36C25220Q0188-006.xlsx

XLSX spreadsheet Posted Jan 28, 2020

Attached to: Q301--NEW - Cytogenetic Laboratory Service VA69D-15-D-0069 (607)
Solicitation number: 36C25220Q0188
Issued by: Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 12

About this file

From the source

36C25220Q0188 S02- RFQ Attachment A Cytogenetic Laboratory Schedule of Svc.xlsx

View the file

Other files

File	Type	Posted
36C25220Q0188-005.docx	DOCX document	Jan 28, 2020
36C25220Q0188-008.pdf	PDF	Jan 28, 2020
36C25220Q0188-007.pdf	PDF	Jan 28, 2020

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.

Summary

Cytogenetic Laboratory Testing Services

Madison

Contract Pricing

Year I

Year II

Year III

Year IV

Year V

Total Proposal Price $ - 0

Yr I

ATTACHMENT A - SCHEDULE OF ITEMS

SPECIALIZED TESTING: Year I Pricing (01 Aug. 2020 - 31 July 2021)
	Reference CPT Code	DESCRIPTION	Base Period

Estimated volume	Base Period Estimated Volume	Year I Estimated Volume	Pricing	Result Turn-Around-Times in Hours (offeror to complete)
			Cytogenetic Testing
	1	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow	80	81	51
	2	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow core biopsy	1	1	1
	3	88237, 88264	Cancer and Leukemia Chromosome Analysis - Peripheral blood	20	20	2
	4	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Lymph node	2	2	3
	5	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Tumor/Tissue biopsy	2	2	1
	6	88271 (10), 88275 (5)	Acute Myelocytic Leukemia Panel (includes t(8;21), MLL(11q23), inv(16), 7q31, and 5q31)	15	15	4
	7	88271 (5), 88275 (4)	Chronic Lymphocytic Leukemia Panel (includes ATM, CEP 12, del(13), and p53)	5	5	10
	8	88271 (6), 88275 (4)	Myelodysplastic Syndrome Panel (includes -5/del(5), -7/del(7), CEP 8 and del(20))	15	15	2
	9	88271 (16), 88275 (9)*	Multiple Myeloma Panel (includes CCND 1, del(13), IgH and p53, ATM, 1p/1q, t(4;14), t(14;16), MAFB, FGFR3IGH)	15	15	8
	10	88271 (2), 88275	Individual FISH probe for 1q gain	1	1	2
	11	88271 (2), 88275	Individual FISH probe for IGH/MAFB	3	3	1
	12	88271, 88275	FISH on Interphase Cells (100-300 nuclei) - Aneuploidy detection (monosomy, trisomy or copy number)	5	5	1
	13	88271, 88273	FISH on Interphase Cells (100-300 nuclei) - Deletion detection	1	1	1
	14	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Translocations	1	1	2
	15	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Break-apart probe for mutation detection	5	5	3
	16	83950	HER2/neu - Gene Amplification Study includes technical and interpretation (paraffin section slides) on 9p21	1	1	16
	17	88271 (2), 88275	Individual FISH Probe - ALK Gene Rearrangement, 2p23	1	1	1
