S03 Solicitation Attachment E Price Schedule.xlsx
XLSX spreadsheet 70 KB Posted
- Attached to
- Q403-MDE International Federal contract opportunity
- Solicitation number
- 36C10X22R0004
About this file
This is a Request for Proposal (RFP) for Medical Disability Examinations International services. The RFP seeks proposals to provide medical examinations of veterans overseas as authorized by Public Law 104-275. The Department of Veterans Affairs Strategic Acquisition Center Frederick is the contracting agency. Eligible vendors would conduct medical exams and assessments of disability compensation claims for veterans living abroad. Pricing terms and evaluation criteria are not specified in the RFP template provided. The document appears to be a template only and does not include information on products or services required, response dates, or other salient details needed to summarize the procurement opportunity.
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Price Schedule
| MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | ||||||||||||||||
| REGION 1 (NORTHEAST) | A | |||||||||||||||
| SCHEDULE OF PRICES | ||||||||||||||||
| BASE AND ALL OPTION PERIODS | A | |||||||||||||||
| LINE ITEM | DESCRIPTION | UNIT OF ISSUE | % OF MEDICARE BASELINE RATE | BASE YR UNIT PRICE | OPT YR 1 UNIT PRICE | OPT YR 2 UNIT PRICE | OPT YR 3 UNIT PRICE | OPT YR 4 UNIT PRICE | OPT YR 5 UNIT PRICE | OPT YR 6 UNIT PRICE | OPT YR 7 UNIT PRICE | OPT YR 8 UNIT PRICE | OPT YR 9 UNIT PRICE | A | ||
| 0001 | General Medical Examination | A | ||||||||||||||
| 0001A | General Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body parts | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001AA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001AD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001B | General Medical - Pension | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001BA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001BD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001C | General Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations) | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CA | Requiring 1-5 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CB | Requiring 6-10 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CC | Requiring 11-15 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001CD | Requiring 16 or more DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001D | Aid and Attendance or Housebound | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001DA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001DD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001E | Cold Injury Residuals | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001F | General Medical - Comprehensive Medical Examination to include a Gulf War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001FA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001FD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001G | General Medical - Comprehensive Medical Examination to include a Prisoner of War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | A | ||
| 0001GA | Requiring 1-5 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GB | Requiring 6-10 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GC | Requiring 11-15 DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0001GD | Requiring 16 or more DBQs | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002 | Musculoskeletal System | A | ||||||||||||||
| 0002A | Osteomyelitis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002B | Arthritis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002C | Amputations | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002D | Shoulder and Arm Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002E | Elbow and Forearm Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002F | Wrist Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002G | Hand and Finger Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002H | Back (Thoracolumbar Spine ) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002I | Neck (Cervical Spine) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002J | Hip and Thigh Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002K | Knee and Lower Leg Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002L | Ankle Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002M | Foot Conditions, Including Flatfoot (Pes Planus) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002N | Bones | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0002O | Muscle Injuries | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0003 | Organs of Special Sense / Eye | A | ||||||||||||||
| 0003A | Eye Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004 | Impairment of Auditory Acuity/Ear and Other Sense Organs | A | ||||||||||||||
| 0004A | Hearing Loss and Tinnitus | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004B | Ear (including vestibular & infectious ) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0004C | Loss of Sense of Smell and/or Taste (ENT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005 | Infectious Diseases, Immune Disorders and Nutritional Deficiencies | A | ||||||||||||||
| 0005A | Persian Gulf/Afghanistan Infectious Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005B | HIV-Related Illnesses | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005C | Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005D | Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005E | Nutritional Deficiencies | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0005F | Chronic Fatigue Syndrome (rheumatological) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006 | Respiratory System | A | ||||||||||||||
