Attachment 2 - Schedule.pdf

Version 0002 Date 4/12/2020

PATHOLOGY AND LABORATORY MEDICINE SERVICE

PATHOLOGY SERVICES CONTRACT

PERFORMANCE WORK STATEMENT (PWS)

SCHEDULE OF SERVICES

The Contractor shall furnish all personnel to provide services necessary to perform Pathology Services to eligible beneficiaries of the Department of Veterans Affairs Medical Center, Fort Meade and Hot Springs

(hereinafter referred to as VAMC). The Contractor’s pathologists shall cover the range of Pathology services as would be provided in a state-of-the-art civilian medical treatment facility and the standard of care shall be of a quality, meeting or exceeding currently recognized national standards as established by

The College of American Pathologists (CAP): https://www.cap.org/laboratory-improvement/accreditation

Place of Performance: Services shall be provided at the Contractor’s place of business, and when needed on site at Fort Meade VAMC, 113 Comanche Road, Fort Meade, SD 57741 and at Hot Springs VAMC, 500 North 5th Street, Hot Springs, SD 57747

Pricing Instructions: The offeror is instructed to edit the number of sub-clins to correspond with the number of pathology services offered for the contract line item number (CLIN). Affiliate Offerors shall include a service description, CPT code (if available) and Medicare reimbursement rate for the service submitted. Other commercial health care Offerors shall include a service description, CPT code (if available) and Medicare reimbursement rate for the service submitted. Also, renumber SUB-CLINs if adding or removing pathology services.

The offeror is instructed to include all other than price and cost information supporting the proposed price as directed in Instructions to Offerors addendum to 52.212-1 and/or Section D- Contract Documents, Exhibits, or attachments.

The Contractor shall propose a minimum level of pathology services to meet the requirements of the contract.

Period of Performance: BASE YEAR: __October 1, 2020_ to _September 30, 2021__

CLIN

No.

Sub-

CLIN

CPT Description Est.

Qty. Unit

Unit Cost

Total Annual Cost

0001 None None Clinical Pathologist on site review of Laboratory quality assurance documentation at Fort Meade and Hot Springs

150 Hours

0002 None On site representation during accreditation inspections at Fort Meade and Hot Springs

4 Hours

0003 Necropsy Services

0003a Charge for gross autopsy performed at Rapid City Regional Hospital

5 Each

0003b Charge for autopsy processing, clerical, pathologist interpretations

5 Each

0003C

Morgue use fee at Rapid City Regional Hospital (Includes diener services and housekeeping)

5 Each

None

None

None

None https://www.cap.org/laboratory-improvement/accreditation

0004 Professional Consultation

0004a

Specialized Pathologist consultation with VA BHHCS Provider. Normal business hours, on site and off site.

10 Hours

0004b

Specialized Pathologist consultation with VA BHHCS Provider. Outside normal business hours, off site only with 2-hour minimum charge.

10 Hours

0005 None Pathology Services billed per current procedural terminology (CPT) code

0005a 81210 B-Raf enzyme molecular marker, BRAF 2 Each

0005b 81235 Epidermal growth factor receptor molecular marker, EGFR gene variant 3 Each

0005c 81301 Microsatellite instability, MSI 2 Each

0005d 81479 Molecular pathology procedure, unlisted 2 Each

0005e 82365 Calculus; infrared spectroscopy 25 Each

0005f 85060 Blood smear, peripheral, interpretation by Pathologist with written report

118 Each

0005g 87491

Chlamydia trachomatis Aptima assay, C.T.

GENPROBE

3 Each

0005h 87591

Neisseria gonorrhoeae Aptima assay, N.G.

GENPROBE

3 Each

0005i 87624 HPV HR testing 187 Each

0005j 87625 HPV HR 16/18 12 Each

0005k 88104 Cytopathology, Fluids (Wash, Brush) 1 Each

0005l 88108 Cytopathology, Concentration 1 Each

0005m 88112 Cytopathology 37 Each

0005n 88141 PAP interpretation by Pathologist 40 Each

0005o 88142 PAP smear / monolayer 14 Each

0005p 88160 Cytopathology, smears, any source; screening and interpretation 2 Each

