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VA263-17-R-0448
PAGE 1 OF
1. REQUISITION NO.
2. CONTRACT NO.
3. AWARD/EFFECTIVE DATE
4. ORDER NO.
5. SOLICITATION NUMBER
6. SOLICITATION ISSUE DATE
a. NAME
b. TELEPHONE NO. (No Collect Calls)
8. OFFER DUE DATE/LOCAL
TIME
9. ISSUED BY
CODE
10. THIS ACQUISITION IS
UNRESTRICTED OR
SET ASIDE:
% FOR:
SMALL BUSINESS
HUBZONE SMALL
BUSINESS
SERVICE-DISABLED
VETERAN-OWNED
SMALL BUSINESS
WOMEN-OWNED SMALL BUSINESS
(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED
SMALL BUSINESS PROGRAM
EDWOSB
8(A)
NAICS:
SIZE STANDARD:
11. DELIVERY FOR FOB DESTINA-
TION UNLESS BLOCK IS
MARKED
SEE SCHEDULE
12. DISCOUNT TERMS
13a. THIS CONTRACT IS A
RATED ORDER UNDER
DPAS (15 CFR 700)
13b. RATING
14. METHOD OF SOLICITATION
RFQ
IFB
RFP
15. DELIVER TO
CODE
16. ADMINISTERED BY
CODE
17a. CONTRACTOR/OFFEROR
CODE
FACILITY CODE
18a. PAYMENT WILL BE MADE BY
CODE
TELEPHONE NO.
DUNS:
DUNS+4:
PHONE:
FAX:
17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER 18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED
SEE ADDENDUM
19.
20.
21.
22.
23.
24.
ITEM NO.
SCHEDULE OF SUPPLIES/SERVICES
QUANTITY
UNIT
UNIT PRICE
AMOUNT
(Use Reverse and/or Attach Additional Sheets as Necessary)
25. ACCOUNTING AND APPROPRIATION DATA
26. TOTAL AWARD AMOUNT (For Govt. Use Only) 27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED.
27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA
ARE
ARE NOT ATTACHED
28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________
29. AWARD OF CONTRACT: REF. ___________________________________ OFFER
COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND
DATED ________________________________. YOUR OFFER ON SOLICITATION
DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY
(BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE
ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED
SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:
30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER) 30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED
AUTHORIZED FOR LOCAL REPRODUCTION
(REV. 2/2012)
PREVIOUS EDITION IS NOT USABLE
Prescribed by GSA - FAR (48 CFR) 53.212
7. FOR SOLICITATION
INFORMATION CALL:
STANDARD FORM 1449
OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30
SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS
618-18-2-106-0041
VA263-17-R-0448
02-09 -2018 Daniel Vagts 651-293-3040 03-0 -2018
10:00AM CST
Department of Veterans Affairs NCO 23 - St Paul Attention: Daniel Vagts 316 Robert Street N.
St. Paul MN 55417 X 621511 $32.5 Million N/A X N/A X VA Medical Center Department of Veteran Affairs One Veterans Drive, Building 70 Minneapolis MN 55417 Department of Veterans Affairs NCO 23 - Minneapolis Attention: Daniel Vagts 316 Robert Street N.
St. Paul MN 55417
Y Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 X See CONTINUATION Page Pathology and Laboratory Medicine Services for the Minneapolis VA Medical Center.