| 0006A | Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006B | Respiratory Conditions (other than Tuberculosis and Sleep Apnea) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006C | Tuberculosis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006D | Sleep Apnea | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006E | Sleep Studies (HSAT) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0006F | Sleep Studies (PSG & ECG) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007 | Cardiovascular System | A | ||||||||||||||
| 0007A | Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007B | Artery and Vein Conditions (Vascular Diseases including Varicose Veins) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0007C | Hypertension | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008 | Digestive System | A | ||||||||||||||
| 0008A | Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal Disorders) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008B | Gallbladder and Pancreas Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008C | Intestinal Conditions (other than Surgical or Infectious), including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008D | Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008E | (Hepatitis, Cirrhosis, and other) Liver Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008F | Peritoneal Adhesions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008G | Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008H | Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008I | Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0008J | Rectum and Anus Conditions (including Hemorrhoids) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009 | Genitourinary System | A | ||||||||||||||
| 0009A | Kidney Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009B | Urinary Tract (including Bladder and Urethra ) Conditions (excluding Male reproductive System) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009C | Prostate Cancer | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0009D | Male Reproductive Organ Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0010 | Gynecological Conditions and Disorders of the Breast | A | ||||||||||||||
| 0010A | Gynecological Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0010B | Breast Conditions and Disorders | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0011 | Hemic and Lymphatic Systems | A | ||||||||||||||
| 0011A | (Hairy Cell and Other B-Cell) Leukemia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0011B | Hematologic and Lymphatic Conditions, including Leukemia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0012 | Skin (Derm) | A | ||||||||||||||
| 0012A | Skin Diseases | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0012B | Scars/Disfigurement | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013 | Endocrine System | A | ||||||||||||||
| 0013A | Diabetes Mellitus | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013B | Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0013C | Thyroid and Parathyroid Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014 | Neurological Conditions and Convulsive Disorders | A | ||||||||||||||
| 0014A | Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014B | Parkinson's Disease | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014C | Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014D | Diabetic Sensory-Motor Peripheral Neuropathy | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014E | Narcolepsy | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014F | Fibromyalgia | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014G | Headaches (including Migraine Headaches) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014H | Multiple Sclerosis (MS) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014I | Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014J | Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014K | Cranial Nerve Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014L | Peripheral Nerve Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014M | Seizure Disorders (epilepsy) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0014N | Spina Bifida | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0015 | Mental Disorders | A | ||||||||||||||
| 0015A | Mental Disorders (other than PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015B | Mental Disorders (other than PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015C | Initial Post Traumatic Stress Disorders (PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015D | Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015E | Review Post Traumatic Stress Disorders (PTSD) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015F | Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015G | Eating Disorders | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0015H | Eating Disorders - Telehealth examination | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0016 | Dental and Oral Conditions | A | ||||||||||||||
| 0016A | Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0016B | Temporomandibular Joint (TMJ) Conditions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0017 | Ancillary Diagnostic Tests (The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.) | A | ||||||||||||||
| 0017A | Procedures | EA | $0.00 | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017B | Tests | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017C | Laboratory Work | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0017D | Radiological Imaging | EA | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | A | ||
| 0018 | Subject Matter Expert (SME) Opinions (e.g., Camp Lejeune Contaminated Water (CLCW)) | A | ||||||||||||||
| 0018A | SME Opinions | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0019 | Record Review Medical File & Medical Opinions | A | ||||||||||||||
| 0019A | Record Review Medical File | |||||||||||||||