	18	88271 (2), 88275	Individual FISH Probe - BCL6 Gene Rearrangement, 3q27	1	1	1
	19	88271 (3), 88275	Individual FISH Probe - F1P1L1-CH1C2-PDGFRA Gene Rearrangement, 4q12	1	1	4
	20	88271 (2), 88275	Individual FISH Probe - FGFR3 IGH Fusion, t(4;14)(p16;q32)	1	1	1
	21	88271 (2), 88275	Individual FISH Probe - Deletion 5q31, EGR1	1	1	7
	22	88271 (2), 88275	Individual FISH Probe - Deletion 7q31, D7S522	1	1	6
	23	88271, 88275	Individual FISH Probe - Trisomy 8, D8Z2	1	1	2
	24	88271 (2), 88275	Individual FISH Probe -MYC IGH Fusion, t(8;14)(q24;q32)	3	3	3
	25	88271 (2), 88275	Individual FISH Probe - MYC Gene Reaggarrangement, 8q24	1	1	4
	26	88271 (2), 88275	Individual FISH Probe - RUNX1T1/RUNX1 Fusion, t(8;21)(q22;q22)	1	1	2
	27	88271 (2), 88275	Individual FISH Probe - BCR ABL1 Fusion, t(9;22)(q34;q11.2)	3	3	3
	28	88271 (2), 88275	Individual FISH Probe - CCND1/IGH Fusion, t(11;14)(q13;q32)	5	5	4
	29	88271 (2), 88275	Individual FISH Probe - AP12/MALT1 Fusion, t(11;18)(q21;q21)	1	1	1
	30	88271, 88275	Individual FISH Probe - 11q22.3 Deletion/Duplication, ATM gene	1	1	2
	31	88271 (2), 88275	Individual FISH Probe - MLL Gene Rearrangement, 11q23	1	1	1
	32	88271, 88275	Individual FISH Probe - Trisomy 12, FISH,D12Z3	1	1	1
	33	88271 (2), 88275	Individual FISH Probe - Deletion 13q14, D13S319	1	1	2
	34	88271 (2), 88275	Individual FISH Probe - IGH/MAF Fusion, t(14;16)(qq32;q23)	1	1	1
	35	88271 (2), 88275	Individual FISH Probe -IGH/BCL2 Fusion, t(14;18)(q32;q21)	3	3	1
	36	88271 (2), 88275	Individual FISH Probe - IGH Gene Rearrangement, 14q32	1	1	2
	37	88271 (2), 88275	Individual FISH Probe - PML/RARA Fusion, t(15;17)(q24;q21)	1	1	1
	38	88271 (2), 88275	Individual FISH Probe -CBFB Gene Rearrangement, 16q,22	1	1	2
	39	88271, 88275	Individual FISH Probe - Deletion 17p13.1, TP53	1	1	2
	40	88271, 88275	Individual FISH Probe - Deletion 20q, D20S108	1	1	2
	41	88271 (2), 88275	Individual FISH Probe - EWSR1 Gene Rearrangement, 22q12.2	1	1	1
	42	88271 (2), 88275	Individual FISH Probe - X and Y sex chromosomes	1	1	1
	43	88271 (4), 88275 (2)	Individual FISH Probe - Deletion 1p36 & 19q13 for glial neoplasia	1	1	2
	44	88237	Specimen set up and hold	1	1	14
	45	88239	Solid Tumor set up and hold	3	3	8
	46	88271, 88273	DiGeorge/Velo-cardio-facial/Shprintzen/….Deletion -22q11.2,TUPEL1,FISH	6	6	1
	47	88271 (2), 88275	FGFR1 Gene Rearrangement, 8p11	3	3	2
	48	88271 (2), 88275	Individual FISH Probe-MDM2 amplification	1	1	2
	49	81245, 81246	FLT3 Mutation analysis	1	1	1

Total Year I Pricing $0.00 https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip Yr II

ATTACHMENT A - SCHEDULE OF ITEMS

SPECIALIZED TESTING: Year II (01 Aug. 2021 - 31 July 2022)
	Reference CPT Code	DESCRIPTION	Base Period