See Schedule of Items (pg.6) See Performance Work Statement (pg.21) See CONTINUATION Page X X X
ONE
Daniel Vagts Contracting Officer Table of Contents
| SECTION A | 1 | |
| A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS | 1 | |
| SECTION B - CONTINUATION OF SF 1449 BLOCKS | 4 | |
| B.1 CONTRACT ADMINISTRATION DATA | 4 | |
| B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011) | 5 | |
| B.3 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011) | 5 | |
| B.4 SCHEDULE OF ITEMS | 6 | |
| B.5 STATEMENT OF WORK | 21 | |
| SECTION C - CONTRACT CLAUSES | 30 | |
| C.1 52.212-4 CONTRACT TERMS AND CONDITIONS—COMMERCIAL ITEMS (MAY 2015) | 30 | |
| C.2 52.204-9 PERSONAL IDENTITY VERIFICATION OF CONTRACTOR PERSONNEL (JAN 2011) | 36 | |
| C.3 52.216-18 ORDERING (OCT 1995) | 37 | |
| C.4 52.216-19 ORDER LIMITATIONS (OCT 1995) | 37 | |
| C.5 52.216-22 INDEFINITE QUANTITY (OCT 1995) | 38 | |
| C.6 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) | 38 | |
| C.7 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) | 38 | |
| C.8 52.228-5 INSURANCE—WORK ON A GOVERNMENT INSTALLATION (JAN 1997) | 39 | |
| C.9 SUPPLEMENTAL INSURANCE REQUIREMENTS | 39 | |
| C.10 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) | 40 | |
| C.11 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) | 40 | |
| C.12 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) | 40 | |
| C.13 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) | 40 | |
| C.14 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS—COMMERCIAL ITEMS (NOV 2017) | 41 | |
| SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS | 49 | |
| D.1 List of Attachments | 49 | |
| SECTION E - SOLICITATION PROVISIONS | 50 | |
| E.1 52.212-1 INSTRUCTIONS TO OFFERORS—COMMERCIAL ITEMS (JAN 2017) | 50 | |
| E.2 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JUL 2013) | 57 | |
| E.3 52.216-1 TYPE OF CONTRACT (APR 1984) | 58 | |
| E.4 52.227-15 REPRESENTATION OF LIMITED RIGHTS DATA AND RESTRICTED COMPUTER SOFTWARE (DEC 2007) | 58 | |
| E.5 52.233-2 SERVICE OF PROTEST (SEP 2006) | 59 | |
| E.6 VAAR 852.209-70 ORGANIZATIONAL CONFLICTS OF INTEREST (JAN 2008) | 59 | |
| E.7 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (JUL 2016) (DEVIATION) | 60 | |
| E.8 VAAR 852.232-72 ELECTRONIC SUBMISSION OF PAYMENT REQUESTS (NOV 2012) | 60 | |
| E.9 VAAR 852.237-7 INDEMNIFICATION AND MEDICAL LIABILITY INSURANCE (JAN 2008) | 62 | |
| E.10 VAAR 852.237-70 CONTRACTOR RESPONSIBILITIES (APR 1984) | 63 | |
| E.11 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) | 63 | |
| E.12 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) | 64 | |
| E.13 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) | 64 | |
| E.14 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) | 64 | |
| E.15 52.252-1 SOLICITATION PROVISIONS INCORPORATED BY REFERENCE (FEB 1998) | 64 | |
| E.16 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY REFERENCE (JAN 2008) | 65 | |
| E.17 52.212-2 | EVALUATION—COMMERCIAL ITEMS (OCT 2014) | 66 |
| E.18 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS—COMMERCIAL ITEMS (NOV 2017) | 68 | |
SECTION B - CONTINUATION OF SF 1449 BLOCKS
B.1 CONTRACT ADMINISTRATION DATA
(continuation from Standard Form 1449, block 18A.)
1. Contract Administration: All contract administration matters will be handled by the following individuals:
a. CONTRACTOR:
b. GOVERNMENT: Contracting Officer 36C618 Department of Veterans Affairs NCO 23 - St Paul Attention: Daniel Vagts 316 Robert Street N.
St. Paul MN 55417
2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with:
| [X] |
| 52.232-33, Payment by Electronic Funds Transfer—System For Award Management, or |
| [] |
| 52.232-36, Payment by Third Party |
3. INVOICES: Invoices shall be submitted in arrears:
| a. Quarterly | [] |
| b. Semi-Annually | [] |
| c. Other | [X] MONTHLY |
4. GOVERNMENT INVOICE ADDRESS: All Invoices from the contractor shall be submitted electronically in accordance with VAAR Clause 852.232-72 Electronic Submission of Payment Requests.
Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:
Page 1 of Page 1 of
B.2 LIMITATIONS ON SUBCONTRACTING-- MONITORING AND COMPLIANCE (JUN 2011)
This solicitation includes FAR 52.219-4 Notice of Price Evaluation Preference for Hub Zone Small Business Concerns. Accordingly, any contract resulting from this solicitation will include this clause. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) retained by VA to assist in assessing the contractor's compliance with the limitations on subcontracting or percentage of work performance requirements specified in the clause. To that end, the support contractor(s) may require access to contractor's offices where the contractor's business records or other proprietary data are retained and to review such business records regarding the contractor's compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor's compliance with the limitations on subcontracting or percentage of work performance requirement.
