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36C25519Q0805 FedBizOpps Combined Synopsis/Solicitation Notice

CLASSIFICATION CODE

SUBJECT

CONTRACTING OFFICE'S

ZIP-CODE

SOLICITATION NUMBER

RESPONSE DATE

(MM-DD-YYYY)

ARCHIVE

DAYS AFTER THE RESPONSE DATE

RECOVERY ACT FUNDS

SET-ASIDE

NAICS CODE

CONTRACTING OFFICE

ADDRESS

POINT OF CONTACT

(POC Information Automatically Filled from User Profile Unless Entered)

DESCRIPTION

See Attachment

AGENCY'S URL

URL DESCRIPTION

AGENCY CONTACT'S EMAIL

ADDRESS

EMAIL DESCRIPTION

ADDRESS

POSTAL CODE

COUNTRY

ADDITIONAL INFORMATION

GENERAL INFORMATION

PLACE OF PERFORMANCE

Required Field FedBizOpps Combined Synopsis/Solicitation Notice Rev. March 2010 Q Copy of On-Site Pathology Services - Wichita - Follow-on 66048 36C25519Q0805 11-13-2019 N 621511 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 Pathology Services

PAGE 1 OF

1. REQUISITION NO.

2. CONTRACT NO.

3. AWARD/EFFECTIVE DATE

4. ORDER NO.

5. SOLICITATION NUMBER

6. SOLICITATION ISSUE DATE

a. NAME

b. TELEPHONE NO. (No Collect Calls)

8. OFFER DUE DATE/LOCAL

TIME

9. ISSUED BY

CODE

10. THIS ACQUISITION IS

UNRESTRICTED OR

SET ASIDE:

% FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION

UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ

IFB

RFP

15. DELIVER TO

CODE

16.

ADMINISTERED BY

CODE

17a. CONTRACTOR/OFFEROR

CODE

FACILITY CODE

18a. PAYMENT WILL BE MADE BY

CODE

TELEPHONE NO.

DUNS:

DUNS+4:

PHONE:

FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b.

SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19.

20.

21.

22.

23.

24.

ITEM NO.

SCHEDULE OF SUPPLIES/SERVICES

QUANTITY

UNIT

UNIT PRICE

AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA

26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA

ARE

ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________

29. AWARD OF CONTRACT: REF. ___________________________________ OFFER

COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND

DATED ________________________________

. YOUR OFFER ON SOLICITATION

DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY

(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE

ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED

SET FORTH HEREIN IS

ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION

(REV. 2/2012)

PREVIOUS EDITION IS NOT USABLE

Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

OFFEROR TO COMPLETE BLOCKS 12, 17,

23, 24, & 30

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS

36C25519Q0805 10- -2019 Donahue-MacDonald, Colleen, Contracting Officer (CO) 913-946-1123 11- -2019 36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048 X Y 621511 $32.5 Million N/A X Robert J.

Dole VAMC 5500 E. Kellogg Ave Wichita, KS 67218

36C255 Department of Veterans Affairs Network Contracting Office (NCO) 15 3450 S 4th Street Trafficway Leavenworth KS 66048

36C255 Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp Austin TX 877-353-9791 512-460-5429 Pathology Services This solicitation is issued under the authority of title 38 U.S.C. 8153 for non-personal services for Pathology services as defined in the solicitation and the Performance Work Statement (PWS). See Section B.2, Schedule of services.

The purpose of this solicitation is to establish an Indefinite Delivery/Indefinite Quantity (IDIQ) contract.

The period of performance: Base Year plus four (4) one (1) year option periods, if authorized by the Contracting Officer.

$0.00 X X Colleen Donahue-MacDonald Contracting Officer Table of Contents

SECTION A3
A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS3
SECTION B - CONTINUATION OF SF 1449 BLOCKS6
B.2 PRICE/COST SCHEDULE8
SECTION C - CONTRACT CLAUSES69
C.1 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)69
C.2 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (OCT 2018)69
C.3 52.216-18 ORDERING (OCT 1995)75
C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)75
C.5 52.216-21 REQUIREMENTS (OCT 1995) ALTERNATE I (APR 1984)76
C.6 52.216-22 INDEFINITE QUANTITY (OCT 1995)77
C.7 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)77
C.8 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)78
C.9 52.232-18 AVAILABILITY OF FUNDS (APR 1984)78
C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)78
C.11 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997)78
C.12 CL-120 SUPPLEMENTAL INSURANCE REQUIREMENTS79
C.13 52.232-40 PROVIDING ACCELERATED PAYMENTS TO SMALL BUSINESS SUBCONTRACTORS (DEC 2013)79
C.14 VAAR 852.211-72 TECHNICAL INDUSTRY STANDARDS (NOV 2018)80
C.15 VAAR 852.217-70 CONTRACT ACTION DEFINITIZATION (JUL 2019)80
C.16 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2018)81
C.17 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008)82
C.18 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984)83
C.19 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008)84
C.20 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (MAY 2019)84
SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS92
SECTION E - SOLICITATION PROVISIONS93
E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (OCT 2018)93
E.2 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998)100
E.3 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (OCT 2018)101
E.4 52.216-1 TYPE OF CONTRACT (APR 1984)102
E.5 52.233-2 SERVICE OF PROTEST (SEP 2006)102
E.6 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008)103
E.7 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016)(DEVIATION)103
E.8 VAAR 852.215-71 EVALUATION FACTOR COMMITMENTS (DEC 2009)104
E.9 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (OCT 2018)104
E.10 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (OCT 2018)105
E.11 VAAR 852.273-73 EVALUATION - HEALTH-CARE RESOURCES (JAN 2003)105
E.12 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (OCT 2018)106

SECTION B - CONTINUATION OF SF 1449 BLOCKS

B.1 CONTRACT ADMINISTRATION DATA

1. Contract Administration: All contract administration matters will be handled by the following individuals:

a. CONTRACTOR (Offerors are required to designate a person for prompt administration):

Name of Company:

Name:____ __
Title:____ __

Address:

_____ _
Fax No.:_ __________ _

DUNS Number: ________________________________

b. GOVERNMENT: Contracting Officer

Colleen Donahue-MacDonald
Department of Veterans Affairs
Network Contracting Office (NCO) 15
3450 South 4th Street
Leavenworth KS 66048
Phone: (913) 946-1123

2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:

[X]52.232-33, Payment by Electronic Funds Transfer -
Other than Central Contractor Registration, or

[] 52.232-36, Payment by Third Party

3. INVOICES: Invoices shall be submitted in arrears:

a. Quarterly[]
b. Semi-Annually[]
c. Other[X] Monthly in arrears

4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.