Estimated volume	Base Period Estimated Volume	Year II Estimated Volume	Pricing	Result Turn-Around-Times in Hours (offeror to complete)
			Cytogenetic Testing
	1	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow	80	81	51
	2	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow core biopsy	1	1	1
	3	88237, 88264	Cancer and Leukemia Chromosome Analysis - Peripheral blood	20	20	2
	4	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Lymph node	2	2	3
	5	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Tumor/Tissue biopsy	2	2	1
	6	88271 (10), 88275 (5)	Acute Myelocytic Leukemia Panel (includes t(8;21), MLL(11q23), inv(16), 7q31, and 5q31)	15	15	4
	7	88271 (5), 88275 (4)	Chronic Lymphocytic Leukemia Panel (includes ATM, CEP 12, del(13), and p53)	5	5	10
	8	88271 (6), 88275 (4)	Myelodysplastic Syndrome Panel (includes -5/del(5), -7/del(7), CEP 8 and del(20))	15	15	2
	9	88271 (16), 88275 (9)*	Multiple Myeloma Panel (includes CCND 1, del(13), IgH and p53, ATM, 1p/1q, t(4;14), t(14;16), MAFB, FGFR3IGH)	15	15	8
	10	88271 (2), 88275	Individual FISH probe for 1q gain	1	1	2
	11	88271 (2), 88275	Individual FISH probe for IGH/MAFB	3	3	1
	12	88271, 88275	FISH on Interphase Cells (100-300 nuclei) - Aneuploidy detection (monosomy, trisomy or copy number)	5	5	1
	13	88271, 88273	FISH on Interphase Cells (100-300 nuclei) - Deletion detection	1	1	1
	14	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Translocations	1	1	2
	15	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Break-apart probe for mutation detection	5	5	3
	16	83950	HER2/neu - Gene Amplification Study includes technical and interpretation (paraffin section slides) on 9p21	1	1	16
	17	88271 (2), 88275	Individual FISH Probe - ALK Gene Rearrangement, 2p23	1	1	1
	18	88271 (2), 88275	Individual FISH Probe - BCL6 Gene Rearrangement, 3q27	1	1	1
	19	88271 (3), 88275	Individual FISH Probe - F1P1L1-CH1C2-PDGFRA Gene Rearrangement, 4q12	1	1	4
	20	88271 (2), 88275	Individual FISH Probe - FGFR3 IGH Fusion, t(4;14)(p16;q32)	1	1	1
	21	88271 (2), 88275	Individual FISH Probe - Deletion 5q31, EGR1	1	1	7
	22	88271 (2), 88275	Individual FISH Probe - Deletion 7q31, D7S522	1	1	6
	23	88271, 88275	Individual FISH Probe - Trisomy 8, D8Z2	1	1	2
	24	88271 (2), 88275	Individual FISH Probe -MYC IGH Fusion, t(8;14)(q24;q32)	3	3	3
	25	88271 (2), 88275	Individual FISH Probe - MYC Gene Reaggarrangement, 8q24	1	1	4
	26	88271 (2), 88275	Individual FISH Probe - RUNX1T1/RUNX1 Fusion, t(8;21)(q22;q22)	1	1	2
	27	88271 (2), 88275	Individual FISH Probe - BCR ABL1 Fusion, t(9;22)(q34;q11.2)	3	3	3
	28	88271 (2), 88275	Individual FISH Probe - CCND1/IGH Fusion, t(11;14)(q13;q32)	5	5	4
	29	88271 (2), 88275	Individual FISH Probe - AP12/MALT1 Fusion, t(11;18)(q21;q21)	1	1	1
	30	88271, 88275	Individual FISH Probe - 11q22.3 Deletion/Duplication, ATM gene	1	1	2
	31	88271 (2), 88275	Individual FISH Probe - MLL Gene Rearrangement, 11q23	1	1	1
	32	88271, 88275	Individual FISH Probe - Trisomy 12, FISH,D12Z3	1	1	1
	33	88271 (2), 88275	Individual FISH Probe - Deletion 13q14, D13S319	1	1	2
	34	88271 (2), 88275	Individual FISH Probe - IGH/MAF Fusion, t(14;16)(qq32;q23)	1	1	1
	35	88271 (2), 88275	Individual FISH Probe -IGH/BCL2 Fusion, t(14;18)(q32;q21)	3	3	1
	36	88271 (2), 88275	Individual FISH Probe - IGH Gene Rearrangement, 14q32	1	1	2
	37	88271 (2), 88275	Individual FISH Probe - PML/RARA Fusion, t(15;17)(q24;q21)	1	1	1
	38	88271 (2), 88275	Individual FISH Probe -CBFB Gene Rearrangement, 16q,22	1	1	2
	39	88271, 88275	Individual FISH Probe - Deletion 17p13.1, TP53	1	1	2
	40	88271, 88275	Individual FISH Probe - Deletion 20q, D20S108	1	1	2
	41	88271 (2), 88275	Individual FISH Probe - EWSR1 Gene Rearrangement, 22q12.2	1	1	1
	42	88271 (2), 88275	Individual FISH Probe - X and Y sex chromosomes	1	1	1
	43	88271 (4), 88275 (2)	Individual FISH Probe - Deletion 1p36 & 19q13 for glial neoplasia	1	1	2
	44	88237	Specimen set up and hold	1	1	14
	45	88239	Solid Tumor set up and hold	3	3	8
	46	88271, 88273	DiGeorge/Velo-cardio-facial/Shprintzen/….Deletion -22q11.2,TUPEL1,FISH	6	6	1
	47	88271 (2), 88275	FGFR1 Gene Rearrangement, 8p11	3	3	2
	48	88271 (2), 88275	Individual FISH Probe-MDM2 amplification	1	1	2
	49	81245, 81246	FLT3 Mutation analysis	1	1	1