VA263-15-R-0860
(End of Clause)
Page 1 of
Page 1 of
Page 1 of
B.3 SUBCONTRACTING COMMITMENTS--MONITORING AND COMPLIANCE (JUN 2011)
This solicitation includes VAAR 852.215-70, Service-Disabled Veteran-Owned and Veteran-Owned Small Business Evaluation Factors, and VAAR 852.215-71, Evaluation Factor Commitments. Accordingly, any contract resulting from this solicitation will include these clauses. The contractor is advised in performing contract administration functions, the CO may use the services of a support contractor(s) to assist in assessing contractor compliance with the subcontracting commitments incorporated into the contract. To that end, the support contractor(s) may require access to the contractor's business records or other proprietary data to review such business records regarding contract compliance with this requirement. All support contractors conducting this review on behalf of VA will be required to sign an “Information Protection and Non-Disclosure and Disclosure of Conflicts of Interest Agreement” to ensure the contractor's business records or other proprietary data reviewed or obtained in the course of assisting the CO in assessing the contractor for compliance are protected to ensure information or data is not improperly disclosed or other impropriety occurs. Furthermore, if VA determines any services the support contractor(s) will perform in assessing compliance are advisory and assistance services as defined in FAR 2.101, Definitions, the support contractor(s) must also enter into an agreement with the contractor to protect proprietary information as required by FAR 9.505-4, obtaining access to proprietary information, paragraph (b). The contractor is required to cooperate fully and make available any records as may be required to enable the CO to assess the contractor compliance with the subcontracting commitments.
B.4 SCHEDULE OF ITEMS
Contractor shall provide the following Pathology and Laboratory Medicine Services to the U.S. Department of Veterans Affairs Medical Center, Minneapolis MN. The offeror’s prices shall include all required labor, equipment, supplies, shipping/courier services and overhead costs as needed to meet the requirements listed in the Schedule of Items and Statement of Work. Prices as quoted shall be firm-fixed prices for the period specified.
BASE YEAR:
| Item # |
| CPT CODE |
| Description |
| Qty |
| Price |
| Extended Amount |
| 0001 |
| #86618 |
| Lyme disease serology |
| 20 |
| 0002 |
| #86617 x 2 |
| Lyme blot (if appropriate) |
| 20 |
| 0003 |
| #88365 |
| Histoplasma-In-Situ Hybridization |
| 2 |
| 0004 |
| #87385 |
| Histoplasma Antigen, Serum |
| 2 |
| 0005 |
| #87385 |
| Histoplasma Antigen, Urine |
| 75 |
| 0006 |
| #87385 |
| Histoplasma Antigen, EIA, Bronchial Wash/Pericardial fluid |
| 2 |
| 0007 |
| #87385 |
| Histoplasma Antigen, Spinal fluid |
| 2 |
| 0008 |
| #85557 |
| Osmotic Fragility Erythrocytes |
| 5 |
| 0009 |
| #86790 x 2 |
| Hantavirus Antibody, IgG, IgM with Reflex to Confirmation |
| 4 |
| 0010 |
| #86790 |
| Hantavirus Antibody, IgG confirmation |
| 2 |
| 0011 |
| #86790 |
