36C25018R0804-0001000.docx

5. PROJECT NUMBER (if applicable)

CODE

7. ADMINISTERED BY

2.

AMENDMENT/MODIFICATION NUMBER

CODE

6. ISSUED BY

8. NAME AND ADDRESS OF CONTRACTOR

4. REQUISITION/PURCHASE REQ. NUMBER

3. EFFECTIVE DATE

9A. AMENDMENT OF SOLICITATION NUMBER

9B. DATED

PAGE

OF PAGES

10A. MODIFICATION OF

CONTRACT/ORDER NUMBER

10B. DATED

BPA NO.

1. CONTRACT ID CODE

FACILITY CODE

CODE

Offers must acknowledge receipt of this amendment prior to the hour and date specified in the solicitation or as amended, by one of the following methods:

The above numbered solicitation is amended as set forth in Item 14. The hour and date specified for receipt of Offers

E. IMPORTANT:

is extended,

(a) By completing Items 8 and 15, and returning __________ copies of the amendment; (b) By acknowledging receipt of this amendment on each copy of the offer submitted; or (c) By separate letter or electronic communication which includes a reference to the solicitation and amendment numbers. FAILURE OF YOUR ACKNOWLEDGMENT TO BE RECEIVED AT THE PLACE DESIGNATED FOR THE RECEIPT OF OFFERS PRIOR TO THE HOUR AND DATE SPECIFIED MAY is not extended.

12. ACCOUNTING AND APPROPRIATION DATA

(REV.

11/2016) is required to sign this document and return ___________ copies to the issuing office.

is not, A. THIS CHANGE ORDER IS ISSUED PURSUANT TO:

Specify authority) THE CHANGES SET FORTH IN ITEM 14 ARE MADE IN THE CONTRACT ORDER NO. IN ITE M 10A.

15C. DATE SIGNED

B. THE ABOVE NUMBERED CONTRACT/ORDER IS MODIFIED TO REFLECT THE ADMINISTRATIVE CHANGES

SET FORTH IN ITEM 14, PURSUANT TO THE AUTHORITY OF FAR

43.103(b).

RESULT IN REJECTION OF YOUR OFFER. If by virtue of this amendment you desire to change an offer already submitted, such change may be made by letter or electronic communication, provided each letter or electronic communication makes r eference to the solicitation and this amendment, and is received prior to the opening hour and date specified.

C. THIS SUPPLEMENTAL AGREEMENT IS

ENTERED INTO

PURSUANT TO AUTHORITY OF:

D. OTHER

BY

Contractor

16C. DATE SIGNED

14.

DESCRIPTION OF AMENDMENT/MODIFICATION

16B. UNITED STATES OF AMERICA

Except as provided herein, all terms and conditions of the document referenced in Item 9A or 10A, as heretofore changed, remains unchanged and in full force and effect.

15A. NAME

AND TITLE OF SIGNER

16A. NAME AND TITLE OF CONTRACTING OFFICER

15B. CONTRACTOR/OFFEROR

STANDARD FORM 30

PREVIOUS EDITION NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.243 (Type or print) (Type or print) (Organized by UCF section headings, including solicitation/contract subject matter where feasible.)

(Number, street, county, State and ZIP Code) (If other than Item 6) (Specify type of modification and authority) (such as changes in paying office, appropriation date, etc.)

(If required)

(SEE ITEM 11)

(SEE ITEM 13)

(X)

CHECK

ONE

13. THIS ITEM APPLIES ONLY TO MODIFICATIONS OF CONTRACTS/ORDERS,

IT MODIFIES THE CONTRACT/ORDER NO. AS DESCRIBED IN ITEM 14.