Total Year II Pricing $0.00 https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip

Yr III

ATTACHMENT A - SCHEDULE OF ITEMS

SPECIALIZED TESTING: Year III (01 Aug. 2022 - 31 July 2023)
	Reference CPT Code	DESCRIPTION	Opt Yr I Period

Estimated volume	1.5% inflation	Year III Estimated Volume	Pricing	Result Turn-Around-Times in Hours (offeror to complete)
			Cytogenetic Testing
	1	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow	80	81	51
	2	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow core biopsy	1	1	1
	3	88237, 88264	Cancer and Leukemia Chromosome Analysis - Peripheral blood	20	20	2
	4	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Lymph node	2	2	3
	5	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Tumor/Tissue biopsy	2	2	1
	6	88271 (10), 88275 (5)	Acute Myelocytic Leukemia Panel (includes t(8;21), MLL(11q23), inv(16), 7q31, and 5q31)	15	15	4
	7	88271 (5), 88275 (4)	Chronic Lymphocytic Leukemia Panel (includes ATM, CEP 12, del(13), and p53)	5	5	10
	8	88271 (6), 88275 (4)	Myelodysplastic Syndrome Panel (includes -5/del(5), -7/del(7), CEP 8 and del(20))	15	15	2
	9	88271 (16), 88275 (9)*	Multiple Myeloma Panel (includes CCND 1, del(13), IgH and p53, ATM, 1p/1q, t(4;14), t(14;16), MAFB, FGFR3IGH)	15	15	8
	10	88271 (2), 88275	Individual FISH probe for 1q gain	1	1	2
	11	88271 (2), 88275	Individual FISH probe for IGH/MAFB	3	3	1
	12	88271, 88275	FISH on Interphase Cells (100-300 nuclei) - Aneuploidy detection (monosomy, trisomy or copy number)	5	5	1
	13	88271, 88273	FISH on Interphase Cells (100-300 nuclei) - Deletion detection	1	1	1
	14	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Translocations	1	1	2
	15	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Break-apart probe for mutation detection	5	5	3
	16	83950	HER2/neu - Gene Amplification Study includes technical and interpretation (paraffin section slides) on 9p21	1	1	16
	17	88271 (2), 88275	Individual FISH Probe - ALK Gene Rearrangement, 2p23	1	1	1
	18	88271 (2), 88275	Individual FISH Probe - BCL6 Gene Rearrangement, 3q27	1	1	1
	19	88271 (3), 88275	Individual FISH Probe - F1P1L1-CH1C2-PDGFRA Gene Rearrangement, 4q12	1	1	4
	20	88271 (2), 88275	Individual FISH Probe - FGFR3 IGH Fusion, t(4;14)(p16;q32)	1	1	1
	21	88271 (2), 88275	Individual FISH Probe - Deletion 5q31, EGR1	1	1	7