0005q 88173 Cytology, evaluation of fine needle aspirate;

interpretation and report 2 Each

0005r 88175 PAP IMAGE GUIDED 209 Each

0005s 88184 FLOW CYTO, TC,1ST MK 5 Each

0005t 88185 FLOW CYTO, TC, ADD MK 139 Each

0005u 88189 FLOW CYTO, INTRP >16 6 Each

0005v 88237 CHROM CULT, BONE MARROW 5 Each

0005w 88271 MOLECULAR CYTO, DNA 14 Each

0005x 88275 MOLECUL. CYT,100-300 7 Each

0005y 88280 CHROMOSOM ANALYSIS ADD KARYOTYPES 1 Each

0005z 88291 MOLECULR CYTO INTERP 7 Each

0005aa 88300 SURGICAL PATHOLOGY, LEVEL I 17 Each

0005ab 88302 SURGICAL PATHOLOGY, LEVEL II- 9 Each

0005ac 88304 SURGICAL PATHOLOGY, LEVEL III 125 Each

0005ad 88305 CELL BLOCK ONLY 8 Each

0005ae 88305 SURGICAL PATHOLOGY, LEVEL IV 3693 Each

0005af 88305 SURGICAL PATHOLOGY, technical component 111 Each

0005ag 88307 SURGICAL PATHOLOGY, LEVEL V 7 Each

0005ah 88309 SURGICAL PATHOLOGY, LEVEL VI 2 Each

0005ai 88311 DECALCIFICATION 12 Each

0005aj 88312 Special stained specimen slides to identify organisms including interpretation and report 30 Each

0005ak 88312

Special stained specimen slides to identify organisms including interpretation and report, reference lab.

1 Each

0005al 88313 Special stained specimen slides to examine tissue including interpretation and report 10 Each

0005am 88313

Special stained specimen slides to examine tissue including interpretation and report, reference lab.

1 Each

0005an 88321 Surgical pathology consultation and report 6 Each

0005ao 88323 Surgical pathology consultation and report 11 Each

0005ap 88341

Immunohistochemistry, additional, reference lab

55 Each

0005aq 88341

Immunohistochemistry, additional, reference lab

44 Each

0005ar 88342 Immunohistochemistry 90 Each

0005as 88342 Immunohistochemistry, reference lab 8 Each

0005at 88346 CUTANEOUS IMMUNOFLUORESCENCE 1 Each

0005au 88350

IMMUNOFLUORESCENCE, EACH ADDITIONAL

ANTIBODY

4 Each

0005av 88360 MORPHOMET ANALYS, MAN 16 Each

0005aw 88374 MULTIPLEX PROBE STAIN PROC AUTO, EACH 8 Each

0005ax 88377 MULTIPLEX PROBE STAIN PROC MAN, EACH 7 Each

Option YEAR 1: __October 1, 2021_ to _September 30, 2022__

CLIN

No.

Sub-

CLIN

CPT Description Unit Unit Cost

Total Annual Cost

1001 None Clinical Pathologist on site review of Laboratory quality assurance documentation at Fort Meade and Hot Springs

150 Hours

1002 None On site representation during accreditation inspections at Fort Meade and Hot Springs

4 Hours

1003 Necropsy Services

None

None

Est.

Qty.

Total Cost for Base Period: $___________________

1003a Charge for gross autopsy performed at Rapid City Regional Hospital

5 Each

1003b Charge for autopsy processing, clerical, pathologist interpretations

5 Each

1003C

Morgue use fee at Rapid City Regional Hospital (Includes diener services and housekeeping)

5 Each

1004 Professional Consultation

1004a

Specialized Pathologist consultation with VA BHHCS Provider. Normal business hours, on site and off site.

10 Hours

1004b

Specialized Pathologist consultation with VA BHHCS Provider. Outside normal business hours, off site only with 2-hour minimum charge.

10 Hours

1005 None Pathology Services billed per current procedural terminology (CPT) code

1005a 81210 B-Raf enzyme molecular marker, BRAF 2 Each

1005b 81235 Epidermal growth factor receptor molecular marker, EGFR gene variant 3 Each

1005c 81301 Microsatellite instability, MSI 2 Each

1005d 81479 Molecular pathology procedure, unlisted 2 Each

1005e 82365 Calculus; infrared spectroscopy 25 Each

1005f 85060 Blood smear, peripheral, interpretation by Pathologist with written report

118 Each

1005g 87491

Chlamydia trachomatis Aptima assay, C.T.

GENPROBE

3 Each

1005h 87591

Neisseria gonorrhoeae Aptima assay, N.G.