| Hantavirus Antibody, IgM Confirmation |
| 2 |
| 0012 |
| #86635 x 3 |
| Coccidioides Antibody, CSF |
| 2 |
| 0013 |
| #82657 |
| Thiopurine Methyltransferase, RBC |
| 100 |
| 0014 |
| #83520 |
| Anti-IgA,IgG, Serum |
| 6 |
| 0015 |
| #83520 |
| Neuron Specific Enolase, CSF |
| 5 |
| 0016 |
| #82525 |
| Copper, Liver tissue |
| 4 |
| 0017 |
| #83540 |
| Iron, Liver tissue |
| 5 |
| 0018 |
| #80323 |
| Nicotine and Metabolites, Urine |
| 10 |
| 0019 |
| #84305 |
| Insulin-Like Growth Factor 1, Serum |
| 2 |
| 0020 |
| #86335 |
| Beta-2 Transferrinin |
| 5 |
| 0021 |
| #85246 |
| Von Willebrands Factor Antigen |
| 15 |
| 0022 |
| #85397 |
| Von Willebrands Factor Activity |
| 15 |
| 0023 |
| #85245 |
| Reflex to Ristocetin if indicated |
| 15 |
| 0024 |
| #85247 |
| Von Willebrand Multimers (result ID 8844) |
| 7 |
| 0025 |
| #82024 |
| ACTH Adenocorticotropic Hormone, Plasma |
| 4 |
| 0026 |
| #82652 |
| 1,25 Dihydroxyvitamin D, serum |
| 100 |
| 0027 |
| #80299 |
| Infliximab Quant w Reflex to Antibodies to Infliximab,Serum |
| 100 |
| 0028 |
| #82657 |
| Acid Alpha-Glucosidase, Blood Spot |
| 3 |
| 0029 |
| #83021 |
| Hemoglobin Electrophoresis, A2 and F |
| 2 |
| 0030 |
| #83021 |
| Hemoglobin Electrophoresis, B |
| 2 |
| 0031 |
| #83020 |
| Quantitiation by Electrophoresis |
| 5 |
| 0032 |
| #83021 |
| Quantitiation by HPLC |
| 5 |
| 0033 |
| #82664 |
| IEF Confirms-Elecrophoresis,not Elsewhere specified |
| 5 |
| 0034 |
| #83068 |
| Hemoglobin, Unstable, Blood |
| 5 |
| 0035 |
| #83789 |
| Hemoglobin Variant by Mass Spectrometry (MS), Blood |
| 5 |
| 0036 |
| #81259 |
| Hemoglobin electrophoresis, Molecular HBA1/HBA2 |
| 5 |
| 0037 |
| #81364 |
| Hemoglobin Electrophoresis, Molecular HBB |
| 5 |
| 0038 |
| #81363 |
| Hemoglobin Electrophoresis, Molecular HBB |
| 5 |
| 0039 |
| #85660 |
| Hemoglobin S, Screen, Blood |
| 5 |
| 0040 |
| #88184 |
| Hemoglobin F, Red Blood Cell Distribution, Blood |
| 5 |
| 0041 |
| #87186 |
| Antimicrobial Sensitivity, Nocardia Species |
| 2 |
| 0042 |
| #88184 x 2 |
| Flow Cytometry/TC 1 Marker |
| 5 |
| 0043 |
| #88185 x 7 |
| Flow Cytometry/TC Add-on |
| 5 |
| 0044 |
| #88188 |
| Flow Cytometry Interp, 9-15 Markers (Reflex Test) |
| 5 |
| 0046 |
| #88380 |
| Microdissection, Laser Capture |
| 6 |
| 0047 |
| #83605 |
| D-Lactate, Plasma |
| 2 |
| 0048 |
| #87207 |
| Microspidia Detection (Concentration) |
| 2 |
| 0049 |
| #87015 |
| Microsporidia Detection Stain |
| 2 |
| 0050 |
| #83970 |
| Parathyroid Hormone (PTH), Serum |
| 5 |
| 0051 |
| #84311 |
| Adenosine Deaminase, Pericardial Fluid |
| 2 |
| 0052 |
| #84439 |
| T4 (Thyroxine), Free, Serum |
| 2 |
| 0053 |
| #84443 |
| Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum |
| 2 |
| 0054 |
| #84442 |
| Thyroxine-Binding Globulin (TBG), Serum |
| 2 |
| 0055 |
| #87536 |
| HIV-1 RNA Detection and Quantification, Plasma |
| 10 |
| 0056 |
| #87538 |
| HIV-2 DNA/RNA Qualitative Real-Time PCR |
| 10 |
| 0057 |
| #86701 |
| HIV-1 Antibody |
| 5 |
| 0058 |
| #86702 |
| HIV-2 Antibody |
| 5 |
| 0059 |
| #86038 |
| Antinuclear antibodies (ANA) |
| 5 |
| 0060 |
| #86039 |
| if positive (if appropriate) |