	22	88271 (2), 88275	Individual FISH Probe - Deletion 7q31, D7S522	1	1	6
	23	88271, 88275	Individual FISH Probe - Trisomy 8, D8Z2	1	1	2
	24	88271 (2), 88275	Individual FISH Probe -MYC IGH Fusion, t(8;14)(q24;q32)	3	3	3
	25	88271 (2), 88275	Individual FISH Probe - MYC Gene Reaggarrangement, 8q24	1	1	4
	26	88271 (2), 88275	Individual FISH Probe - RUNX1T1/RUNX1 Fusion, t(8;21)(q22;q22)	1	1	2
	27	88271 (2), 88275	Individual FISH Probe - BCR ABL1 Fusion, t(9;22)(q34;q11.2)	3	3	3
	28	88271 (2), 88275	Individual FISH Probe - CCND1/IGH Fusion, t(11;14)(q13;q32)	5	5	4
	29	88271 (2), 88275	Individual FISH Probe - AP12/MALT1 Fusion, t(11;18)(q21;q21)	1	1	1
	30	88271, 88275	Individual FISH Probe - 11q22.3 Deletion/Duplication, ATM gene	1	1	2
	31	88271 (2), 88275	Individual FISH Probe - MLL Gene Rearrangement, 11q23	1	1	1
	32	88271, 88275	Individual FISH Probe - Trisomy 12, FISH,D12Z3	1	1	1
	33	88271 (2), 88275	Individual FISH Probe - Deletion 13q14, D13S319	1	1	2
	34	88271 (2), 88275	Individual FISH Probe - IGH/MAF Fusion, t(14;16)(qq32;q23)	1	1	1
	35	88271 (2), 88275	Individual FISH Probe -IGH/BCL2 Fusion, t(14;18)(q32;q21)	3	3	1
	36	88271 (2), 88275	Individual FISH Probe - IGH Gene Rearrangement, 14q32	1	1	2
	37	88271 (2), 88275	Individual FISH Probe - PML/RARA Fusion, t(15;17)(q24;q21)	1	1	1
	38	88271 (2), 88275	Individual FISH Probe -CBFB Gene Rearrangement, 16q,22	1	1	2
	39	88271, 88275	Individual FISH Probe - Deletion 17p13.1, TP53	1	1	2
	40	88271, 88275	Individual FISH Probe - Deletion 20q, D20S108	1	1	2
	41	88271 (2), 88275	Individual FISH Probe - EWSR1 Gene Rearrangement, 22q12.2	1	1	1
	42	88271 (2), 88275	Individual FISH Probe - X and Y sex chromosomes	1	1	1
	43	88271 (4), 88275 (2)	Individual FISH Probe - Deletion 1p36 & 19q13 for glial neoplasia	1	1	2
	44	88237	Specimen set up and hold	1	1	14
	45	88239	Solid Tumor set up and hold	3	3	8
	46	88271, 88273	DiGeorge/Velo-cardio-facial/Shprintzen/….Deletion -22q11.2,TUPEL1,FISH	6	6	1
	47	88271 (2), 88275	FGFR1 Gene Rearrangement, 8p11	3	3	2
	48	88271 (2), 88275	Individual FISH Probe-MDM2 amplification	1	1	2
	49	81245, 81246	FLT3 Mutation analysis	1	1	1

Total Year III Pricing $0.00 https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip

Yr IV

ATTACHMENT A - SCHEDULE OF ITEMS

SPECIALIZED TESTING: Year IV (01 Aug. 2023 - 31 July 2024)
	Reference CPT Code	DESCRIPTION	Opt Yr II Period