Department of Veterans Affairs Financial Services Center http://www.fsc.va.gov/einvoice.asp Austin TX

ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

AMENDMENT NO DATE

5. SECURE FAX: In accordance with VA Handbook 6500, the following statement is required on all fax cover sheets; if it is determined the ordering process will include a fax: “This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution or copying of this communication is prohibited. If you have received this fax in error, please notify this office immediately at the telephone number listed above.”

6. POST-AWARD ORIENTATION (Contract Awards Exceeding $1M): The Contracting Officer will schedule a post-award orientation conference for contract orientation purposes as required by Procurement Policy Memorandum (PPM) (https://www.va.gov/oal/docs/business/pps/ppm201901.pdf).

7. SUBCONTRACTING PLAN--MONITORING AND COMPLIANCE (JUN 2011)

This solicitation includes FAR 52.219-9, Small Business Subcontracting Plan, and VAAR 852.219-9, VA Small Business Subcontracting Plan Minimum Requirement. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing the contractor's compliance with the plan, including reviewing the contractor's accomplishments in achieving the subcontracting goals in the plan. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting plan.

B.2 PRICE/COST SCHEDULE

SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform off-site and on-site Pathology/Pathologist Services to eligible beneficiaries of the Robert J. Dole, Department of Veterans Affairs Medical Center (VAMC), Wichita, KS (hereinafter referred to as VAMC). The Contractor shall cover the range of Pathology services meeting or exceeding currently recognized national standards American Board of Medical Specialties (ABMS) www.ABMS.org and the American Board of Pathology http://abpath.org/index.php/to-become-certified/requirements-for-certification.

Contract type is Firm Fixed Price, Indefinite Delivery Indefinite Quantity. Contractor shall price base and option years(s) the same. Contractor will only be compensated for on-call services that are actually performed.

a. The contract line items (CLINs) listed in the price schedules are to identify the anticipated range of test required so as to define scope. The Government cannot predetermine, above the stated minimum, the precise quantities of services the Government will require during the contract period. While it is impossible to accurately forecast the quantity and time of delivery for each CLIN, line items marked with a “- “estimated quantity indicate the test has historically not been performed but does not preclude the test from being ordered at a future time and within stated order limits.

b. The pricing is inclusive of all peripheral services and supplies required for the respective CPT codes as stated in the Performance Work Statement (PWS) to include, but not be limited to reagents, and reading of results.

c. Option years shall be priced at the Medicare rate in effect at the time of the exercising of the option period with the same percentage increase or decrease applied to the Medicare rate as quoted for the base year pricing. Rates will remain the same for the full option period.

Estimated Period of Performance: BASE YEAR: January 1, 2020 to December 31, 2020

CPT codes to be for Off-site services

Contract Line Item

(CLIN)

SUB-CLINs
CPT Code
Description
Medicare Geographic Rates (KS)

