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Phoenix
| PHOENIX VA HEALTH CARE SYSTEM | | | |
| BASE YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 50 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 10 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 25 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 1450 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 1250 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 12 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 1st OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1450 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1400 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 2nd OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1455 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1200 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 3rd OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1460 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1200 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 4th OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1465 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1200 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 5th OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1465 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1200 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 6th OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1470 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1300 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
| A014PHO | Cylinder, size “B” (M6) refill. Aluminum tanks required. E0443 | 550 | EACH |
| A015PHO | Portable Oxygen Concentrator Rental for Traveling Patients. Only models that have continuous flow option or those devices that meet the patients liter per minute as indicated on prescription. E1392 | 240 | EACH |
| A016PHO | Monthly rental liquid oxygen system with stationary reservoir, (each reservoir) any size suitable for residential use. HCPCS:E0439 | 70 | EACH |
| A017PHO | Monthly rental portable liquid oxygen system. HCPCS: E0434 | | |
| 60 | EACH | | |
| A018PHO | Liquid oxygen per pound for item #0016. HCPCS: E0444 | 18,300 | LBS |
| A019PHO | Home visit by Patient Services Technician for home oxygen patients. Home visit includes assessment of equipment compliance, educational needs and replacement of equipment as needed. HCPCS: VA160 | 350 | JOB |
| A020PHO | Delivery, initial set-up, and education/training of ventilator for continuous and/or intermittent ventilation patients with backup ventilator and specified supplies. An LRT must perform initial set-up. Two (2) ventilators per patient are required at all times: 1 primary and 1 backup. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 9 | JOB |
| A021PHO | Monthly Rental of ventilators for continuous or intermittent ventilation patients with backup ventilator. Includes delivery, setup, supplies and education/training. | | |
If a request is received to deliver a Government-owned ventilator and there is no Government inventory available, a vendor-owned ventilator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned ventilator switched out and there is no Government-owned inventory available, a vendor-owned ventilator will be supplied and billed at the vendor-owned monthly rate.
| 3 | JOB | | |
| A022PHO | Monthly Licensed Respiratory Therapist (LRT) visit to inspect equipment and environment, re-educate and/or re-train caregiver, provide supplies as necessary and perform routine preventive maintenance to include support of 2 ventilators per patient: 1 primary and 1 backup. | 12 | JOB |
| A023PHO | Delivery of ventilator to local VA Medical Center for hospital discharge purposes only. | 1 | JOB |
| A024PHO | Service Call: Trouble shoot or delivery of replacement ventilator to the patient's home. | 1 | HOUR |
| A025PHO | Cost to package and ship Government-Owned ventilator to manufacturer for annual preventative maintenance or repairs (outside of warranty) | 1 | |
| A026PHO | Delivery for re-supply and/or relocation of equipment due to change in beneficiary’s residence within Region. HCPCS: A9901 | 1 | JOB |
| A027PHO | Fee for deliveries/pickups made for over 100 miles from the closest Contractor facility or VAMC/CBOC to the delivery location, whichever is closer. HCPCS: A9901 | 15 | JOB |
| 7th OPTION YEAR: XX/XX/XXXX through XX/XX/XXXX | | | |
| ITEM NUMBER | DESCRIPTION OF SUPPLIES/SERVICES | ESTIMATED QUANTITY MONTHLY | UNIT |
| A001PHO | Delivery, initial set-up, and education of stationary oxygen concentrator system. Back-up system shall be provided consisting of compressed gas source, regulator, stand, nasal cannula or mask, humidifier, tubing, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure. Concentrator to be provided by VA with liter flow 0 to 5 and 0 to 10 liters per minute. Health Care Procedural Coding System (HCPCS): A9901. Initial Setups: Initial set-ups are considered to be for those beneficiaries who do not have a VA authorized oxygen therapy delivery system. | 1470 | JOB |
| A002PHO | Delivery, initial set-up, and education of portable oxygen concentrator system. Portable system for new set ups consists of “E”, “C”, “D”, or “B” (M6) size aluminum cylinder with regulator, flow meter, handcart, pouch/backpack and disposable supplies. Includes delivery, setup, and education. This is a one-time charge for new set-ups. HCPCS: A9901. | 1250 | JOB |
| A003PHO | Preventive Maintenance (PM) for Government-Owned concentrators. (Includes all labor, tools, equipment, travel and materials necessary to perform PM in accordance with manufactures instructions. HCPCS: VA160 | 1300 | JOB |
| A004PHO | Monthly Rental of stationary oxygen concentrator system. Back-up system shall be provided for stationary oxygen concentrators consisting of compressed gas source regulator, stand, nasal cannula or mask, tubing, humidifier, trachea collar and fire safe valves when specified. Back-up system minimum supply of oxygen shall be equal to three times the maximum response time for use in case of system malfunction and/or power failure; With flow rate of 0 – 5 and 0-10 liters per minute. HCPCS: E1390 | | |
If a request is received to deliver a Government-owned concentrator and there is no Government inventory available, a vendor-owned concentrator will be supplied at the vendor monthly rate. In the event a patient needs to have the Government-owned concentrator switched out and there is no Government-owned inventory available, a vendor-owned concentrator will be supplied and billed at the vendor-owned monthly rate.
| 50 | EACH | | |
| A005PHO | Monthly Rental of portable oxygen concentrator system. Portable system includes flow meter, 2 rechargable batteries, handcart, pouch/backpack and disposable supplies. HCPCS: E0431 | 10 | EACH |
| A006PHO | Delivery, set-up, and education of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription (M6, C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator (as needed) HCPCS: VA160 | 15 | JOB |
| A007PHO | Rental of self fill oxygen system to include 4 self-fill compatible oxygen tanks as specified on prescription(B (M6), C, D, or E), carrying bag, cart, conserving device, fill station and self-fill compatible concentrator. Line item shall include all consumable supplies, e.g. tubing, cannulas, connectors. HCPCS: K0738 | 15 | EACH |
| A008PHO | Stationary Cylinder set-up, size H or M60. Set-up consisting of regulator, flow meter, safety stand, humidifier and disposable supplies. This is a one time charge for set-up. (This can be used as a back up system or as a primary system). Includes delivery, setup, and education. | 41 | JOB |
| A009PHO | Cylinder, size H refill (Backup/Primary) E0441 | 41 | EACH |
| A010PHO | Cylinder, size M60 refill (Backup/Primary) E0441 | 15 | EACH |
| A011PHO | Cylinder, size “E” refill. Aluminum tanks required. E0443 | 2400 | EACH |
| A012PHO | Cylinder, size “C” refill. Aluminum tanks required. E0443 | 12 | EACH |
| A013PHO | Cylinder, size “D” refill. Aluminum tanks required. E0443 | 150 | EACH |
This is the start of the file's text. The full file is on GovTribe.
