Attachment A - Number of Tests by Hospital for year 2024 - CPH.docx
DOCX document 63 KB Posted
- Solicitation number
- RFP-491-250000003122-2
- Issued by
- Van Buren County, Michigan
About this file
This is a Schedule A attachment for a Laboratory Services contract with the State of Michigan for in-patient psychiatric hospitals, specifically detailing the number of tests required by hospital location for the year 2024. The schedule outlines anticipated test volumes across multiple hospital facilities, with Caro hospital representing the primary location for the testing services outlined. The contract encompasses a comprehensive range of laboratory tests including comprehensive metabolic panels (276 tests), basic metabolic panels (94 tests), hepatic panels (6 tests), lipid panels (43 tests), thyroid function tests (122 tests), viral hepatitis panels (98 tests), anemia panels (20 tests), urine drug screens, and specialized medication level monitoring for psychiatric drugs such as lithium (133 tests), Depakote/Valproic Acid (99 tests), and Clozaril (32 tests). Additional services include urinalysis with culture (187 tests), complete blood counts with differential (178 tests), admission and annual follow-up comprehensive medical profiles (101 and 26 tests respectively), and various individual specialty tests including HIV testing, tuberculosis screening via QuantiFERON GOLD (55 tests), and hepatitis serology testing.
The document serves as a quantitative baseline for anticipated laboratory testing volumes and does not contain information regarding pricing terms, set-asides, incumbent vendors, funding sources, or contract award dates. The schedule reflects the specific testing requirements for psychiatric hospitalized patients and appears to have been revised in February 2019, suggesting this 2024 schedule may be based on historical utilization patterns. The test quantities indicate significant reliance on baseline monitoring panels for psychiatric patients, with particular emphasis on medication level monitoring and metabolic panels consistent with psychiatric pharmaceutical management protocols.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Q&A RFP 250000003122 Caro Lab Services.docx | DOCX document | |
| RFP 250000003122 Lab Services Caro Psychiatric Hospital.docx | DOCX document |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
STATE OF MICHIGAN
Laboratory Services for the State In-patient Psychiatric Hospitals
SCHEDULE A
Number of Tests By Hospital for year 2024
| CPT CODE |
| DESCRIPTION |
| Caro |
| 80053 |
| Comprehensive Metabolic Panel |
· Sodium
· Potassium
· Chloride
· CO2
· Albumen
· ALT
· AST
· Alkaline Phosphatase
· Bilirubin (total)
· Protein (total)
· BUN
· Creatinine
· GFR
· Calcium
· Glucose
| 80048 |
| Basic Metabolic Panel |
· Sodium
· Potassium
· Chloride
· CO2
· Glucose
· BUN
· Creatinine
· Calcium
· Anion gap
| 80051 |
| Electrolytes Panel |
· Sodium
· Potassium
· Chloride
· CO2
| 80069 |
| Standard Renal Panel: |
· Sodium
· Potassium
· Chloride
· CO2
· BUN
· GFR
· Creatinine
· Glucose
· Calcium
· Albumen
· Phosphorus
| 80074 |
| Acute Hepatitis Panel: |
HAV IgM, HBsAg & reflex Confirmation, HBcIgM, HCV IgG
| 80076 |
| Hepatic Panel |
· Albumin
· Alkaline Phosphatase (ALP)
· ALT (alanine transaminase)
· AST (aspartate aminotransferase)
· Direct Bilirubin
· Total Bilirubin
· Total Protein
| 80051 |
| Lipid Panel |