GENPROBE

3 Each

1005i 87624 HPV HR testing 187 Each

1005j 87625 HPV HR 16/18 12 Each

1005k 88104 Cytopathology, Fluids (Wash, Brush) 1 Each

1005l 88108 Cytopathology, Concentration 1 Each

1005m 88112 Cytopathology 37 Each

1005n 88141 PAP interpretation by Pathologist 40 Each

1005o 88142 PAP smear / monolayer 14 Each

1005p 88160 Cytopathology, smears, any source; screening and interpretation 2 Each

1005q 88173 Cytology, evaluation of fine needle aspirate;

interpretation and report 2 Each

1005r 88175 PAP IMAGE GUIDED 209 Each

1005s 88184 FLOW CYTO, TC,1ST MK 5 Each

1005t 88185 FLOW CYTO, TC, ADD MK 139 Each

None

None

None

1005u 88189 FLOW CYTO, INTRP >16 6 Each

1005v 88237 CHROM CULT, BONE MARROW 5 Each

1005w 88271 MOLECULAR CYTO, DNA 14 Each

1005x 88275 MOLECUL. CYT,100-300 7 Each

1005y 88280 CHROMOSOM ANALYSIS ADD KARYOTYPES 1 Each

1005z 88291 MOLECULR CYTO INTERP 7 Each

1005aa 88300 SURGICAL PATHOLOGY, LEVEL I 17 Each

1005ab 88302 SURGICAL PATHOLOGY, LEVEL II- 9 Each

1005ac 88304 SURGICAL PATHOLOGY, LEVEL III 125 Each

1005ad 88305 CELL BLOCK ONLY 8 Each

1005ae 88305 SURGICAL PATHOLOGY, LEVEL IV 3693 Each

1005af 88305 SURGICAL PATHOLOGY, technical component 111 Each

1005ag 88307 SURGICAL PATHOLOGY, LEVEL V 7 Each

1005ah 88309 SURGICAL PATHOLOGY, LEVEL VI 2 Each

1005ai 88311 DECALCIFICATION 12 Each

1005aj 88312 Special stained specimen slides to identify organisms including interpretation and report 30 Each

1005ak 88312

Special stained specimen slides to identify organisms including interpretation and report, reference lab.

1 Each

1005al 88313 Special stained specimen slides to examine tissue including interpretation and report 10 Each

1005am 88313

Special stained specimen slides to examine tissue including interpretation and report, reference lab.

1 Each

1005an 88321 Surgical pathology consultation and report 6 Each

1005ao 88323 Surgical pathology consultation and report 11 Each

1005ap 88341

Immunohistochemistry, additional, reference lab

55 Each

1005aq 88341

Immunohistochemistry, additional, reference lab

44 Each

1005ar 88342 Immunohistochemistry 90 Each

1005as 88342 Immunohistochemistry, reference lab 8 Each

1005at 88346 CUTANEOUS IMMUNOFLUORESCENCE 1 Each

1005au 88350

IMMUNOFLUORESCENCE, EACH ADDITIONAL

ANTIBODY

4 Each

1005av 88360 MORPHOMET ANALYS, MAN 16 Each

1005aw 88374 MULTIPLEX PROBE STAIN PROC AUTO, EACH 8 Each

1005ax 88377 MULTIPLEX PROBE STAIN PROC MAN, EACH 7 Each

Total Cost for Option Year One: $___________________

Option YEAR 2: __October 1, 2022_ to _September 30, 2023__

CLIN

No.

Sub-

CLIN

CPT Description Unit Unit Cost

Total Annual Cost

2001 None Clinical Pathologist on site review of Laboratory quality assurance documentation at Fort Meade and Hot Springs

150 Hours

2002 None On site representation during accreditation inspections at Fort Meade and Hot Springs

4 Hours

2003 Necropsy Services

2003a Charge for gross autopsy performed at Rapid City Regional Hospital

5 Each

2003b Charge for autopsy processing, clerical, pathologist interpretations

5 Each

2003C

Morgue use fee at Rapid City Regional Hospital (Includes diener services and housekeeping)

5 Each

2004 Professional Consultation

2004a

Specialized Pathologist consultation with VA BHHCS Provider. Normal business hours, on site and off site.

10 Hours

2004b

Specialized Pathologist consultation with VA BHHCS Provider. Outside normal business hours, off site only with 2-hour minimum charge.

10 Hours

2005 None Pathology Services billed per current procedural terminology (CPT) code

2005a 81210 B-Raf enzyme molecular marker, BRAF 2 Each

2005b 81235 Epidermal growth factor receptor molecular marker, EGFR gene variant 3 Each

2005c 81301 Microsatellite instability, MSI 2 Each

2005d 81479 Molecular pathology procedure, unlisted 2 Each

2005e 82365 Calculus; infrared spectroscopy 25 Each

2005f 85060 Blood smear, peripheral, interpretation by Pathologist with written report

118 Each

2005g 87491

Chlamydia trachomatis Aptima assay, C.T.