Estimated Amount

Unit
% Discount to the Medicare Geographic Rate
Total Price

Pathology Current Procedural Terminology Off-site services

0001A
80500
Clinical pathology consultation; limited, without review of patient’s history and medical records.
$22.31
1
EA
0001B
85060
Blood Smear Interpretation with Report
$24.21
5
EA
0001C
85097
Bone Marrow; Smear Interpretation
$71.76
24
EA
0001D
88104
Cytopathology, fluids, except cervical & Vaginal; smears; global
$66.59
1
EA
0001E
88104-TC
Cytopathology fluids, except cervical & Vaginal; smears; technical component
$37.98
1
EA
0001F
88104-26
Cytopathology, fluids, except cervical & Vaginal; smears; professional component
$28.61
1
EA
0001G
88106
Cytopathology, fluids, except cervical & Vaginal; filter
$60.40
1
EA
0001H
88108
Cytopathology, concentration technique, Smears & Interpret; global
$57.34
3
EA
0001I
88108-TC
Cytopathology, concentration technique, Smears & Interpret; technical component
$34.69
3
EA
0001J
88108-26
Cytopathology, concentration technique, Smears & Interpret; professional component
$22.65
1
EA
0001K
88112
Cytopathology, liquid based slide preparation (SUREPATH); global
$63.96
20
EA
0001L
88112-TC
Cytopathology, liquid based slide preparation (SUREPATH); technical component
$25.24
170
EA
0001M
88112-26
Cytopathology, liquid based slide preparation (SUREPATH); professional component
$30.68
1
EA
0001N
88125
Cytopathology, forensic (eg, sperm)
$0.00
1
EA
0001O
88141
Cytopathology; cervical or vaginal, interpretation by a physician; global
$0.00
25
EA
0001P
88160
Cytopathology; any other source, screen & interpretation; global
$67.38
1
EA
0001Q
88160-TC
Cytopathology; any other source, screen & interpretation; technical component
$41.26
9
EA
0001R
88160-26
Cytopathology; any other source, screen & interpretation; professional component
$26.12
1
EA
0001S
88161
Cytopathology; any other source, preparation, screen & interp.; global
$62.79
1
EA
0001T
88161-TC
Cytopathology; any other source, preparation, screen & interp.; technical component
$37.32
1
EA
0001U
88161-26
Cytopathology; any other source, preparation, screen & interp; professional component.
$25.46
1
EA
0001V
88172
Cytopathology, eval. of fine needle aspirate; deter. adequacy
$54.42
1
EA
0001W
88173
Cytopathology, eval. of fine needle aspirate; interp. And report; global
$145.76
6
EA
0001X
88173-TC
Cytopathology, eval. of fine needle aspirate; interp. And report; technical component
$74.31
49
EA
0001Y
88173-26
Cytopathology, eval. of fine needle aspirate; interp; professional component
$71.44
1
EA
0001Z
88182
Cell Marker study
$126.37
1
EA
0001AA
88184
Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker
$61.51
1
EA
0001AB
88185
Flow Cytometry, each additional marker, tech. only
$22.65
1
EA
0001AC
88187
Flow Cytometry, interpretation; 2 to 8 markers
$37.51
5
EA
0001AD
88188
Flow Cytometry, interpretation; 9 to 15 markers
$63.29
31
EA
0001AE
88189
Flow Cytometry, interpretation; 16 or more markers
$85.04
75
EA
0001AF
88300
Surg. Path., Gross Only, Level I; global
$14.82
18
EA
0001AG
88300-TC
Surg. Path., Gross Only, Level I; technical component
$10.40
1
EA
0001AH
88300-26
Surg. Path., Gross Only, Level I; professional component
$4.42
1
EA
0001AI
88302
Surg. Path., Gross Only, Level II; global
$28.77
13
EA
0001AJ
88302-TC
Surg. Path., Gross Only, Level II; technical component
$21.89
10
EA
0001AK
88302-26
Surg. Path., Gross Only, Level II; professional component
$6.88
1
EA
0001AL
88304
Surg. Path., Gross Only, Level III; global
$37.92
250
EA
0001AM
88304-TC
Surg. Path., Gross Only, Level III; technical component
$26.49
30
EA
0001AN
88304-26
Surg. Path., Gross Only, Level III; professional component
$11.43
1
EA
0001AO
88305
Surg. Path., Gross Only, Level IV; global
$66.11
4114
EA
0001AP
88305-TC
Surg. Path., Gross Only, Level IV; technical component
$27.80
451
EA
0001AQ
88305-26
Surg. Path., Gross Only, Level IV; professional component
$38.31
1
EA
0001AR
88307
Surg. Path., Gross Only, Level V; global
$253.65
145
EA
0001AS
88307-TC
Surg. Path., Gross Only, Level V; technical component
$169.85
16
EA
0001AT
88307-26
Surg. Path., Gross Only, Level V; professional component
$83.80
1
EA
0001AU
88309
Surg. Path., Gross Only, Level IV; global
$386.46
24
EA
0001AV
88309-TC
Surg. Path., Gross Only, Level IV; technical component
$238.37
3
EA
0001AW
88309-26
Surg. Path., Gross Only, Level IV; professional component
$148.10
1
EA
0001AX
88311
Decalcify Tissue; global
$20.58
90
EA
0001AY
88311-TC
Decalcify Tissue; technical component
$8.10
9
EA
0001AZ
88311-26
Decalcify Tissue; professional component
$12.48
1
EA
0001BA
88312
Special Stains, Group I; global
$94.43
319
EA
0001BB
88312-TC
Special Stains, Group I; technical component
$67.53
36
EA
0001BC
88312-26
Special Stains, Group I; professional component
$26.91
1
EA
0001BD
88313
Special Stains, Group II; global
$67.86
118
EA
0001BE
88313-TC
Special Stains, Group II; technical component
$55.71
10
EA
0001BF
88313-26
Special Stains, Group II; professional component
$12.15
1
EA
0001BG
88314
Special Stains, Histochem. w/Frozen Section
$86.59
1
EA
0001BH
88319
Determinative histochemistry or cytochemistry to identify enzyme
$91.45
1
EA
0001BI
88321
Consultation and report on referred slides prepared elsewhere
$97.94
20
EA
0001BJ
88323
Consultation and report on referred material requiring preparation of slides
$113.13
1
EA
0001BK
88325
Consultation, comprehensive, review records with report
$175.75
1
EA
0001BL
88329
Pathology consultation during surgery
$49.98
1
EA
0001BM
88331
Pathology consultation during surgery first tissue block with frozen
$93.68
4
EA
0001BN
88332
Pathology consolation during surgery each additional tissue block with frozen
$51.25
6
EA
0001BO
88333
Pathology consolation during surgery cytologic exam (touch prep) initial
$86.49
1
EA
0001BP
88334
Pathology consolation during surgery cytologic exam (touch prep) initial
$54.00
1
EA
0001BQ
88341
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global
$87.71
653
EA
0001BR
88341-TC
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component
$58.77
70
EA
0001BS
88341-26
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component
$28.94
1
EA
0001BT
88342
Immunohistochemistry (including immunoperoxidase) each antibody; global
$100.75
201
EA
0001BU
88342-TC
Immunohistochemistry (including immunoperoxidase) each antibody; technical component
$64.90
20
EA
0001BV
88342-26
Immunohistochemistry (including immunoperoxidase) each antibody; professional component
$35.85
1
EA
0001BW
88346
Immunofluorescent study, each antibody; direct method
$104.16
1
EA
0001BX
88347
Immunofluorescent study, each antibody; indirect method
$0.00
1
EA
0001BY
88348
Electron microscopy, diagnostic
$337.23
1
EA
0001BZ
88360
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual
$120.60
1
EA
0001CA
88361
M/PHMTRC ALYS TUM IMHCEM ANTB CPTB
$124.86
1
EA
0001CB
88365
SITU HYBRIDIZATIOHN EA PRB
$166.33
1
EA
0001CD
88368
M/PHMTRC ALYS ISH EA PRB MNL
$120.37
1
EA

Total CLIN 001

Description

KEY PERSONNEL

CLIN

SUB-CLINs

.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services

70
HR
002A
N/A
Name:

HR

Rank:

002B
N/A
Name:

HR

Rank:

Total CLIN 002

70
HR

Estimated Period of Performance: OPTION 1: January 1, 2021 to December 31, 2021

CPT codes to be for Off-site services

Contract Line Item

SUB-CLINs
CPT Code
Description
Medicare Geographic Rates (KS)