| (1 hour or <250 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019AA | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (1 hour or <250 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019B | Record Review Medical File | |||||||||||||||
| (2 hours or 250-749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019BB | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (2 hours or 250-749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019C | Record Review Medical File | |||||||||||||||
| (3 hours or >749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0019CC | Record Review Medical File w/ Medical Opinion | |||||||||||||||
| (hours or >749 pgs) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | |||
| 0020 | No Shows (If Claimant does not appear for appointment or does not contact vendor within the acceptable timeframe to reschedule but does request a rescheduled appointment, No show is charged on initial appointment but at a lower price since administrative prep work is eventually used by examiner) | A | ||||||||||||||
| 0020A | Complete No Show (Claimant does not appear) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0020B | Partial No Show (Claimant requests to reschedule appointment within less than 24 hours notice) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | A | ||
| 0021 | Deliverables | A | ||||||||||||||
| 0021A | Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS) | Not Separately Priced (NSP) | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021B | Training Plan in accordance with Section 4.5 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021C | Monthly Status Reports in accordance with Section 4.6 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021D | Ramp-up Plan in accordance with Section 1.10 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021E | Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | A | ||
| 0021F | Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021G | Incident Report in accordance with Sections 2 and 4.8 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021H | Contractor Portal in accordance with Section 2.3 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021I | Veteran Portal in accordance with Section 2.4 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021J | Service Recovery Plan in accordance with Section 3.3 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021K | Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021L | Quality Assurance Plan in accordance with Section 4.4 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021M | Monthly Invoice Report in accordance with Section 4.7 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021N | Emergency Plan in accordance with Section 4.8 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021O | Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0021P | Response to Government Audits in accordance with Section 8.3 of the PWS | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||
| 0022 | Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement | A | ||||||||||||||
| 0022A | Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | A | ||
| 0022B | Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | A | ||
| 0022BA | Physician Assistant (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BB | Nurse Practitioner (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BC | Physician, Generalist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BD | Physician, Ophthalmology (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BE | Optometrist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BF | Audiologist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BG | Psychologist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BH | Psychiatrist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BI | Physician, Physiatry (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BJ | Physician, Neurology (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BK | Surgeon, Neurologist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BL | Dentist (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BM | Otolaryngologis (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BN | Assistant (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022BO | Chaperone (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0022C | Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | |||
| 0022D | Claimant Mileage Reimbursement | To be invoiced and paid in accordance with Section 2.12 in the PWS | ||||||||||||||
| 0023 | Monitory Incentives | |||||||||||||||
| 0023A | Monitory Incentives | To be invoiced and paid in accordance with Section 3.5 of the PWS | ||||||||||||||
| 0024 | Ramp Up Activities | |||||||||||||||
| 0024A | Ramp-up: Initial Contract Award | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| 0024AA | Initial IT Development Activities | EA | N/A | $0.00 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| 0024AB | Initial Examiner Network Building Activities | EA | N/A | $0.00 | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| 0024B | Ramp-up: Major Contract Modifications | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||
| 0024BA | Additional IT Development Activities | EA | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | |||
| 0024BB | Additional Examiner Network Building Activities | EA | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | |||
| 0024C | Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work | EA | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | |||
| 0025 | Mobile Events and Mobile Exams | |||||||||||||||
| 0025A | Examiners Costs (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0025B | Mobile Units (daily) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0026 | Required Assistant, Chaperone and / or Tele Presenter (hourly) | EA | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0027 | International Contracts Only - Single-Source Sub-contracted Examinations (SSSCE) | NTE | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||