| 5 |
| 0061 |
| #84402 |
| Testosterone, free |
| 2 |
| 0071 |
| #83516 |
| Anti-PM/Scl Ab |
| 1 |
| 0072 |
| #86235 |
| Anti-Jo 1 Ab |
| 1 |
| 0073 |
| #80375 |
| Azathioprine (Imuran) as 6-mercaptopurine |
| 3 |
| 0074 |
| #80299 |
| Quantification of Drug |
| 2 |
| 0075 |
| #83516 |
| Chemiluminescent Assay |
| 2 |
| 0076 |
| #82397 |
| Antibodies to Inliximab (Reflex Test) |
| 30 |
| 0077 |
| #88321 |
| Pathology Consultation, Outside case |
| 20 |
| 0078 |
| #88323 |
| Pathology Consult, with Slide Prep |
| 2 |
| 0079 |
| #88342 |
| Immunohistochemistry (each stain) |
| 10 |
| 0080 |
| #88312 |
| Stain Group I (each stain) |
| 2 |
| 0081 |
| #81301 |
| Microsatellite Instability Analysis |
| 4 |
| 0082 |
| #88341 |
| MLH-1, Immunostain |
| 2 |
| 0083 |
| #88341 |
| MLH-2 Immunostain |
| 2 |
| 0084 |
| #88341 |
| MSH-6 Immunostain |
| 2 |
| 0085 |
| #88342 |
| PMS-2 Immunostain |
| 2 |
| 0086 |
| #88381 |
| Microdissection, manual |
| 2 |
| 0087 |
| #83912 |
| Inerpretation and Report |
| 2 |
| 0088 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 0089 |
| #83900 x2 |
| Amp of pt nucleic acid, first 2 nucleic acid sequences |
| 4 |
| 0090 |
| #83901 x4 |
| Amp of pt nucleic acid, Each additional nucleic acid |
| 8 |
| 0091 |
| #83909 x6 |
| Separation/ID by High Resolution Technique |
| 12 |
| 0092 |
| #81340 |
| T-Cell antigen receptor, beta |
| 8 |
| 0093 |
| #83909 x6 |
| T-Cell receptor, gamma |
| 8 |
| Volage-Gated Potassium Channel (VGKC) Antibody |
| 5 |
| 0097 |
| #87902 |
| Hepatitis C Viral RNA NS5a Drug Resistance |
| 1 |
| 0098 |
| #87902 |
| Hepatitis C Viral Rna NS3 Genotype |
| 1 |
| 0099 |
| #83912 |
| Interpretation and Report |
| 2 |
| 0100 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 0101 |
| #83900 x2 |
| Amp of pt nucleic acid, first 2 nucleic acid sequences |
| 4 |
| 0102 |
| #83901 x4 |
| Amp of pt nucleic acid, EA add nucleic acid sequence |
| 8 |
| 0103 |
| #83909 x4 |
| Separation/ID by High Resolution Technique |
| 8 |
| 0104 |
| #83912 |
| Interpretation and Report |
| 2 |
| 0105 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 0106 |
| #83898 x2 |
| Amp of pt nucleic acid,Single primer pair Each primer pair |
| 4 |
| 0107 |
| #83909 x2 |
| Separation/ID by High Resolution Technique |
| 4 |
| 0108 |
| #81245 |
| FLT3 ITD mutation detection |
| 10 |
| 0110 |
| #83892 |
| Enzymatic digestion |
| 4 |
| 0111 |
| #83909 x2 |
| Separation/ID by High Resolution Technique |
| 8 |
| 0116 |
| #81275 |
| KRAS Gene, 7 Mutation Panel |
| 5 |
| 0117 |
| #88381 |
| KRAS Gene, 7 Mutation Panel |
| 5 |
| 0118 |
| #88291 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 0119 |
| #88271 x10 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 0120 |
| #88274 x2 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 0121 |
| #88275 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 0122 |
| #88361 |
| HER2, Breast,Quantitative Immunohistochemistry,Automated |
| 10 |
| 0123 |
| #88291 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 0124 |
| #88271 x10 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 0125 |