GENPROBE

3 Each

2005h 87591

Neisseria gonorrhoeae Aptima assay, N.G.

GENPROBE

3 Each

2005i 87624 HPV HR testing 187 Each

2005j 87625 HPV HR 16/18 12 Each

2005k 88104 Cytopathology, Fluids (Wash, Brush) 1 Each

2005l 88108 Cytopathology, Concentration 1 Each

2005m 88112 Cytopathology 37 Each

None

None

None

None

None

None

None

Est.

2005n 88141 PAP interpretation by Pathologist 40 Each

2005o 88142 PAP smear / monolayer 14 Each

2005p 88160 Cytopathology, smears, any source; screening and interpretation 2 Each

2005q 88173 Cytology, evaluation of fine needle aspirate;

interpretation and report 2 Each

2005r 88175 PAP IMAGE GUIDED 209 Each

2005s 88184 FLOW CYTO, TC,1ST MK 5 Each

2005t 88185 FLOW CYTO, TC, ADD MK 139 Each

2005u 88189 FLOW CYTO, INTRP >16 6 Each

2005v 88237 CHROM CULT, BONE MARROW 5 Each

2005w 88271 MOLECULAR CYTO, DNA 14 Each

2005x 88275 MOLECUL. CYT,100-300 7 Each

2005y 88280 CHROMOSOM ANALYSIS ADD KARYOTYPES 1 Each

2005z 88291 MOLECULR CYTO INTERP 7 Each

2005aa 88300 SURGICAL PATHOLOGY, LEVEL I 17 Each

2005ab 88302 SURGICAL PATHOLOGY, LEVEL II- 9 Each

2005ac 88304 SURGICAL PATHOLOGY, LEVEL III 125 Each

2005ad 88305 CELL BLOCK ONLY 8 Each

2005ae 88305 SURGICAL PATHOLOGY, LEVEL IV 3693 Each

2005af 88305 SURGICAL PATHOLOGY, technical component 111 Each

2005ag 88307 SURGICAL PATHOLOGY, LEVEL V 7 Each

2005ah 88309 SURGICAL PATHOLOGY, LEVEL VI 2 Each

2005ai 88311 DECALCIFICATION 12 Each

2005aj 88312 Special stained specimen slides to identify organisms including interpretation and report 30 Each

2005ak 88312

Special stained specimen slides to identify organisms including interpretation and report, reference lab.

1 Each

2005al 88313 Special stained specimen slides to examine tissue including interpretation and report 10 Each

2005am 88313

Special stained specimen slides to examine tissue including interpretation and report, reference lab.

1 Each

2005an 88321 Surgical pathology consultation and report 6 Each

2005ao 88323 Surgical pathology consultation and report 11 Each

2005ap 88341

Immunohistochemistry, additional, reference lab

55 Each

2005aq 88341

Immunohistochemistry, additional, reference lab

44 Each

2005ar 88342 Immunohistochemistry 90 Each

2005as 88342 Immunohistochemistry, reference lab 8 Each

2005at 88346 CUTANEOUS IMMUNOFLUORESCENCE 1 Each

2005au 88350

IMMUNOFLUORESCENCE, EACH ADDITIONAL

ANTIBODY

4 Each

2005av 88360 MORPHOMET ANALYS, MAN 16 Each

2005aw 88374 MULTIPLEX PROBE STAIN PROC AUTO, EACH 8 Each

2005ax 88377 MULTIPLEX PROBE STAIN PROC MAN, EACH 7 Each

Option YEAR 3: __October 1, 2023_ to _September 30, 2024__

CLIN

No.

Sub-

CLIN

CPT Description Unit Unit Cost

Total Annual Cost

3001 None Clinical Pathologist on site review of Laboratory quality assurance documentation at Fort Meade and Hot Springs

150 Hours

3002 None On site representation during accreditation inspections at Fort Meade and Hot Springs

4 Hours

3003 Necropsy Services

3003a Charge for gross autopsy performed at Rapid City Regional Hospital

5 Each

3003b Charge for autopsy processing, clerical, pathologist interpretations

5 Each

3003C

Morgue use fee at Rapid City Regional Hospital (Includes diener services and housekeeping)

5 Each

3004 Professional Consultation

3004a

Specialized Pathologist consultation with VA BHHCS Provider. Normal business hours, on site and off site.