| 0028 | International Contracts Only - Alternative Medical Evidence (AME) Examinations | NTE | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
&F | &A
Sample Task Order
| MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | |||||||||||||||||||
| REGION 1 (NORTHEAST) | a | ||||||||||||||||||
| SAMPLE TASK ORDER - SCHEDULE OF PRICES | a | ||||||||||||||||||
| LINE ITEM | DESCRIPTION | UNIT OF ISSUE | EST QTY (PER YEAR) | % OF MEDICARE BASELINE RATE | SAMPLE TO BASE YR PRICE | SAMPLE TO YR 1 PRICE | SAMPLE TO YR 2 PRICE | SAMPLE TO YR 3 PRICE | SAMPLE TO YR 4 PRICE | SAMPLE TO YR 5 PRICE | SAMPLE TO YR 6 PRICE | SAMPLE TO YR 7 PRICE | SAMPLE TO YR 8 PRICE | SAMPLE TO YR 9 PRICE | SAMPLE TO TOTAL PRICE | a | |||
| 0001 | General Medical Examination | a | |||||||||||||||||
| 0001A | General Medical - Compensation: Comprehensive General Medical Examination to include a complete base-line exam covering all body parts | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001AA | Requiring 1-5 DBQs | EA | 2,587 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001AB | Requiring 6-10 DBQs | EA | 3,363 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001AC | Requiring 11-15 DBQs | EA | 3,984 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001AD | Requiring 16 or more DBQs | EA | 3,984 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001B | General Medical - Pension | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001BA | Requiring 1-5 DBQs | EA | 68 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001BB | Requiring 6-10 DBQs | EA | 113 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001BC | Requiring 11-15 DBQs | EA | 117 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001BD | Requiring 16 or more DBQs | EA | 117 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001C | General Medical - Separation Health Assessment for Shared Examinations for VA/DOD (including BDD, IDES, and Examinations) | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001CA | Requiring 1-5 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001CB | Requiring 6-10 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001CC | Requiring 11-15 DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001CD | Requiring 16 or more DBQs | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001D | Aid and Attendance or Housebound | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001DA | Requiring 1-5 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001DB | Requiring 6-10 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001DC | Requiring 11-15 DBQs | EA | 11 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001DD | Requiring 16 or more DBQs | EA | 12 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001E | Cold Injury Residuals | EA | 205 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001F | General Medical - Comprehensive Medical Examination to include a Gulf War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001FA | Requiring 1-5 DBQs | EA | 1337 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001FB | Requiring 6-10 DBQs | EA | 2113 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001FC | Requiring 11-15 DBQs | EA | 2734 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001FD | Requiring 16 or more DBQs | EA | 2734 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001G | General Medical - Comprehensive Medical Examination to include a Prisoner of War DBQ | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | a | ||||||
| 0001GA | Requiring 1-5 DBQs | EA | 87 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001GB | Requiring 6-10 DBQs | EA | 863 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001GC | Requiring 11-15 DBQs | EA | 1484 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0001GD | Requiring 16 or more DBQs | EA | 1484 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002 | Musculoskeletal System | a | |||||||||||||||||
| 0002A | Osteomyelitis | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002B | Arthritis | EA | 372 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002C | Amputations | EA | 213 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002D | Shoulder and Arm Conditions | EA | 1,811 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002E | Elbow and Forearm Conditions | EA | 1,140 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002F | Wrist Conditions | EA | 644 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002G | Hand and Finger Conditions | EA | 824 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002H | Back (Thoracolumbar Spine ) Conditions | EA | 1,335 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002I | Neck (Cervical Spine) Conditions | EA | 776 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002J | Hip and Thigh Conditions | EA | 1,164 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002K | Knee and Lower Leg Conditions | EA | 3,084 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002L | Ankle Conditions | EA | 1,366 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002M | Foot Conditions, Including Flatfoot (Pes Planus) | EA | 346 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002N | Bones | EA | 105 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0002O | Muscle Injuries | EA | 377 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0003 | Organs of Special Sense / Eye | a | |||||||||||||||||
| 0003A | Eye Conditions | EA | 2,551 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0004 | Impairment of Auditory Acuity/Ear and Other Sense Organs | a | |||||||||||||||||