Estimated Amount

Unit
% Discount to the Medicare Geographic Rate
Total Price

Pathology Current Procedural Terminology Off-site services

1001A
80500
Clinical pathology consultation; limited, without review of patient’s history and medical records.
$22.31
1
EA
1001B
85060
Blood Smear Interpretation with Report
$24.21
5
EA
1001C
85097
Bone Marrow; Smear Interpretation
$71.76
24
EA
1001D
88104
Cytopathology, fluids, except cervical & Vaginal; smears; global
$66.59
1
EA
1001E
88104-TC
Cytopathology fluids, except cervical & Vaginal; smears; technical component
$37.98
1
EA
1001F
88104-26
Cytopathology, fluids, except cervical & Vaginal; smears; professional component
$28.61
1
EA
1001G
88106
Cytopathology, fluids, except cervical & Vaginal; filter
$60.40
1
EA
1001H
88108
Cytopathology, concentration technique, Smears & Interpret; global
$57.34
3
EA
1001I
88108-TC
Cytopathology, concentration technique, Smears & Interpret; technical component
$34.69
3
EA
1001J
88108-26
Cytopathology, concentration technique, Smears & Interpret; professional component
$22.65
1
EA
1001K
88112
Cytopathology, liquid based slide preparation (SUREPATH); global
$63.96
20
EA
1001L
88112-TC
Cytopathology, liquid based slide preparation (SUREPATH); technical component
$25.24
170
EA
1001M
88112-26
Cytopathology, liquid based slide preparation (SUREPATH); professional component
$30.68
1
EA
1001N
88125
Cytopathology, forensic (eg, sperm)
$0.00
1
EA
1001O
88141
Cytopathology; cervical or vaginal, interpretation by a physician; global
$0.00
25
EA
1001P
88160
Cytopathology; any other source, screen & interpretation; global
$67.38
1
EA
1001Q
88160-TC
Cytopathology; any other source, screen & interpretation; technical component
$41.26
9
EA
1001R
88160-26
Cytopathology; any other source, screen & interpretation; professional component
$26.12
1
EA
1001S
88161
Cytopathology; any other source, preparation, screen & interp.; global
$62.79
1
EA
1001T
88161-TC
Cytopathology; any other source, preparation, screen & interp.; technical component
$37.32
1
EA
1001U
88161-26
Cytopathology; any other source, preparation, screen & interp; professional component.
$25.46
1
EA
1001V
88172
Cytopathology, eval. of fine needle aspirate; deter. adequacy
$54.42
1
EA
1001W
88173
Cytopathology, eval. of fine needle aspirate; interp. And report; global
$145.76
6
EA
1001X
88173-TC
Cytopathology, eval. of fine needle aspirate; interp. And report; technical component
$74.31
49
EA
1001Y
88173-26
Cytopathology, eval. of fine needle aspirate; interp; professional component
$71.44
1
EA
1001Z
88182
Cell Marker study
$126.37
1
EA
1001AA
88184
Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker
$61.51
1
EA
1001AB
88185
Flow Cytometry, each additional marker, tech. only
$22.65
1
EA
1001AC
88187
Flow Cytometry, interpretation; 2 to 8 markers
$37.51
5
EA
1001AD
88188
Flow Cytometry, interpretation; 9 to 15 markers
$63.29
31
EA
1001AE
88189
Flow Cytometry, interpretation; 16 or more markers
$85.04
75
EA
1001AF
88300
Surg. Path., Gross Only, Level I; global
$14.82
18
EA
1001AG
88300-TC
Surg. Path., Gross Only, Level I; technical component
$10.40
1
EA
1001AH
88300-26
Surg. Path., Gross Only, Level I; professional component
$4.42
1
EA
1001AI
88302
Surg. Path., Gross Only, Level II; global
$28.77
13
EA
1001AJ
88302-TC
Surg. Path., Gross Only, Level II; technical component
$21.89
10
EA
1001AK
88302-26
Surg. Path., Gross Only, Level II; professional component
$6.88
1
EA
1001AL
88304
Surg. Path., Gross Only, Level III; global
$37.92
250
EA
1001AM
88304-TC
Surg. Path., Gross Only, Level III; technical component
$26.49
30
EA
1001AN
88304-26
Surg. Path., Gross Only, Level III; professional component
$11.43
1
EA
1001AO
88305
Surg. Path., Gross Only, Level IV; global
$66.11
4114
EA
1001AP
88305-TC
Surg. Path., Gross Only, Level IV; technical component
$27.80
451
EA
1001AQ
88305-26
Surg. Path., Gross Only, Level IV; professional component
$38.31
1
EA
1001AR
88307
Surg. Path., Gross Only, Level V; global
$253.65
145
EA
1001AS
88307-TC
Surg. Path., Gross Only, Level V; technical component
$169.85
16
EA
1001AT
88307-26
Surg. Path., Gross Only, Level V; professional component
$83.80
1
EA
1001AU
88309
Surg. Path., Gross Only, Level IV; global
$386.46
24
EA
1001AV
88309-TC
Surg. Path., Gross Only, Level IV; technical component
$238.37
3
EA
1001AW
88309-26
Surg. Path., Gross Only, Level IV; professional component
$148.10
1
EA
1001AX
88311
Decalcify Tissue; global
$20.58
90
EA
1001AY
88311-TC
Decalcify Tissue; technical component
$8.10
9
EA
1001AZ
88311-26
Decalcify Tissue; professional component
$12.48
1
EA
1001BA
88312
Special Stains, Group I; global
$94.43
319
EA
1001BB
88312-TC
Special Stains, Group I; technical component
$67.53
36
EA
1001BC
88312-26
Special Stains, Group I; professional component
$26.91
1
EA
1001BD
88313
Special Stains, Group II; global
$67.86
118
EA
1001BE
88313-TC
Special Stains, Group II; technical component
$55.71
10
EA
1001BF
88313-26
Special Stains, Group II; professional component
$12.15
1
EA
1001BG
88314
Special Stains, Histochem. w/Frozen Section
$86.59
1
EA
1001BH
88319
Determinative histochemistry or cytochemistry to identify enzyme
$91.45
1
EA
1001BI
88321
Consultation and report on referred slides prepared elsewhere
$97.94
20
EA
1001BJ
88323
Consultation and report on referred material requiring preparation of slides
$113.13
1
EA
1001BK
88325
Consultation, comprehensive, review records with report
$175.75
1
EA
1001BL
88329
Pathology consultation during surgery
$49.98
1
EA
1001BM
88331
Pathology consultation during surgery first tissue block with frozen
$93.68
4
EA
1001BN
88332
Pathology consolation during surgery each additional tissue block with frozen
$51.25
6
EA
1001BO
88333
Pathology consolation during surgery cytologic exam (touch prep) initial
$86.49
1
EA
1001BP
88334
Pathology consolation during surgery cytologic exam (touch prep) initial
$54.00
1
EA
1001BQ
88341
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global
$87.71
653
EA
1001BR
88341-TC
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component
$58.77
70
EA
1001BS
88341-26
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component
$28.94
1
EA
1001BT
88342
Immunohistochemistry (including immunoperoxidase) each antibody; global
$100.75
201
EA
1001BU
88342-TC
Immunohistochemistry (including immunoperoxidase) each antibody; technical component
$64.90
20
EA
1001BV
88342-26
Immunohistochemistry (including immunoperoxidase) each antibody; professional component
$35.85
1
EA
1001BW
88346
Immunofluorescent study, each antibody; direct method
$104.16
1
EA
1001BX
88347
Immunofluorescent study, each antibody; indirect method
$0.00
1
EA
1001BY
88348
Electron microscopy, diagnostic
$337.23
1
EA
1001BZ
88360
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual
$120.60
1
EA
1001CA
88361
M/PHMTRC ALYS TUM IMHCEM ANTB CPTB
$124.86
1
EA
1001CB
88365
SITU HYBRIDIZATIOHN EA PRB
$166.33
1
EA
1001CD
88368
M/PHMTRC ALYS ISH EA PRB MNL
$120.37
1
EA