· Cholesterol
· HDL Cholesterol
· Triglycerides
· LDL Cholesterol (calculated)
Thyroid Function Tests (Thyroid Profile)
· T3 Free CPT 84481
· T3 Uptake CPT 84479
· T4 Total CPT 84436
· TSH CPT 84443
· Free T4 CPT 84436
| Anemia Panel: CBC, Iron, TIBC, Ferritin, Folate, Methylmalonic acid, Retic count, Peripheral smear |
| 20 |
| 80101 |
| Urine Drug Screen |
| 0 |
PCP/Phencyclidine 83992
Methadone 80101
Propoxyphene 80101
Opiates 83925
Benzodiazepines 80154
Methaqualone 80101
Amphetamines 82145
Cannabinoid/THC100 80101
Cocaine 82520
Barbiturates 82205
Viral Hepatitis Panel Hepatitis Immunity profile, CPT 86704, 86706, 86708 Acute Hepatitis Profile CPT 80074
· Anti-HBsAg
· HBsAg & Reflex Confirmation
· HAV Total
· HBC Total
· HAV IgM
· HBsAg & Reflex Confirmation
· HBc IgM
· HCV IgG
Vitamin B12/ Folate
| 82607 |
| Vitamin B12 plus Folic Acid |
| 37 |
| 82746 |
| Folate |
| 26 |
| Iron Profile |
| 29 |
| 83550 |
| Iron, TIBC, % Saturation |
| 7 |
| 83540 |
| Iron |
| 22 |
| 82728 |
| Ferritin |
| 11 |
Thyroid Function Tests (Thyroid Profile)
· T3 Free CPT 84481, T3 Uptake CPT 84479
· T4 Total CPT 84436
· TSH CPT 84443
· Free T4 CPT 84436
Wound Culture
| 87070 |
| Wound Superficial |
| 0 |
| Comprehensive Medical Profile -1 (Admission Panel) |
| 101 |
· CBC with DIFF (CBC with Differential must be reported as absolute numbers and not percentage values), CPT 85027
· Complete Metabolic Profile: CPT 80053 Sodium, Potassium, Chloride, CO2, Albumen, ALT, AST, Alk Phos, Bilirubin (total), Protein (total) BUN, Creatinine, Calcium, Glucose
· Lipid Profile: CPT 80061 Cholesterol, HDL Cholesterol, Triglycerides, LDL (calculated)
· Bilirubin, Direct CPT 82248
· Creatinine Kinase (CPK ) CPT 82550
· Magnesium CPT 83735
· Phosphorous (PO4) 84100
· Uric Acid CPT 84550
· HBA1C CPT 83036
· TSH CPT 84443
· Free T4 CPT 84439
· Vit D CPT 82306
· Hepatitis Profile: CPT 80074, 86803, 87522 Anti-HBsAg, HBsAg & reflex confirmation, HBs Antibody, HBc IgM, HAV Total, HAV IgM, HCV IgG with reflex to quantitative (viral load)
· RPR with reflex, CPT 86592, 86780
Comprehensive Medical Profile - 2 (Annual Follow up Panel)
· CBC with Diff (CBC with Differential must be reported as absolute numbers and not percentage values) CPT 85027
· Complete Metabolic Profile: CPT 80053 Sodium, Potassium, Chloride, CO2, Albumen, ALT, AST, Alk Phos, Bilirubin (total), Protein (total) BUN, Creatinine, Calcium, Glucose
· Lipid Profile: CPT 80061 Cholesterol, HDL Cholesterol, Triglycerides, LDL (calculated)
· Bilirubin, Direct CPT 82248
· Creatinine Kinase (CPK ) CPT 82550
· Magnesium CPT 83735
· Phosphorous (PO4) 84100
· Uric Acid CPT 84550
· HBA1C CPT 83036
· TSH CPT 84443
· Free T4 CPT 84439
· Vit D CPT 82306
The Following are Individual Tests:
| 80156 |
| Tegretol/Carbamazepine level |
| 5 |
| 80183 |
| Trileptal (Oxcarbamapine) level |
| 0 |
| 82491 |
| Clozaril level |
| 32 |
| 80299 |
| Seroquel (Quetiapine) level |
| 0 |
| 80164 |
| Depakote (Valproic Acid) |
| 99 |
| 80175 |
| Lamictal (Lamotrigine) |
| 0 |
| 80178 |
| Lithium |
| 133 |
| 80184 |
| Phenobarbital |
| 0 |
| 80185 |
| Phenytoin/Dilantin |
| 0 |
| 81001 |
| Urinalysis, Reflex to Culture |
| 187 |
| 82140 |
| Ammonia |
| 0 |
| 82270 |
| Colo FIT Occult Blood, fecal |
| 15 |
| 82310 |
| CALCIUM |
| 0 |
| 84100 |
| Phosphorus |
| 1 |
| 82378 |
| Carcinogenic Antigen (CEA) |
| 0 |
| 82390 |
| Ceruloplasmin |
| 0 |
| 82486 |