| 0004A | Hearing Loss and Tinnitus | EA | 814 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0004B | Ear (including vestibular & infectious ) | EA | 4,947 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0004C | Loss of Sense of Smell and/or Taste (ENT) | EA | 82 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005 | Infectious Diseases, Immune Disorders and Nutritional Deficiencies | a | |||||||||||||||||
| 0005A | Persian Gulf/Afghanistan Infectious Diseases | EA | 10 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005B | HIV-Related Illnesses | EA | 10 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005C | Infectious Diseases (other than HIV-Related Illnesses, Chronic Fatigue Syndrome, or Tuberculosis) | EA | 160 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005D | Systemic Lupus Erythematosus (SLE) and Other Autoimmune Diseases | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005E | Nutritional Deficiencies | EA | 103 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0005F | Chronic Fatigue Syndrome (rheumatological) | EA | 98 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006 | Respiratory System | a | |||||||||||||||||
| 0006A | Sinusitis, Rhinitis, and Other Conditions of the Nose, Throat, Larynx, and Pharynx (ENT) | EA | 1,811 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006B | Respiratory Conditions (other than Tuberculosis and Sleep Apnea) | EA | 755 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006C | Tuberculosis | EA | 41 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006D | Sleep Apnea | EA | 182 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006E | Sleep Studies (HSAT) | EA | 250 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0006F | Sleep Studies (PSG & ECG) | EA | 200 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0007 | Cardiovascular System | a | |||||||||||||||||
| 0007A | Heart Conditions (including IHD, Non-IHD, Arrhythmias, Vascular Disease and Cardiac Surgery) | EA | 1,138 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0007B | Artery and Vein Conditions (Vascular Diseases including Varicose Veins) | EA | 213 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0007C | Hypertension | EA | 968 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008 | Digestive System | a | |||||||||||||||||
| 0008A | Esophageal Disorders (including GERD, Hiatal Hernia and Other Esophageal Disorders) | EA | 745 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008B | Gallbladder and Pancreas Conditions | EA | 72 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008C | Intestinal Conditions (other than Surgical or Infectious), including Irritable Bowel Syndrome, Crohn's Disease, Ulcerative Colitis and Diverticulitis | EA | 403 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008D | Intestinal Surgery (Bowel Resection, Colostomy, Illiostomy) | EA | 46 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008E | (Hepatitis, Cirrhosis, and other) Liver Conditions | EA | 506 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008F | Peritoneal Adhesions | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008G | Stomach and Duodenum Conditions (not including GERD or Esophageal Disorders) | EA | 263 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008H | Infectious Intestinal Disorders (including Bacterial and Parasitic Infections) | EA | 55 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008I | Hernias (including Abdominal, Inguinal and Femoral Hernias) surgical | EA | 419 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0008J | Rectum and Anus Conditions (including Hemorrhoids) | EA | 424 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0009 | Genitourinary System | a | |||||||||||||||||
| 0009A | Kidney Conditions | EA | 341 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0009B | Urinary Tract (including Bladder and Urethra ) Conditions (excluding Male reproductive System) | EA | 243 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0009C | Prostate Cancer | EA | 217 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0009D | Male Reproductive Organ Conditions | EA | 952 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0010 | Gynecological Conditions and Disorders of the Breast | 0 | a | ||||||||||||||||
| 0010A | Gynecological Conditions | EA | 245 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0010B | Breast Conditions and Disorders | EA | 82 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0011 | Hemic and Lymphatic Systems | 0 | a | ||||||||||||||||
| 0011A | (Hairy Cell and Other B-Cell) Leukemia | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0011B | Hematologic and Lymphatic Conditions, including Leukemia | EA | 193 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0012 | Skin (Derm) | a | |||||||||||||||||
| 0012A | Skin Diseases | EA | 1,496 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0012B | Scars/Disfigurement | EA | 1,479 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0013 | Endocrine System | a | |||||||||||||||||
| 0013A | Diabetes Mellitus | EA | 695 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0013B | Endocrine Diseases (other than Thyroid and Parathyroid, or Diabetes Mellitus) | EA | 125 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0013C | Thyroid and Parathyroid Conditions | EA | 124 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014 | Neurological Conditions and Convulsive Disorders | a | |||||||||||||||||