Total CLIN 1001

Description

KEY PERSONNEL

CLIN

SUB-CLINs

.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services

70
HR
1002A
N/A
Name:

HR

Rank:

1002B
N/A
Name:

HR

Rank:

Total CLIN 1002

70
HR

Estimated Period of Performance: OPTION 2: January 1, 2022 to December 31, 2022

CPT codes to be for Off-site services

Contract Line Item

SUB-CLINs
CPT Code
Description
Medicare Geographic Rates (KS)
Estimated Amount
Unit
% Discount to the Medicare Geographic Rate
Total Price

Pathology Current Procedural Terminology Off-site services

2001A
80500
Clinical pathology consultation; limited, without review of patient’s history and medical records.
$22.31
1
EA
2001B
85060
Blood Smear Interpretation with Report
$24.21
5
EA
2001C
85097
Bone Marrow; Smear Interpretation
$71.76
24
EA
2001D
88104
Cytopathology, fluids, except cervical & Vaginal; smears; global
$66.59
1
EA
2001E
88104-TC
Cytopathology fluids, except cervical & Vaginal; smears; technical component
$37.98
1
EA
2001F
88104-26
Cytopathology, fluids, except cervical & Vaginal; smears; professional component
$28.61
1
EA
2001G
88106
Cytopathology, fluids, except cervical & Vaginal; filter
$60.40
1
EA
2001H
88108
Cytopathology, concentration technique, Smears & Interpret; global
$57.34
3
EA
2001I
88108-TC
Cytopathology, concentration technique, Smears & Interpret; technical component
$34.69
3
EA
2001J
88108-26
Cytopathology, concentration technique, Smears & Interpret; professional component
$22.65
1
EA
2001K
88112
Cytopathology, liquid based slide preparation (SUREPATH); global
$63.96
20
EA
2001L
88112-TC
Cytopathology, liquid based slide preparation (SUREPATH); technical component
$25.24
170
EA
2001M
88112-26
Cytopathology, liquid based slide preparation (SUREPATH); professional component
$30.68
1
EA
2001N
88125
Cytopathology, forensic (eg, sperm)
$0.00
1
EA
2001O
88141
Cytopathology; cervical or vaginal, interpretation by a physician; global
$0.00
25
EA
2001P
88160
Cytopathology; any other source, screen & interpretation; global
$67.38
1
EA
2001Q
88160-TC
Cytopathology; any other source, screen & interpretation; technical component
$41.26
9
EA
2001R
88160-26
Cytopathology; any other source, screen & interpretation; professional component
$26.12
1
EA
2001S
88161
Cytopathology; any other source, preparation, screen & interp.; global
$62.79
1
EA
2001T
88161-TC
Cytopathology; any other source, preparation, screen & interp.; technical component
$37.32
1
EA
2001U
88161-26
Cytopathology; any other source, preparation, screen & interp; professional component.
$25.46
1
EA
2001V
88172
Cytopathology, eval. of fine needle aspirate; deter. adequacy
$54.42
1
EA
2001W
88173
Cytopathology, eval. of fine needle aspirate; interp. And report; global
$145.76
6
EA
2001X
88173-TC
Cytopathology, eval. of fine needle aspirate; interp. And report; technical component
$74.31
49
EA
2001Y
88173-26
Cytopathology, eval. of fine needle aspirate; interp; professional component
$71.44
1
EA
2001Z
88182
Cell Marker study
$126.37
1
EA
2001AA
88184
Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker
$61.51
1
EA
2001AB
88185
Flow Cytometry, each additional marker, tech. only
$22.65
1
EA
2001AC
88187
Flow Cytometry, interpretation; 2 to 8 markers
$37.51
5
EA
2001AD
88188
Flow Cytometry, interpretation; 9 to 15 markers
$63.29
31
EA
2001AE
88189
Flow Cytometry, interpretation; 16 or more markers
$85.04
75
EA
2001AF
88300
Surg. Path., Gross Only, Level I; global
$14.82
18
EA
2001AG
88300-TC
Surg. Path., Gross Only, Level I; technical component
$10.40
1
EA
2001AH
88300-26
Surg. Path., Gross Only, Level I; professional component
$4.42
1
EA
2001AI
88302
Surg. Path., Gross Only, Level II; global
$28.77
13
EA
2001AJ
88302-TC
Surg. Path., Gross Only, Level II; technical component
$21.89
10
EA
2001AK
88302-26
Surg. Path., Gross Only, Level II; professional component
$6.88
1
EA
2001AL
88304
Surg. Path., Gross Only, Level III; global
$37.92
250
EA
2001AM
88304-TC
Surg. Path., Gross Only, Level III; technical component
$26.49
30
EA
2001AN
88304-26
Surg. Path., Gross Only, Level III; professional component
$11.43
1
EA
2001AO
88305
Surg. Path., Gross Only, Level IV; global
$66.11
4114
EA
2001AP
88305-TC
Surg. Path., Gross Only, Level IV; technical component
$27.80
451
EA
2001AQ
88305-26
Surg. Path., Gross Only, Level IV; professional component
$38.31
1
EA
2001AR
88307
Surg. Path., Gross Only, Level V; global
$253.65
145
EA
2001AS
88307-TC
Surg. Path., Gross Only, Level V; technical component
$169.85
16
EA
2001AT
88307-26
Surg. Path., Gross Only, Level V; professional component
$83.80
1
EA
2001AU
88309
Surg. Path., Gross Only, Level IV; global
$386.46
24
EA
2001AV
88309-TC
Surg. Path., Gross Only, Level IV; technical component
$238.37
3
EA
2001AW
88309-26
Surg. Path., Gross Only, Level IV; professional component
$148.10
1
EA
2001AX
88311
Decalcify Tissue; global
$20.58
90
EA
2001AY
88311-TC
Decalcify Tissue; technical component
$8.10
9
EA
2001AZ
88311-26
Decalcify Tissue; professional component
$12.48
1
EA
2001BA
88312
Special Stains, Group I; global
$94.43
319
EA
2001BB
88312-TC
Special Stains, Group I; technical component
$67.53
36
EA
2001BC
88312-26
Special Stains, Group I; professional component
$26.91
1
EA
2001BD
88313
Special Stains, Group II; global
$67.86
118
EA
2001BE
88313-TC
Special Stains, Group II; technical component
$55.71
10
EA
2001BF
88313-26
Special Stains, Group II; professional component
$12.15
1
EA
2001BG
88314
Special Stains, Histochem. w/Frozen Section
$86.59
1
EA
2001BH
88319
Determinative histochemistry or cytochemistry to identify enzyme
$91.45
1
EA
2001BI
88321
Consultation and report on referred slides prepared elsewhere
$97.94
20
EA
2001BJ
88323
Consultation and report on referred material requiring preparation of slides
$113.13
1
EA
2001BK
88325
Consultation, comprehensive, review records with report
$175.75
1
EA
2001BL
88329
Pathology consultation during surgery
$49.98
1
EA
2001BM
88331
Pathology consultation during surgery first tissue block with frozen
$93.68
4
EA
2001BN
88332
Pathology consolation during surgery each additional tissue block with frozen
$51.25
6
EA
2001BO
88333
Pathology consolation during surgery cytologic exam (touch prep) initial
$86.49
1
EA
2001BP
88334
Pathology consolation during surgery cytologic exam (touch prep) initial
$54.00
1
EA
2001BQ
88341
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global
$87.71
653
EA
2001BR
88341-TC
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component
$58.77
70
EA
2001BS
88341-26
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component
$28.94
1
EA
2001BT
88342
Immunohistochemistry (including immunoperoxidase) each antibody; global
$100.75
201
EA
2001BU
88342-TC
Immunohistochemistry (including immunoperoxidase) each antibody; technical component
$64.90
20
EA
2001BV
88342-26
Immunohistochemistry (including immunoperoxidase) each antibody; professional component
$35.85
1
EA
2001BW
88346
Immunofluorescent study, each antibody; direct method
$104.16
1
EA
2001BX
88347
Immunofluorescent study, each antibody; indirect method
$0.00
1
EA
2001BY
88348
Electron microscopy, diagnostic
$337.23
1
EA
2001BZ
88360
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual
$120.60
1
EA
2001CA
88361
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure
$124.86
1
EA
2001CB
88365
SITU hybridization ea PRB
$166.33
1
EA
2001CD
88368
M/PHMTRC ALYS ISH EA PRB MNL
$120.37
1
EA

