
0002OMuscle InjuriesEAN/A
0003Organs of Special Sense / Eye
0003AEye ConditionsEAN/A
0004Impairment of Auditory Acuity/Ear and Other Sense Organs
0004AHearing Loss and TinnitusEAN/A
0004BEar (including vestibular & infectious)EAN/A
0004CLoss of Sense of Smell and/or Taste (ENT)EAN/A
0004DHearing Loss and Tinnitus Conducted with Boothless Audio TechnologyEAN/A
0005Infectious Diseases, Immune Disorders and Nutritional Deficiencies
0005APersian Gulf/Afghanistan Infectious DiseasesEAN/A
0005BHIV-Related IllnessesEAN/A
0005CInfectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis)EAN/A
0005DSystemic Lupus Erythematosus (SLE) and Other Autoimmune DiseasesEAN/A
0005ENutritional DeficienciesEAN/A
0005FChronic Fatigue Syndrome
(rheumatological)EAN/A
0006Respiratory System
0006ASinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT)EAN/A
0006BRespiratory Conditions (other than Tuberculosis and Sleep Apnea)EAN/A
0006CTuberculosisEAN/A
0006DSleep ApneaEAN/A
0006ESleep Studies (HSAT)EAN/A
0006FSleep Studies (PSG & ECG)EAN/A
0007Cardiovascular System
0007AHeart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery)EAN/A
0007BArtery and Vein Conditions (Vascular Diseases including Varicose Veins)EAN/A
0007CHypertensionEAN/A
0008Digestive System
0008AEsophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal
Disorders)EAN/A
0008BGallbladder ConditionsEAN/A
0008CIntestinal Conditions DBQEAN/A
0008DRESERVEDEAN/AN/AN/A
0008E(Hepatitis, Cirrhosis, and other) Liver ConditionsEAN/A
0008FPeritoneal AdhesionsEAN/A
0008GStomach and Duodenum Conditions (not including GERD or Esophageal Disorders)EAN/A
0008HRESERVEDEAN/AN/AN/A
0008IHernias (including Abdominal, Inguinal and Femoral Hernias) surgicalEAN/A
0008JRectum and Anus Conditions
(including Hemorrhoids)EAN/A
0008KPancreas ConditionsEAN/A
0009Genitourinary System
0009AKidney ConditionsEAN/A
0009BUrinary Tract (including Bladder and Urethra) Conditions (excluding Male Reproductive System)EAN/A
0009CProstate Cancer - Discontinued 12/21/21EAN/A
0009DMale Reproductive Organ
ConditionsEAN/A
0010Gynecological Conditions and Disorders of the Breast
0010AGynecological ConditionsEAN/A
0010BBreast Conditions and DisordersEAN/A
0011Hemic and Lymphatic Systems
0011A(Hairy Cell and Other B-Cell)
LeukemiaEAN/A
0011BHematologic and Lymphatic
Conditions, including LeukemiaEAN/A
0012Skin (Derm)
0012ASkin DiseasesEAN/A
0012BScars/DisfigurementEAN/A
0013Endocrine System
0013ADiabetes MellitusEAN/A
0013BEndocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus)EAN/A
0013CThyroid and Parathyroid
ConditionsEAN/A
0014Neurological Conditions and Convulsive Disorders
0014ACentral Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS,
Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS)EAN/A
0014BParkinson's DiseaseEAN/A
0014CAmyotrophic Lateral Sclerosis (Lou Gehrig's Disease)EAN/A
0014DDiabetic Sensory-Motor Peripheral NeuropathyEAN/A
0014ENarcolepsyEAN/A
0014FFibromyalgiaEAN/A
0014GHeadaches (including Migraine Headaches)EAN/A
0014HMultiple Sclerosis (MS)EAN/A
0014IInitial Evaluation of Residuals of Traumatic Brain Injury (I-TBI)EAN/A
0014JReview Evaluation of Residuals of Traumatic Brain Injury (R- TBI)EAN/A
0014KCranial Nerve ConditionsEAN/A
0014LPeripheral Nerve Conditions(not including Diabetic Sensory-Motor
Peripheral Neuropathy)EAN/A
0014MSeizure Disorders (epilepsy)EAN/A
0014NSpina BifidaEAN/A
0015Mental Disorders
0015AMental Disorders (other than PTSD)EAN/A
0015BMental Disorders (other than PTSD) - Telehealth examinationEAN/A
0015CInitial Post Traumatic StressDisorders (PTSD)EAN/A
0015DInitial Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015EReview Post Traumatic Stress Disorders (PTSD)EAN/A
0015FReview Post Traumatic Stress Disorders (PTSD) - Telehealth examinationEAN/A
0015GEating DisordersEAN/A
0015HEating Disorders - Telehealth
examinationEAN/A
0016Dental and Oral Conditions
0016AOral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions)EAN/A
0016BTemporomandibular Joint (TMJ) ConditionsEAN/A
0017Ancillary 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.)