| 0014A | Central Nervous System and Neuromuscular Diseases (except TBI, ALS, PD, MS, Headaches, TMJ, Epilepsy, Narcolepsy, Peripheral Nerves, Sleep Apnea, Cranial Nerves, Fibromyalgia, and CFS) | EA | 188 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014B | Parkinson's Disease | EA | 36 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014C | Amyotrophic Lateral Sclerosis (Lou Gehrig's Disease) | EA | 25 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014D | Diabetic Sensory-Motor Peripheral Neuropathy | EA | 486 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014E | Narcolepsy | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014F | Fibromyalgia | EA | 77 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014G | Headaches (including Migraine Headaches) | EA | 1,472 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014H | Multiple Sclerosis (MS) | EA | 20 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014I | Initial Evaluation of Residuals of Traumatic Brain Injury (I-TBI) | EA | 2,794 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014J | Review Evaluation of Residuals of Traumatic Brain Injury (R-TBI) | EA | 658 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014K | Cranial Nerve Conditions | EA | 77 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014L | Peripheral Nerve Conditions (not including Diabetic Sensory-Motor Peripheral Neuropathy) | EA | 2,407 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014M | Seizure Disorders (epilepsy) | EA | 56 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0014N | Spina Bifida | EA | 4 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0015 | Mental Disorders | a | |||||||||||||||||
| 0015A | Mental Disorders (other than PTSD) | EA | 1,344 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015B | Mental Disorders (other than PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015C | Initial Post Traumatic Stress Disorders (PTSD) | EA | 2,535 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015D | Initial Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015E | Review Post Traumatic Stress Disorders (PTSD) | EA | 6,934 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015F | Review Post Traumatic Stress Disorders (PTSD) - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015G | Eating Disorders | EA | 54 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0015H | Eating Disorders - Telehealth examination | EA | 51 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0016 | Dental and Oral Conditions | a | |||||||||||||||||
| 0016A | Oral and Dental Conditions, including Mouth, Lips, and Tongue (other than Temporomandibular Joint Conditions) | EA | 1,733 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0016B | Temporomandibular Joint (TMJ) Conditions | EA | 188 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0017 | Ancillary Diagnostic Tests ((The percentage proposed listed shall be used when invoicing all costs for the below ancillary diagnostic tests based on the current National Medicare baseline using the applicable Current Procedural Terminology (CPT) code to determine the “unit price” at the time of invoice.) | a | |||||||||||||||||
| 0017A | Procedures (@ $200 Sample Medicare National Baseline Rate) | EA | 1,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0017B | Tests (@ $200 Sample Medicare National Baseline Rate) | EA | 2,000 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0017C | Laboratory Work (@ $50 Sample Medicare National Baseline Rate) | EA | 4,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0017D | Radiological Imaging (@ $50 Sample Medicare National Baseline Rate) | EA | 3,500 | 0% | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0018 | Subject Matter Expert (SME) Opinions (e.g., Camp Lejeune Contaminated Water (CLCW)) | a | |||||||||||||||||
| 0018A | SME Opinions | EA | 200 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0019 | Record Review Medical File & Medical Opinions | a | |||||||||||||||||
| 0019A | Record Review Medical File | ||||||||||||||||||
| (1 hour or <250 pgs) | EA | 1,451 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0019AA | Record Review Medical File w/ Medical Opinion | ||||||||||||||||||
| (1 hour or <250 pgs) | EA | 478 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0019B | Record Review Medical File | ||||||||||||||||||
| (2 hours or 250-749 pgs) | EA | 3,207 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0019BB | Record Review Medical File w/ Medical Opinion | ||||||||||||||||||
| (2 hours or 250-749 pgs) | EA | 1,058 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0019C | Record Review Medical File | ||||||||||||||||||
| (3 hours or >749 pgs) | EA | 3,149 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0019CC | Record Review Medical File w/ Medical Opinion | ||||||||||||||||||
| (3 hours or >749 pgs) | EA | 1,039 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | |||||||
| 0020 | No Shows (If Claimant does not appear for appointment or does not contact vendor within the acceptable timeframe to reschedule but does request a rescheduled appointment, No show is charged on initial appointment but at a lower price since administrative prep work is eventually used by examiner) | a | |||||||||||||||||
| 0020A | Complete No Show (Claimant does not appear) | EA | 5,083 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | ||||||
| 0020B | Partial No Show (Claimant requests to reschedule appointment within less than 24 hours notice) | EA | 660 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | a | SAMPLE TO TOTAL PRICE | |||||
| 0021 | Deliverables | a | |||||||||||||||||