Total CLIN 2001

Description

CLIN

.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services

KEY PERSONNEL

2002A
N/A
Name

HR

Rank

2002B
N/A
Name

HR

Rank

Total CLIN 2002

HR

Estimated Period of Performance: OPTION 3: January 1, 2023 to December 31, 2023

CPT codes to be for Off-site services

Contract Line Item

SUB-CLINs
CPT Code
Description
Medicare Geographic Rates (KS)

Estimated Amount

Unit
% Discount to the Medicare Geographic Rate
Total Price

Pathology Current Procedural Terminology Off-site services

3001A
80500
Clinical pathology consultation; limited, without review of patient’s history and medical records.
$22.31
5
EA
3001B
85060
Blood Smear Interpretation with Report
$24.21
24
EA
3001C
85097
Bone Marrow; Smear Interpretation
$71.76
1
EA
3001D
88104
Cytopathology, fluids, except cervical & Vaginal; smears; global
$66.59
1
EA
3001E
88104-TC
Cytopathology fluids, except cervical & Vaginal; smears; technical component
$37.98
1
EA
3001F
88104-26
Cytopathology, fluids, except cervical & Vaginal; smears; professional component
$28.61
1
EA
3001G
88106
Cytopathology, fluids, except cervical & Vaginal; filter
$60.40
3
EA
3001H
88108
Cytopathology, concentration technique, Smears & Interpret; global
$57.34
3
EA
3001I
88108-TC
Cytopathology, concentration technique, Smears & Interpret; technical component
$34.69
1
EA
3001J
88108-26
Cytopathology, concentration technique, Smears & Interpret; professional component
$22.65
20
EA
3001K
88112
Cytopathology, liquid based slide preparation (SUREPATH); global
$63.96
170
EA
3001L
88112-TC
Cytopathology, liquid based slide preparation (SUREPATH); technical component
$25.24
1
EA
3001M
88112-26
Cytopathology, liquid based slide preparation (SUREPATH); professional component
$30.68
1
EA
3001N
88125
Cytopathology, forensic (eg, sperm)
$0.00
25
EA
3001O
88141
Cytopathology; cervical or vaginal, interpretation by a physician; global
$0.00
1
EA
3001P
88160
Cytopathology; any other source, screen & interpretation; global
$67.38
9
EA
3001Q
88160-TC
Cytopathology; any other source, screen & interpretation; technical component
$41.26
1
EA
3001R
88160-26
Cytopathology; any other source, screen & interpretation; professional component
$26.12
1
EA
3001S
88161
Cytopathology; any other source, preparation, screen & interp.; global
$62.79
1
EA
3001T
88161-TC
Cytopathology; any other source, preparation, screen & interp.; technical component
$37.32
1
EA
3001U
88161-26
Cytopathology; any other source, preparation, screen & interp; professional component.
$25.46
1
EA
3001V
88172
Cytopathology, eval. of fine needle aspirate; deter. adequacy
$54.42
6
EA
3001W
88173
Cytopathology, eval. of fine needle aspirate; interp. And report; global
$145.76
49
EA
3001X
88173-TC
Cytopathology, eval. of fine needle aspirate; interp. And report; technical component
$74.31
1
EA
3001Y
88173-26
Cytopathology, eval. of fine needle aspirate; interp; professional component
$71.44
1
EA
3001Z
88182
Cell Marker study
$126.37
1
EA
3001AA
88184
Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker
$61.51
1
EA
3001AB
88185
Flow Cytometry, each additional marker, tech. only
$22.65
5
EA
3001AC
88187
Flow Cytometry, interpretation; 2 to 8 markers
$37.51
31
EA
3001AD
88188
Flow Cytometry, interpretation; 9 to 15 markers
$63.29
75
EA
3001AE
88189
Flow Cytometry, interpretation; 16 or more markers
$85.04
18
EA
3001AF
88300
Surg. Path., Gross Only, Level I; global
$14.82
1
EA
3001AG
88300-TC
Surg. Path., Gross Only, Level I; technical component
$10.40
1
EA
3001AH
88300-26
Surg. Path., Gross Only, Level I; professional component
$4.42
13
EA
3001AI
88302
Surg. Path., Gross Only, Level II; global
$28.77
10
EA
3001AJ
88302-TC
Surg. Path., Gross Only, Level II; technical component
$21.89
1
EA
3001AK
88302-26
Surg. Path., Gross Only, Level II; professional component
$6.88
250
EA
3001AL
88304
Surg. Path., Gross Only, Level III; global
$37.92
30
EA
3001AM
88304-TC
Surg. Path., Gross Only, Level III; technical component
$26.49
1
EA
3001AN
88304-26
Surg. Path., Gross Only, Level III; professional component
$11.43
4114
EA
3001AO
88305
Surg. Path., Gross Only, Level IV; global
$66.11
451
EA
3001AP
88305-TC
Surg. Path., Gross Only, Level IV; technical component
$27.80
1
EA
3001AQ
88305-26
Surg. Path., Gross Only, Level IV; professional component
$38.31
145
EA
3001AR
88307
Surg. Path., Gross Only, Level V; global
$253.65
16
EA
3001AS
88307-TC
Surg. Path., Gross Only, Level V; technical component
$169.85
1
EA
3001AT
88307-26
Surg. Path., Gross Only, Level V; professional component
$83.80
24
EA
3001AU
88309
Surg. Path., Gross Only, Level IV; global
$386.46
3
EA
3001AV
88309-TC
Surg. Path., Gross Only, Level IV; technical component
$238.37
1
EA
3001AW
88309-26
Surg. Path., Gross Only, Level IV; professional component
$148.10
90
EA
3001AX
88311
Decalcify Tissue; global
$20.58
9
EA
3001AY
88311-TC
Decalcify Tissue; technical component
$8.10
1
EA
3001AZ
88311-26
Decalcify Tissue; professional component
$12.48
319
EA
3001BA
88312
Special Stains, Group I; global
$94.43
36
EA
3001BB
88312-TC
Special Stains, Group I; technical component
$67.53
1
EA
3001BC
88312-26
Special Stains, Group I; professional component
$26.91
118
EA