0017AProceduresEA0%0%
0017BTestsEA0%0%0%
0017CLaboratory WorkEA0%0%0%
0017DRadiological ImagingEA0%0%0%
0018Subject Matter Expert (SME) Opinions (e.g. Camp Lejeune Contaminated Water (CLCW))
0018ASME OpinionsEA (per opinion)N/A
0019Record Review Medical File & Medical Opinions
0019ARESERVEDEAN/AN/AN/A
0019AARESERVEDEAN/AN/AN/A
0019BRESERVEDEAN/AN/AN/A
0019BBRESERVEDEAN/AN/AN/A
0019CRESERVEDEAN/AN/AN/A
0019CCRESERVEDEAN/AN/AN/A
0019DRESERVEDEAN/AN/AN/A
0019EMedical Record ReivewEAN/A
0019FTERA Medical Record ReviewEAN/A
0019GMedical OpinionEAN/A
0020No 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)
0020AComplete No Show (Claimant does not appear)EAN/A
0020BPartial No Show (Claimant requests to reschedule appointment within less than 24 hours’ notice)EAN/A
0021Deliverables
0021ADetailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS)EANSPNSPNSP
0021BTraining Plan in accordance with Section 4.5 of the PWSEANSPNSPNSP
0021CMonthly Status Reports in accordance with Section 4.6 ofthe PWSEANSPNSPNSP
0021DRamp-up Plan in accordance with Section 1.10 of the PWSEANSPNSPNSP
0021EReports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWSEANSPNSPNSP
0021FCompleted DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWSEANSPNSPNSP
0021GIncident Report in accordance with Sections 2 and 4.8 of the PWSEANSPNSPNSP
0021HContractor Portal in accordance with Section 2.3 of the PWSEANSPNSPNSP
0021IVeteran Portal in accordance with Section 2.4 of the PWSEANSPNSPNSP
0021JService Recovery Plan in accordance with Section 3.3 of the PWSEANSPNSPNSP
0021KKickoff Meeting Minutes in accordance with Section 4.3 of the PWSEANSPNSPNSP
0021LQuality Assurance Plan in accordance with Section 4.4 of the PWSEANSPNSPNSP
0021MMonthly Invoice Report in accordance with Section 4.7 of the PWSEANSPNSPNSP
0021NEmergency Plan in accordance
with Section 4.8 of the PWSEANSPNSPNSP
0021OAd-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWSEANSPNSPNSP
0021PResponse to Government Audits in accordance with Section 8.3 of the PWSEANSPNSPNSP
0021QAdministrative Site ReviewsEAN/ANSPNSP
0022Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement
0022ATravel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/ATBDTBD
0022BTravel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranNTEN/AN/AN/A
0022BAPhysician AssistantEA (hourly)N/A
0022BBNurse PractitionerEA (hourly)N/A
0022BCPhysician, GeneralistEA (hourly)N/A
0022BDPhysician, OphthalmologyEA (hourly)N/A
0022BEOptometristEA (hourly)N/A
0022BFAudiologistEA (hourly)N/A
0022BGPsychologistEA (hourly)N/A
0022BHPsychiatristEA (hourly)N/A
0022BIPhysician, PhysiatryEA (hourly)N/A
0022BJPhysician, NeurologyEA (hourly)N/A
0022BKSurgeon, NeurologistEA (hourly)N/A
0022BLDentistEA (hourly)N/A
0022BMOtolaryngologistEA (hourly)N/A
0022BNAssistantEA (hourly)N/A
0022BOChaperoneEA (hourly)N/A
0022CTravel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound VeteranTBDN/ATBDTBD
0022DClaimant Milage ReimbursementTo be invoiced and paid in accordance with Section 2.12 of the PWS
0022E
0022FCommon Carrier TravelTBDN/ATBDTBD
0022GCommon Carrier Travel (other than automobile)TBDN/ATBDTBD
0023Monitary Incentive
0023AMonitary IncentivesTo be invoiced and paid in accordance with Section 3.5 of the PWS
0024Ramp Up Activities
0024ARamp-up: Initial Contract AwardTBDN/ATBDTBD
0024AAIT Development ActivitiesTBDN/ATBDTBD
0024ABExaminer Network Building ActivitiesTBDN/ATBDTBD
0024BRamp-up: Major Contract ModificationTBDN/AN/AN/A
0024BAIT Development ActivitiesTBDN/ATBDTBD
0024BBExaminer Network Building ActivitiesTBDN/ATBDTBD
0024CRamp-up: Assignment of Additional ESR Workload and Reallocation of WorkTBDN/ATBDTBD
0025Mobile Unit Activities
0025AExaminers CostsEA (hourly)N/A
0025BMobile UnitsEA (daily)N/A
0026Required Assistant, Chaperone and/or Tele PresenterEA (hourly)N/A

File details come from the government source that posted it. Updated .