| #88274 x2 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 0126 |
| #88275 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 0127 |
| #88630 |
| HER2 Gastric/Esophageal,semi quant. Immunhistochem,manu |
| 36 |
| 0128 |
| #88271 x2 |
| DNA probe, each; first probe set |
| 2 |
| 0129 |
| #88291 |
| Interpretation and report |
| 2 |
| 0130 |
| #88271 x2 |
| DNA probe,EA (multiplied by number of add probe sets) |
| 2 |
| 0131 |
| #88274 |
| Interphase in situ hybridization, less than 25 cells, EA probe |
| 2 |
| 0132 |
| #88274 |
| Interphase in situ hybridization, 25 to 99 cells, EA probe set |
| 2 |
| 0133 |
| #88275 |
| Interphase in situ hybridization, 100 to 300 cells, each probe |
| 2 |
| 0134 |
| #88630 |
| HER2,Gastric/Esophageal,semi quant Immunohistochemistry |
| 36 |
| 0135 |
| #88361 |
| HER2,breast,quantitative,immunohistochemistry, automated |
| 10 |
| 0137 |
| #88381 |
| Microdissection, manual |
| 2 |
| 0138 |
| #81401 |
| MYH Gene Analysis for Multiple Adenoma, Y165C and G382D |
| 1 |
| 0139 |
| #81403 x2 |
| IDH1/2, Mutation Analysis |
| 1 |
| 0140 |
| #83520 |
| Interleukin 2 Receptor (CD25), Soluble |
| 1 |
| 0141 |
| #88360 x2 |
| Estrogen/Progesterone Receptor, Semi Quant. Immunohisto |
| 10 |
| 0142 |
| #81401 |
| Hereditary Pancreatitis, Mutation (PRSS1) |
| 2 |
| 0143 |
| #81170 |
| BAKDM (BCR/ABL), Tyrosine Kinase Inhib. Resist., Kinase scre |
| 3 |
| 0144 |
| #81287 |
| MGMT(O-6-methylguanine-DNA methyltransferase |
| 2 |
| 0145 |
| #88381 |
| Slide Review |
| 2 |
| 0146 |
| #81445 |
| Melanoma Targeted Gene Panel by Next Generation, Tumor |
| 5 |
| 0147 |
| #88381 |
| Microdissection, manual |
| 5 |
| 0148 |
| #81315 |
| PML/RARA Quantitative, PCR |
| 7 |
| 0150 |
| #81228 |
| Cytogenomic constitutional (genome-wide) microarray analy |
| 1 |
| 0151 |
| #81228 |
| Hereditary Colon Cancer CGH Array |
| 1 |
| 0152 |
| #87798 x2 |
| Tick-Borne Panel, Molecular Detection PCR, Blood |
| 2 |
| 0153 |
| #87798 |
| Tropheryma whipplei, Molecular Dectection, PCR |
| 2 |
| 0154 |
| #86255 |
| Antineuronal Nuc Aby, Type 1 |
| 10 |
| 0155 |
| #86255 |
| Antineuronal Nuc Aby, Type 2 |
| 10 |
| 0156 |
| #86255 |
| Antineuronal Nuc Aby, Type 3 |
| 10 |
| 0157 |
| #86255 |
| Anti-Glial Nuc Aby, Type 1 |
| 10 |
| 0158 |
| #86255 |
| Purkinje Cell Cyto Aby, Type 1 |
| 10 |
| 0159 |
| #86255 |
| Purkinje Cell Cyto Aby, Type 2 |
| 10 |
| 0160 |
| #86256 |
| Purkinje Cell Aby, Type TR |
| 10 |
| 0161 |
| #86256 |
| Amphiphysin Aby, S |
| 10 |
| 0162 |
| #86256 |
| CRMP-5-IgG |
| 10 |
| 0163 |
| #83520 |
| Striational Muscle Aby |
| 10 |
| 0164 |
| #83519 |
| P/Q Type Calcium Channel Aby |
| 10 |
| 0165 |
| #83519 |
| N-Type Calcium Channel Aby |
| 8 |
| 0166 |
| #83519 |
| Acetylcholine Receptor Binding Aby |
| 8 |
| 0167 |
| #83519 |
| AChR Ganglinoic Neuronal Aby S |
| 8 |
| 0168 |
| #83519 |
| Neuronal (V-G) K+ Channel Aby |
| 8 |
| 0169 |
| #84182 |
| Ach recptor (muscle) modulating antibodies (if appropriate) |
| 2 |
| 0170 |
| #84182 |
| CRMP-5-IgG Western Blot (if appropriate) |
| 4 |
| 0171 |
| #84182 |
| Amphiphysin Western Blot confirmation (if appropriate) |