Estimated volume	1% Inflation	Year IV Estimated Volume	Pricing	Result Turn-Around-Times in Hours (offeror to complete)
			Cytogenetic Testing
	1	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow	80	81	51
	2	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow core biopsy	1	1	1
	3	88237, 88264	Cancer and Leukemia Chromosome Analysis - Peripheral blood	20	20	2
	4	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Lymph node	2	2	3
	5	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Tumor/Tissue biopsy	2	2	1
	6	88271 (10), 88275 (5)	Acute Myelocytic Leukemia Panel (includes t(8;21), MLL(11q23), inv(16), 7q31, and 5q31)	15	15	4
	7	88271 (5), 88275 (4)	Chronic Lymphocytic Leukemia Panel (includes ATM, CEP 12, del(13), and p53)	5	5	10
	8	88271 (6), 88275 (4)	Myelodysplastic Syndrome Panel (includes -5/del(5), -7/del(7), CEP 8 and del(20))	15	15	2
	9	88271 (16), 88275 (9)*	Multiple Myeloma Panel (includes CCND 1, del(13), IgH and p53, ATM, 1p/1q, t(4;14), t(14;16), MAFB, FGFR3IGH)	15	15	8
	10	88271 (2), 88275	Individual FISH probe for 1q gain	1	1	2
	11	88271 (2), 88275	Individual FISH probe for IGH/MAFB	3	3	1
	12	88271, 88275	FISH on Interphase Cells (100-300 nuclei) - Aneuploidy detection (monosomy, trisomy or copy number)	5	5	1
	13	88271, 88273	FISH on Interphase Cells (100-300 nuclei) - Deletion detection	1	1	1
	14	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Translocations	1	1	2
	15	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Break-apart probe for mutation detection	5	5	3
	16	83950	HER2/neu - Gene Amplification Study includes technical and interpretation (paraffin section slides) on 9p21	1	1	16
	17	88271 (2), 88275	Individual FISH Probe - ALK Gene Rearrangement, 2p23	1	1	1
	18	88271 (2), 88275	Individual FISH Probe - BCL6 Gene Rearrangement, 3q27	1	1	1
	19	88271 (3), 88275	Individual FISH Probe - F1P1L1-CH1C2-PDGFRA Gene Rearrangement, 4q12	1	1	4
	20	88271 (2), 88275	Individual FISH Probe - FGFR3 IGH Fusion, t(4;14)(p16;q32)	1	1	1
	21	88271 (2), 88275	Individual FISH Probe - Deletion 5q31, EGR1	1	1	7
	22	88271 (2), 88275	Individual FISH Probe - Deletion 7q31, D7S522	1	1	6
	23	88271, 88275	Individual FISH Probe - Trisomy 8, D8Z2	1	1	2
	24	88271 (2), 88275	Individual FISH Probe -MYC IGH Fusion, t(8;14)(q24;q32)	3	3	3
	25	88271 (2), 88275	Individual FISH Probe - MYC Gene Reaggarrangement, 8q24	1	1	4
	26	88271 (2), 88275	Individual FISH Probe - RUNX1T1/RUNX1 Fusion, t(8;21)(q22;q22)	1	1	2
	27	88271 (2), 88275	Individual FISH Probe - BCR ABL1 Fusion, t(9;22)(q34;q11.2)	3	3	3
	28	88271 (2), 88275	Individual FISH Probe - CCND1/IGH Fusion, t(11;14)(q13;q32)	5	5	4
	29	88271 (2), 88275	Individual FISH Probe - AP12/MALT1 Fusion, t(11;18)(q21;q21)	1	1	1
	30	88271, 88275	Individual FISH Probe - 11q22.3 Deletion/Duplication, ATM gene	1	1	2
	31	88271 (2), 88275	Individual FISH Probe - MLL Gene Rearrangement, 11q23	1	1	1
	32	88271, 88275	Individual FISH Probe - Trisomy 12, FISH,D12Z3	1	1	1
	33	88271 (2), 88275	Individual FISH Probe - Deletion 13q14, D13S319	1	1	2
	34	88271 (2), 88275	Individual FISH Probe - IGH/MAF Fusion, t(14;16)(qq32;q23)	1	1	1
	35	88271 (2), 88275	Individual FISH Probe -IGH/BCL2 Fusion, t(14;18)(q32;q21)	3	3	1
	36	88271 (2), 88275	Individual FISH Probe - IGH Gene Rearrangement, 14q32	1	1	2
	37	88271 (2), 88275	Individual FISH Probe - PML/RARA Fusion, t(15;17)(q24;q21)	1	1	1
	38	88271 (2), 88275	Individual FISH Probe -CBFB Gene Rearrangement, 16q,22	1	1	2
	39	88271, 88275	Individual FISH Probe - Deletion 17p13.1, TP53	1	1	2
	40	88271, 88275	Individual FISH Probe - Deletion 20q, D20S108	1	1	2
	41	88271 (2), 88275	Individual FISH Probe - EWSR1 Gene Rearrangement, 22q12.2	1	1	1
	42	88271 (2), 88275	Individual FISH Probe - X and Y sex chromosomes	1	1	1
	43	88271 (4), 88275 (2)	Individual FISH Probe - Deletion 1p36 & 19q13 for glial neoplasia	1	1	2
	44	88237	Specimen set up and hold	1	1	14
	45	88239	Solid Tumor set up and hold	3	3	8
	46	88271, 88273	DiGeorge/Velo-cardio-facial/Shprintzen/….Deletion -22q11.2,TUPEL1,FISH	6	6	1
	47	88271 (2), 88275	FGFR1 Gene Rearrangement, 8p11	3	3	2
	48	88271 (2), 88275	Individual FISH Probe-MDM2 amplification	1	1	2
	49	81245, 81246	FLT3 Mutation analysis	1	1	1
						1
	Total Year IV Pricing						$0.00