3001BD

88313
Special Stains, Group II; global
$67.86
10
EA
3001BE
88313-TC
Special Stains, Group II; technical component
$55.71
1
EA
3001BF
88313-26
Special Stains, Group II; professional component
$12.15
1
EA
3001BG
88314
Special Stains, Histochem. w/Frozen Section
$86.59
1
EA
3001BH
88319
Determinative histochemistry or cytochemistry to identify enzyme
$91.45
20
EA
3001BI
88321
Consultation and report on referred slides prepared elsewhere
$97.94
1
EA
3001BJ
88323
Consultation and report on referred material requiring preparation of slides
$113.13
1
EA
3001BK
88325
Consultation, comprehensive, review records with report
$175.75
1
EA
3001BL
88329
Pathology consultation during surgery
$49.98
4
EA
3001BM
88331
Pathology consultation during surgery first tissue block with frozen
$93.68
6
EA
3001BN
88332
Pathology consolation during surgery each additional tissue block with frozen
$51.25
1
EA
3001BO
88333
Pathology consolation during surgery cytologic exam (touch prep) initial
$86.49
1
EA
3001BP
88334
Pathology consolation during surgery cytologic exam (touch prep) initial
$54.00
653
EA
3001BQ
88341
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global
$87.71
70
EA
3001BR
88341-TC
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component
$58.77
1
EA
3001BS
88341-26
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component
$28.94
201
EA
3001BT
88342
Immunohistochemistry (including immunoperoxidase) each antibody; global
$100.75
20
EA
3001BU
88342-TC
Immunohistochemistry (including immunoperoxidase) each antibody; technical component
$64.90
1
EA
3001BV
88342-26
Immunohistochemistry (including immunoperoxidase) each antibody; professional component
$35.85
1
EA
3001BW
88346
Immunofluorescent study, each antibody; direct method
$104.16
1
EA
3001BX
88347
Immunofluorescent study, each antibody; indirect method
$0.00
1
EA
3001BY
88348
Electron microscopy, diagnostic
$337.23
1
EA
3001BZ
88360
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual
$120.60
1
EA
3001CA
88361
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure
$124.86
1
EA
3001CB
88365
SITU hybridization ea PRB
$166.33
1
EA
3001CD
88368
M/PHMTRC ALYS ISH EA PRB MNL
$120.37
5
EA

Total CLIN 3001

On-site Services

CLIN

.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology services

70
HR

KEY PERSONNEL

3002A
N/A
Name:

HR

Rank:

3002B
N/A
Name:

HR

Rank:

Total CLIN 3002

HR

Estimated Period of Performance: OPTION 4: January 1, 2024 to December 31, 2024

CPT codes to be for Off-site services

Contract Line Item

SUB-CLINs
CPT Code
Description
Medicare Geographic Rates (KS)