11. THIS ITEM ONLY APPLIES TO AMENDMENTS

OF SOLICITATIONS

AMENDMENT OF SOLICITATION/MODIFICATION OF CONTRACT

(Signature of person authorized to sign) (Signature of Contracting Officer) None Department of Veterans Affairs Ann Arbor Healthcare System Network Contracting Office 10 2215 Fuller Road Ann Arbor MI 48105 Y Department of Veterans Affair Ann Arbor Healthcare System Network Contracting Office 10 2215 Fuller Road Ann Arbor MI 48105 To all Offerors/Bidders

36C25018R0804 08-22-2018

X X X 583-3690160-191-824800-2632 010024843 X

See pages 2-3 for questions and answers.

Charles Lakin Contracting Officer

CONTINUATION PAGE

1. Item #1: What type of alloy will be requested for the “Metal Ceramic Crowns”? High Nobel?

Oftentimes, providers choose High noble to be the metal of choice underneath the metal ceramic crowns. However, providers can choose any type of metal underneath Metal Ceramic Crowns. This ranges from high noble metal (usually contains gold/palladium/platinum in excess of 60% with gold over 40%) to base metal which includes mostly alloys of tin and nickel.

Traditionally, high noble crowns are easier to remove for replacement and easier to access should endo need to be completed.

1. Item #2: What type of alloy will be requested for the “Metal Ceramic Bridge”? High Nobel? Also, would this be per unit?

See above for answer regarding Metal underneath ceramic. Metal Ceramic Bridges are coded out on a per unit basis (mixture of abutment units & pontic units). Lab bills reflect these per unit charges.

1. Item #3: ‘Implant Crowns” – Will this be a “Metal Ceramic Crown” or “All Ceramic”?

These can be either option. Typically, in the posterior providers have been selecting metal ceramic implant crowns, however in the anterior esthetic area, sometimes an all ceramic implant crown is preferable. Oftentimes, a patient’s occlusal scheme will determine which is best.

1. Item #8: “All Ceramic Crowns” – Is this referring to “Full Zirconia” or “Layered Zirconia” or “e.max”?

The All Ceramic Crown code D2950 is used for any type of all ceramic restoration (included full zirconia vs. emax vs. layered zirconia). There are different indications for each. Typically, E.max is preferred in areas of high esthetics & translucency. Zirconia is often preferred in areas where occlusal space is limited and an increased strength is needed. There are pricing differences regarding each. Emax is a pressed ceramic requiring more work and effort.

1. Item #13: “Implant bar” – Will this be billed per implant or per bar? We usually bill per implant.

Providers code out D6055 as a single implant bar spanning across the number of implants present. The lab then fabricates a cost of milling a titatnium bar with then additional attachments depending on the number of implants used to support the bar and if there are any other corresponding attachment parts. For instance, some implant bars may have additional locator abutments or hader attachments that reside in addition to the implant bar.

1. Item #14: “Implant Custom Abutment” – Is this a UCLA style abutment? If so, will the part be provided with the case by the dental clinic? Also, what alloy would be requested to be used? High Nobel? Would using a CAD/CAM abutment be on option?

Yes, UCLA style abutment. There is no part provided with the case other than the impression pickup coping and corresponding analog that is used to take the implant impression. The lab then fabricates or mills the custom abutment based off this impression & fabrication of a soft tissue cast. Often, titatnium is the choice of material that is used to fabricate a custom abutment. Certain times, in need of extreme esthetics, a ceramic abutment may be able to be used/milled but is still done in the lab itself.

In theory, CAD/CAM technology could be used to fabricate an abutment, however we do not possess a CAD unit here in the clinic. Additionally, in the VA indy dental clinic, a majority of our implant crowns are fabricated in a screw-retained fashion, meaning that the lab fabricates the abutment and the crown and then cements them together in the lab – the entire unit is then torqued in and restored allowing for greater retrievability. We do not routinely practice milling abutments and then cementing implant crowns ontop of them. There are exceptions.

1. Item #20: “Surgical Stents for Dental Implants” – Is this a Guided Surgical Guide?

Yes, stents fabricated to guide the surgical aspect of implants from a restorative perspective.

1. Item #22: Would the “Full Cast Bridges” be billed per unit?

Yes, Bridges are coded out on a per unit basis (mixture of abutment units & pontic units). Lab bills reflect these per unit charges.