https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip

Yr V

ATTACHMENT A - SCHEDULE OF ITEMS

SPECIALIZED TESTING: Year V (01 Aug. 2024 - 31 July 2025)
	Reference CPT Code	DESCRIPTION	Base Period

Estimated volume	Base Period Estimated Volume	Year V Estimated Volume	Pricing	Result Turn-Around-Times in Hours (offeror to complete)
			Cytogenetic Testing
	1	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow	80	81	51
	2	88237, 88264	Cancer and Leukemia Chromosome Analysis - Bone marrow core biopsy	1	1	1
	3	88237, 88264	Cancer and Leukemia Chromosome Analysis - Peripheral blood	20	20	2
	4	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Lymph node	2	2	3
	5	88239, 88264, 88280	Cancer and Leukemia Chromosome Analysis - Tumor/Tissue biopsy	2	2	1
	6	88271 (10), 88275 (5)	Acute Myelocytic Leukemia Panel (includes t(8;21), MLL(11q23), inv(16), 7q31, and 5q31)	15	15	4
	7	88271 (5), 88275 (4)	Chronic Lymphocytic Leukemia Panel (includes ATM, CEP 12, del(13), and p53)	5	5	10
	8	88271 (6), 88275 (4)	Myelodysplastic Syndrome Panel (includes -5/del(5), -7/del(7), CEP 8 and del(20))	15	15	2
	9	88271 (16), 88275 (9)*	Multiple Myeloma Panel (includes CCND 1, del(13), IgH and p53, ATM, 1p/1q, t(4;14), t(14;16), MAFB, FGFR3IGH)	15	15	8
	10	88271 (2), 88275	Individual FISH probe for 1q gain	1	1	2
	11	88271 (2), 88275	Individual FISH probe for IGH/MAFB	3	3	1
	12	88271, 88275	FISH on Interphase Cells (100-300 nuclei) - Aneuploidy detection (monosomy, trisomy or copy number)	5	5	1
	13	88271, 88273	FISH on Interphase Cells (100-300 nuclei) - Deletion detection	1	1	1
	14	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Translocations	1	1	2
	15	88271 (2), 88275	FISH on Interphase Cells (100-300 nuclei) - Break-apart probe for mutation detection	5	5	3
	16	83950	HER2/neu - Gene Amplification Study includes technical and interpretation (paraffin section slides) on 9p21	1	1	16
	17	88271 (2), 88275	Individual FISH Probe - ALK Gene Rearrangement, 2p23	1	1	1
	18	88271 (2), 88275	Individual FISH Probe - BCL6 Gene Rearrangement, 3q27	1	1	1
	19	88271 (3), 88275	Individual FISH Probe - F1P1L1-CH1C2-PDGFRA Gene Rearrangement, 4q12	1	1	4
	20	88271 (2), 88275	Individual FISH Probe - FGFR3 IGH Fusion, t(4;14)(p16;q32)	1	1	1
	21	88271 (2), 88275	Individual FISH Probe - Deletion 5q31, EGR1	1	1	7