Unit

Estimated Amount

% Discount to the Medicare Geographic Rate
Total Price

Pathology Current Procedural Terminology Off-site services

4001A
80500
Clinical pathology consultation; limited, without review of patient’s history and medical records.
$22.31
5
EA
4001B
85060
Blood Smear Interpretation with Report
$24.21
24
EA
4001C
85097
Bone Marrow; Smear Interpretation
$71.76
1
EA
4001D
88104
Cytopathology, fluids, except cervical & Vaginal; smears; global
$66.59
1
EA
4001E
88104-TC
Cytopathology fluids, except cervical & Vaginal; smears; technical component
$37.98
1
EA
4001F
88104-26
Cytopathology, fluids, except cervical & Vaginal; smears; professional component
$28.61
1
EA
4001G
88106
Cytopathology, fluids, except cervical & Vaginal; filter
$60.40
3
EA
4001H
88108
Cytopathology, concentration technique, Smears & Interpret; global
$57.34
3
EA
4001I
88108-TC
Cytopathology, concentration technique, Smears & Interpret; technical component
$34.69
1
EA
4001J
88108-26
Cytopathology, concentration technique, Smears & Interpret; professional component
$22.65
20
EA
4001K
88112
Cytopathology, liquid based slide preparation (SUREPATH); global
$63.96
170
EA
4001L
88112-TC
Cytopathology, liquid based slide preparation (SUREPATH); technical component
$25.24
1
EA
4001M
88112-26
Cytopathology, liquid based slide preparation (SUREPATH); professional component
$30.68
1
EA
4001N
88125
Cytopathology, forensic (eg, sperm)
$0.00
25
EA
4001O
88141
Cytopathology; cervical or vaginal, interpretation by a physician; global
$0.00
1
EA
4001P
88160
Cytopathology; any other source, screen & interpretation; global
$67.38
9
EA
4001Q
88160-TC
Cytopathology; any other source, screen & interpretation; technical component
$41.26
1
EA
4001R
88160-26
Cytopathology; any other source, screen & interpretation; professional component
$26.12
1
EA
4001S
88161
Cytopathology; any other source, preparation, screen & interp.; global
$62.79
1
EA
4001T
88161-TC
Cytopathology; any other source, preparation, screen & interp.; technical component
$37.32
1
EA
4001U
88161-26
Cytopathology; any other source, preparation, screen & interp; professional component.
$25.46
1
EA
4001V
88172
Cytopathology, eval. of fine needle aspirate; deter. adequacy
$54.42
6
EA
4001W
88173
Cytopathology, eval. of fine needle aspirate; interp. And report; global
$145.76
49
EA
4001X
88173-TC
Cytopathology, eval. of fine needle aspirate; interp. And report; technical component
$74.31
1
EA
4001Y
88173-26
Cytopathology, eval. of fine needle aspirate; interp; professional component
$71.44
1
EA
4001Z
88182
Cell Marker study
$126.37
1
EA
4001AA
88184
Flow Cytometry, cell, cytoplasmic, nuclear marker tech. only: first marker
$61.51
1
EA
4001AB
88185
Flow Cytometry, each additional marker, tech. only
$22.65
5
EA
4001AC
88187
Flow Cytometry, interpretation; 2 to 8 markers
$37.51
31
EA
4001AD
88188
Flow Cytometry, interpretation; 9 to 15 markers
$63.29
75
EA
4001AE
88189
Flow Cytometry, interpretation; 16 or more markers
$85.04
18
EA
4001AF
88300
Surg. Path., Gross Only, Level I; global
$14.82
1
EA
4001AG
88300-TC
Surg. Path., Gross Only, Level I; technical component
$10.40
1
EA
4001AH
88300-26
Surg. Path., Gross Only, Level I; professional component
$4.42
13
EA
4001AI
88302
Surg. Path., Gross Only, Level II; global
$28.77
10
EA
4001AJ
88302-TC
Surg. Path., Gross Only, Level II; technical component
$21.89
1
EA
4001AK
88302-26
Surg. Path., Gross Only, Level II; professional component
$6.88
250
EA
4001AL
88304
Surg. Path., Gross Only, Level III; global
$37.92
30
EA
4001AM
88304-TC
Surg. Path., Gross Only, Level III; technical component
$26.49
1
EA
4001AN
88304-26
Surg. Path., Gross Only, Level III; professional component
$11.43
4114
EA
4001AO
88305
Surg. Path., Gross Only, Level IV; global
$66.11
451
EA
4001AP
88305-TC
Surg. Path., Gross Only, Level IV; technical component
$27.80
1
EA
4001AQ
88305-26
Surg. Path., Gross Only, Level IV; professional component
$38.31
145
EA
4001AR
88307
Surg. Path., Gross Only, Level V; global
$253.65
16
EA
4001AS
88307-TC
Surg. Path., Gross Only, Level V; technical component
$169.85
1
EA
4001AT
88307-26
Surg. Path., Gross Only, Level V; professional component
$83.80
24
EA
4001AU
88309
Surg. Path., Gross Only, Level IV; global
$386.46
3
EA
4001AV
88309-TC
Surg. Path., Gross Only, Level IV; technical component
$238.37
1
EA
4001AW
88309-26
Surg. Path., Gross Only, Level IV; professional component
$148.10
90
EA
4001AX
88311
Decalcify Tissue; global
$20.58
9
EA
4001AY
88311-TC
Decalcify Tissue; technical component
$8.10
1
EA
4001AZ
88311-26
Decalcify Tissue; professional component
$12.48
319
EA
4001BA
88312
Special Stains, Group I; global
$94.43
36
EA
4001BB
88312-TC
Special Stains, Group I; technical component
$67.53
1
EA
4001BC
88312-26
Special Stains, Group I; professional component
$26.91
118
EA
4001BD
88313
Special Stains, Group II; global
$67.86
10
EA
4001BE
88313-TC
Special Stains, Group II; technical component
$55.71
1
EA
4001BF
88313-26
Special Stains, Group II; professional component
$12.15
1
EA
4001BG
88314
Special Stains, Histochem. w/Frozen Section
$86.59
1
EA
4001BH
88319
Determinative histochemistry or cytochemistry to identify enzyme
$91.45
20
EA
4001BI
88321
Consultation and report on referred slides prepared elsewhere
$97.94
1
EA
4001BJ
88323
Consultation and report on referred material requiring preparation of slides
$113.13
1
EA
4001BK
88325
Consultation, comprehensive, review records with report
$175.75
1
EA
4001BL
88329
Pathology consultation during surgery
$49.98
4
EA
4001BM
88331
Pathology consultation during surgery first tissue block with frozen
$93.68
6
EA
4001BN
88332
Pathology consolation during surgery each additional tissue block with frozen
$51.25
1
EA
4001BO
88333
Pathology consolation during surgery cytologic exam (touch prep) initial
$86.49
1
EA
4001BP
88334
Pathology consolation during surgery cytologic exam (touch prep) initial
$54.00
653
EA
4001BQ
88341
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); global
$87.71
70
EA
4001BR
88341-TC
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); technical component
$58.77
1
EA
4001BS
88341-26
Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain procedure (List separately in addition to code for primary procedure); professional component
$28.94
201
EA
4001BT
88342
Immunohistochemistry (including immunoperoxidase) each antibody; global
$100.75
20
EA
4001BU
88342-TC
Immunohistochemistry (including immunoperoxidase) each antibody; technical component
$64.90
1
EA
4001BV
88342-26
Immunohistochemistry (including immunoperoxidase) each antibody; professional component
$35.85
1
EA
4001BW
88346
Immunofluorescent study, each antibody; direct method
$104.16
1
EA
4001BX
88347
Immunofluorescent study, each antibody; indirect method
$0.00
1
EA
4001BY
88348
Electron microscopy, diagnostic
$337.23
1
EA
4001BZ
88360
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, each antibody, manual
$120.60
1
EA
4001CA
88361
Morphometric analysis, tumor immunohistochemistry, quantitative or semiquantitative, per specimen, each single antibody stain procedure
$124.86
1
EA
4001CB
88365
SITU hybridization ea PRB
$166.33
1
EA
4001CD
88368
M/PHMTRC ALYS ISH EA PRB MNL
$120.37
1
EA

Total CLIN 4001

On-site Services

CLIN

.033 FTE Board Certified/Board Eligible Pathologist to perform on-site Pathology Services

KEY PERSONNEL

4002A
N/A
Name:

HR

Rank:

4002B
N/A
Name:

HR

Rank:

Estimated total for Base year $_______________________

Estimated total for Option Year 1 $_______________________

Estimated total for Option Year 2 $_______________________

Estimated total for Option…

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