| Clonazepam |
| 0 |
| 82550 |
| CPK |
| 40 |
| 82533 |
| Cortisol-Serum |
| 82525 |
| Copper |
| 0 |
| 82565 |
| Creatinine, Blood |
| 1 |
| 82575 |
| Creatinine Clearance |
| 0 |
| 82670 |
| Estradiol-Serum |
| 1 |
| 82728 |
| Ferritin |
| 11 |
| 82947 |
| Glucose, fasting , 1 hour |
| 0 |
| 83001 |
| FSH |
| 1 |
| 83020 |
| Hemoglobin Electrophoresis |
| 1 |
| 83036 |
| HbA1C (Glycohemoglobin) |
| 75 |
| 87389 |
| HIV1/HIV2 Ag/Ab with Reflex Confirmation |
| 6 |
| 83090 |
| Homocysteine (HCY) |
| 2 |
| 83550 |
| Iron and Iron Binding |
| 29 |
| 83605 |
| Lactic Acid |
| 0 |
| 86355 |
| Lead |
| 1 |
| 83735 |
| Magnesium |
| 4 |
| 83921 |
| Methylmalonic Acid Serum |
| 0 |
| 84100 |
| Phosphorous |
| 1 |
| 84146 |
| Prolactin |
| 21 |
| 84153 |
| PSA – Total – Abbott |
| 3 |
| 84156 & 84166, 82570 |
| Protein Electrophoresis-Urine |
| 0 |
| 84155 & 84165 |
| Protein Electrophoresis-Serum |
| 0 |
| 84311 |
| Arylsulfatase A, Blood |
| 0 |
| 84402 |
| Free Testosterone |
| 0 |
| 84403 |
| Testosterone |
| 0 |
| 84436 |
| T4 Total |
| 84439 |
| T4 Free |
| 84443 |
| TSH |
| 122 |
| 84479 |
| T3, free and T3, Total |
| 0 |
| 84450 |
| SGOT/AST |
| 0 |
| 84460 |
| SGPT/ALT |
| 0 |
| 84466 |
| Transferrin |
| 1 |
| 84520 & 82565 |
| BUN & CREATININE |
| 0 |
| 84545 |
| Urea Nitrogen (BUN) |
| 0 |
| 84550 |
| Uric Acid-Serum |
| 6 |
| 81025 |
| Preg Test, Urine hCG |
| 2 |
| 84702 |
| Pregnancy test, hCG Total (quantitative) |
| 4 |
| 84999 |
| Fragile X DNA, Procedure 462W |
| 0 |
| 84999 |
| Chromosome Analysis, Procedure 461W |
| 0 |
| 85025 |
| CBC Including Differential |
| 178 |
| 85044 |
| Reticulocyte Count |
| 5 |
| 85610 |
| PT w/INR |
| 0 |
| 85651 |
| ESR |
| 2 |
| 85660 |
| Sickle Cell/Sickle Dex screen |
| 0 |
| 86141 |
| CRP – Quantitative |
| 15 |
| 86160 |
| Complement,C-3 |
| 0 |
| 86431 |
| RA Factor |
| 4 |
86592, 86780
| RPR with reflex |
| 2 |
| 86663 |
| EBV Early Antigen |
| 0 |
| 86664 |
| EBV Nuclear Antigen |
| 0 |
| 86665 |
| EBV Capsid Antibody-IgG |
| 0 |
| 86480 |
| QuantiFERON GOLD |
| 55 |
| 86703 |
| HIV-1 /2 Ag/Ab Combo, Rapid (RHIV) |
| 7 |
| 87389 |
| HIV Ag/Ab Combo (CHIV) Assay |
| 0 |
| 86704 |
| Hepatitis B Core Antigen (Total Antibody) |
| 0 |
| 86706 |
| Hepatitis B Surface Antibody (HBsAb) |
| 0 |
87341 87340
| Hepatitis B Surface Antigen (HBsAg & reflex confirmation) |
| 0 |
| 86705 |
| Hepatitis B Core IgM (HBcIgM) |
| 0 |
| 86708 |
| Hepatitis A Antibody total (HAV total) |
| 0 |
| 86709 |
| Hepatitis A lgM Antibody (HAV IgM) |
| 0 |
| 86803 |
| Hepatitis C IgG (HCV IgG) |
| 0 |
| 87522 |
| Hepatitis C Quantitative (HCV viral load) |
| 5 |
| 87070 |
| Culture any source except urine, blood, stool |
| 0 |
| 87081 |
| Direct Strep Antigen Performed STAT Results within 1 hr |
| 6 |
| 87086 |
| Urine Culture & Colony Count |
| 0 |
| 87177 |
| Ova & Parasites |
| 0 |
| 87210 |
| Trichomonas |
| 0 |
| 87324 |
| Clostridium difficile Toxin A |
| 0 |
| 87338 |
| H. Pylori, stool |
| 0 |
| 86677 |
| H. Pylori Antibody |
| 0 |
| 83010 |
| Haptoglobin |
| 0 |
| 87490 |
| Chlamydia/DNA/GC Probe |
| 1 |
| 87491 |
| Chlamydia trachomatis rRNA |
| 0 |
| 88164 |
| Pap Smear (single slide) |
| 86038 |
| ANA screening test |
| 5 |
| 86039 |
| ANA Titer and pattern testing – Anti-Streptolysin |
| 0 |
| 82024 |
| ACTH plasma |
| 0 |
Revised 2/2019
File details come from the government source that posted it. Updated .