	22	88271 (2), 88275	Individual FISH Probe - Deletion 7q31, D7S522	1	1	6
	23	88271, 88275	Individual FISH Probe - Trisomy 8, D8Z2	1	1	2
	24	88271 (2), 88275	Individual FISH Probe -MYC IGH Fusion, t(8;14)(q24;q32)	3	3	3
	25	88271 (2), 88275	Individual FISH Probe - MYC Gene Reaggarrangement, 8q24	1	1	4
	26	88271 (2), 88275	Individual FISH Probe - RUNX1T1/RUNX1 Fusion, t(8;21)(q22;q22)	1	1	2
	27	88271 (2), 88275	Individual FISH Probe - BCR ABL1 Fusion, t(9;22)(q34;q11.2)	3	3	3
	28	88271 (2), 88275	Individual FISH Probe - CCND1/IGH Fusion, t(11;14)(q13;q32)	5	5	4
	29	88271 (2), 88275	Individual FISH Probe - AP12/MALT1 Fusion, t(11;18)(q21;q21)	1	1	1
	30	88271, 88275	Individual FISH Probe - 11q22.3 Deletion/Duplication, ATM gene	1	1	2
	31	88271 (2), 88275	Individual FISH Probe - MLL Gene Rearrangement, 11q23	1	1	1
	32	88271, 88275	Individual FISH Probe - Trisomy 12, FISH,D12Z3	1	1	1
	33	88271 (2), 88275	Individual FISH Probe - Deletion 13q14, D13S319	1	1	2
	34	88271 (2), 88275	Individual FISH Probe - IGH/MAF Fusion, t(14;16)(qq32;q23)	1	1	1
	35	88271 (2), 88275	Individual FISH Probe -IGH/BCL2 Fusion, t(14;18)(q32;q21)	3	3	1
	36	88271 (2), 88275	Individual FISH Probe - IGH Gene Rearrangement, 14q32	1	1	2
	37	88271 (2), 88275	Individual FISH Probe - PML/RARA Fusion, t(15;17)(q24;q21)	1	1	1
	38	88271 (2), 88275	Individual FISH Probe -CBFB Gene Rearrangement, 16q,22	1	1	2
	39	88271, 88275	Individual FISH Probe - Deletion 17p13.1, TP53	1	1	2
	40	88271, 88275	Individual FISH Probe - Deletion 20q, D20S108	1	1	2
	41	88271 (2), 88275	Individual FISH Probe - EWSR1 Gene Rearrangement, 22q12.2	1	1	1
	42	88271 (2), 88275	Individual FISH Probe - X and Y sex chromosomes	1	1	1
	43	88271 (4), 88275 (2)	Individual FISH Probe - Deletion 1p36 & 19q13 for glial neoplasia	1	1	2
	44	88237	Specimen set up and hold	1	1	14
	45	88239	Solid Tumor set up and hold	3	3	8
	46	88271, 88273	DiGeorge/Velo-cardio-facial/Shprintzen/….Deletion -22q11.2,TUPEL1,FISH	6	6	1
	47	88271 (2), 88275	FGFR1 Gene Rearrangement, 8p11	3	3	2
	48	88271 (2), 88275	Individual FISH Probe-MDM2 amplification	1	1	2
	49	81245, 81246	FLT3 Mutation analysis	1	1	1

Total Year V Pricing $0.00 https://www.cms.gov/apps/ama/license.asp?file=/ClinicalLabFeeSched/downloads/13clab.zip

File details come from the government source that posted it. Updated Jan 28, 2020.