| 0021A | Detailed PMP in accordance with Section 4.1 of the Performance Work Statement (PWS) | Not Separately Priced (NSP) | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021B | Training Plan in accordance with Section 4.5 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021C | Monthly Status Reports in accordance with Section 4.6 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021D | Ramp-up Plan in accordance with Section 1.10 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021E | Reports of ADA & OSHA Compliance in accordance with Section 2.11 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021F | Completed DBQs and all associated examination results related to the examination finding (including diagnostics) in accordance with Section 2 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021G | Incident Report in accordance with Sections 2 and 4.8 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021H | Contractor Portal in accordance with Section 2.3 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021I | Veteran Portal in accordance with Section 2.4 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021J | Service Recovery Plan in accordance with Section 3.3 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021K | Kickoff Meeting Minutes in accordance with Section 4.3 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021L | Quality Assurance Plan in accordance with Section 4.4 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021M | Monthly Invoice Report in accordance with Section 4.7 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | a | ||||||
| 0021N | Emergency Plan in accordance with Section 4.8 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||||||
| 0021O | Ad-hoc Reporting and Requests for Information in accordance with Section 4.9 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||||||
| 0021P | Response to Government Audits in accordance with Section 8.3 of the PWS | NSP | N/A | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | NSP | |||||||
| 0022 | Examiner / Assistant / Chaperone Travel for Incarcerated or Housebound Veterans and Claimant Travel Reimbursement | ||||||||||||||||||
| 0022A | Travel Mileage for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0022B | Travel Time for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0022BA | Physician Assistant (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BB | Nurse Practitioner (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BC | Physician, Generalist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BD | Physician, Ophthalmology (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BE | Optometrist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BF | Audiologist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BG | Psychologist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BH | Psychiatrist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BI | Physician, Physiatry (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BJ | Physician, Neurology (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BK | Surgeon, Neurologist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BL | Dentist (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BM | Otolaryngologis (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BN | Assistant (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022BO | Chaperone (hourly) | EA | 67 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0022C | Travel expenses (other than mileage) for Examiner/ assistant/ chaperone for examination of Incarcerated or Housebound Veteran | NTE | N/A | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0022D | Claimant Mileage Reimbursement | To be invoiced and paid in accordance with Section 2.12 in the PWS | |||||||||||||||||
| 0023 | Monitory Incentives | ||||||||||||||||||
| 0023A | Monitory Incentives | To be invoiced and paid in accordance with Section 3.5 of the PWS | |||||||||||||||||
| 0024 | Ramp Up Activities | ||||||||||||||||||
| 0024A | Ramp-up: Initial Contract Award | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||
| 0024AA | Initial IT Development Activities | EA | 1 | N/A | $0.00 | N/A | N/A | N/A | N/A | N/A | N/A | $0.00 | |||||||
| 0024AB | Initial Examiner Network Building Activities | EA | 1 | N/A | $0.00 | N/A | N/A | N/A | N/A | N/A | N/A | $0.00 | |||||||
| 0024B | Ramp-up: Major Contract Modifications | EA | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||
| 0024BA | Additional IT Development Activities | EA | N/A | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0024BB | Additional Examiner Network Building Activities | EA | N/A | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0024C | Ramp-up: Assignment of Additional ESR Workload and Reallocation of Work | EA | N/A | N/A | TBD | TBD | TBD | TBD | TBD | TBD | TBD | N/A | |||||||
| 0025 | Mobile Events and Mobile Exams | ||||||||||||||||||
| 0025A | Examiners Costs (hourly) | EA | 144 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0025B | Mobile Units (daily) | EA | 4 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0026 | Required Assistant, Chaperone and / or Tele Presenter (hourly) | EA | 48 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0027 | International Contracts Only - Single-Source Sub-contracted Examinations (SSSCE) | NTE | 150 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| 0028 | International Contracts Only - Alternative Medical Evidence (AME) Examinations | NTE | 150 | N/A | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | |||||||
| TOTAL PRICE -- SAMPLE TASK ORDER -- MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275 | |||||||||||||||||||
| REGION 1 (NORTHEAST): | SAMPLE TO BASE YR PRICE | SAMPLE TO YR 1 PRICE | SAMPLE TO YR 2 PRICE | SAMPLE TO YR 3 PRICE | SAMPLE TO YR 4 PRICE | SAMPLE TO YR 5 PRICE | SAMPLE TO YR 6 PRICE | SAMPLE TO TOTAL PRICE | |||||||||||
| $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
&F | &A
Regions
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 1 (NORTHEAST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 2 (SOUTHEAST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 3 (MIDWEST)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
REGION 4 (PACIFIC)
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
PRE-DISCHARGE
MEDICAL DISABILITY EXAMINATIONS UNDER P.L. 104-275
INTERNATIONAL
File details come from the government source that posted it. Updated .