10 Hours

3004b

Specialized Pathologist consultation with VA BHHCS Provider. Outside normal business hours, off site only with 2-hour minimum charge.

10 Hours

3005 None Pathology Services billed per current procedural terminology (CPT) code

3005a 81210 B-Raf enzyme molecular marker, BRAF 2 Each

3005b 81235 Epidermal growth factor receptor molecular marker, EGFR gene variant 3 Each

3005c 81301 Microsatellite instability, MSI 2 Each

3005d 81479 Molecular pathology procedure, unlisted 2 Each

3005e 82365 Calculus; infrared spectroscopy 25 Each

3005f 85060 Blood smear, peripheral, interpretation by Pathologist with written report

118 Each

3005g 87491

Chlamydia trachomatis Aptima assay, C.T.

GENPROBE

3 Each

None

None

None

None

None

None

None

Est.

Total Cost for Option Year Two: $___________________

3005h 87591

Neisseria gonorrhoeae Aptima assay, N.G.

GENPROBE

3 Each

3005i 87624 HPV HR testing 187 Each

3005j 87625 HPV HR 16/18 12 Each

3005k 88104 Cytopathology, Fluids (Wash, Brush) 1 Each

3005l 88108 Cytopathology, Concentration 1 Each

3005m 88112 Cytopathology 37 Each

3005n 88141 PAP interpretation by Pathologist 40 Each

3005o 88142 PAP smear / monolayer 14 Each

3005p 88160 Cytopathology, smears, any source; screening and interpretation 2 Each

3005q 88173 Cytology, evaluation of fine needle aspirate;

interpretation and report 2 Each

3005r 88175 PAP IMAGE GUIDED 209 Each

3005s 88184 FLOW CYTO, TC,1ST MK 5 Each

3005t 88185 FLOW CYTO, TC, ADD MK 139 Each

3005u 88189 FLOW CYTO, INTRP >16 6 Each

3005v 88237 CHROM CULT, BONE MARROW 5 Each

3005w 88271 MOLECULAR CYTO, DNA 14 Each

3005x 88275 MOLECUL. CYT,100-300 7 Each

3005y 88280 CHROMOSOM ANALYSIS ADD KARYOTYPES 1 Each

3005z 88291 MOLECULR CYTO INTERP 7 Each

3005aa 88300 SURGICAL PATHOLOGY, LEVEL I 17 Each

3005ab 88302 SURGICAL PATHOLOGY, LEVEL II- 9 Each

3005ac 88304 SURGICAL PATHOLOGY, LEVEL III 125 Each

3005ad 88305 CELL BLOCK ONLY 8 Each

3005ae 88305 SURGICAL PATHOLOGY, LEVEL IV 3693 Each

3005af 88305 SURGICAL PATHOLOGY, technical component 111 Each

3005ag 88307 SURGICAL PATHOLOGY, LEVEL V 7 Each

3005ah 88309 SURGICAL PATHOLOGY, LEVEL VI 2 Each

3005ai 88311 DECALCIFICATION 12 Each

3005aj 88312 Special stained specimen slides to identify organisms including interpretation and report 30 Each

3005ak 88312

Special stained specimen slides to identify organisms including interpretation and report, reference lab.

1 Each

3005al 88313 Special stained specimen slides to examine tissue including interpretation and report 10 Each

3005am 88313

Special stained specimen slides to examine tissue including interpretation and report, reference lab.

1 Each

3005an 88321 Surgical pathology consultation and report 6 Each

3005ao 88323 Surgical pathology consultation and report 11 Each

3005ap 88341

Immunohistochemistry, additional, reference lab

55 Each

3005aq 88341

Immunohistochemistry, additional, reference lab

44 Each

3005ar 88342 Immunohistochemistry 90 Each

3005as 88342 Immunohistochemistry, reference lab 8 Each

3005at 88346 CUTANEOUS IMMUNOFLUORESCENCE 1 Each

3005au 88350

IMMUNOFLUORESCENCE, EACH ADDITIONAL

ANTIBODY

4 Each

3005av 88360 MORPHOMET ANALYS, MAN 16 Each

3005aw 88374 MULTIPLEX PROBE STAIN PROC AUTO, EACH 8 Each

3005ax 88377 MULTIPLEX PROBE STAIN PROC MAN, EACH 7 Each

Total Cost for Option Year Three: $___________________

Total Cost for Base and All Option Years: $___________________ https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2135 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=1364 http://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=2910 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=5472 https://www.va.gov/vhapublications/ViewPublication.asp?pub_ID=8365