| 2 |
| 0172 |
| #84182 |
| Paraneoplastic autoantibody Western Blot confirmation |
| 2 |
| 0173 |
| #86255 |
| Neuromyelitis Optica (NMO) Autoantibody IgG, Serum |
| 2 |
| 0174 |
| #86341 |
| GAD65 antibody assay (if appropriate) |
| 2 |
| 0176 |
| #86255 |
| Amphiphysin |
| 2 |
| 0184 |
| #86256 |
| Antineuronal Nuc Aby, Type 1 |
| 10 |
| 0185 |
| #86256 |
| Antineuronal Nuc Aby, Type 2 |
| 10 |
| 0186 |
| #86256 |
| Anti-Glial Nuc Aby, Type 1 |
| 10 |
| 0187 |
| #86256 |
| Purkinje Cell Cyto Aby, Type 1 |
| 10 |
| 0188 |
| #86256 |
| Purkinje Cell Aby, Type 2 |
| 10 |
| 0189 |
| #86256 |
| Purkinje Cell Aby, Type TR |
| 10 |
| 0190 |
| #86256 |
| Amphiphysin Aby, S |
| 10 |
| 0191 |
| #86256 |
| CRMP-5-IgG |
| 10 |
| 0192 |
| #84182 |
| Amphiphysin Western Blot confirmation (if appropriate) |
| 2 |
| 0193 |
| #83520 |
| 14-3-3 Protein, CSF |
| 5 |
| 0194 |
| #83519 |
| Ach receptor (muscle) binding antibody |
| 4 |
| 0195 |
| #83519 |
| AChR Ganglinoic Neuronal Antibody |
| 4 |
| 0196 |
| #83519 |
| Neuronal VGKC anutoantibody |
| 4 |
| 0197 |
| #83519 |
| N-type calcium channel antibody |
| 4 |
| 0198 |
| #83519 |
| P/Q-type calcium channel antibody |
| 4 |
| 0200 |
| #82656 |
| Amphiphysin |
| 4 |
| 0204 |
| #83519 |
| Ach receptor (muscle) binding antibody |
| 2 |
| 0205 |
| #83519 |
| AChR ganglinoic neuronal antibody |
| 2 |
| 0206 |
| #83519 |
| Neuronal VGKC anutoantibody |
| 2 |
| 0207 |
| #83519 |
| N-type calcium channel antibody |
| 2 |
| 0208 |
| #83519 |
| P/Q Type Calcium Channel Aby |
| 2 |
| 0210 |
| #86255 |
| Amphiphysin |
| 2 |
| 0217 |
| #83519 |
| Neuronal VGKC autoantibody |
| 1 |
| 0219 |
| #86256 |
| Amphiphysin |
| 1 |
| 0220 |
| #84182 |
| Amphiphysin Western Blot |
| 1 |
| 0221 |
| #84182 |
| CRMP - Western blot confirmation |
| 1 |
| 0222 |
| #86255 |
| NMO/AQP4-IgG CBA |
| 1 |
| 0223 |
| #86256 |
| AMPAR-Ab titer |
| 1 |
| 0224 |
| #86256 |
| GABAR-Ab titer |
| 1 |
| 0225 |
| #86256 |
| NMDAR-Ab titer |
| 1 |
| 0227 |
| #81310 |
| Nucleophosmin (NPM1) Mutation Analysis |
| 1 |
| 0228 |
| #81218 |
| CEBPA CEPBA Mutations Gene Sequencing |
| 5 |
| 0229 |
| #81450 |
| NGAML Next Generation Sequencing AML 8-gene panel |
| 5 |
| 0230 |
| #81219 |
| CALR Calreticuling Mutation Analysis, Myeloproliferative Neo |
| 5 |
| 0231 |
| #81403 |
| MPL Exon 10 Mutation Detection Varies |
| 5 |
| 0232 |
| #0027U |
| JAKXB Jak2 Exon 12 Other Non-V617F Mutation Dectection |
| 2 |
| 0233 |
| #88300 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0234 |
| #88302 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0235 |
| #88304 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0236 |
| #88305 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0237 |
| #88307 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0238 |
| #88309 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 0239 |
| #81272 & #88381 |
| KIT11 |
| 0 |
| 0240 |
| #81272 & #88381 |
| KIT13 |
| 0 |
| 0241 |
| #81272 & #88381 |
| KIT17 |
| 0 |
| 0242 |
| GIST |
| GIST-Targeted Gene Panel by Next Gen Sequencing test code |
| 1 |
| 0243 |
| MELP |
| Melanoma panel test code MELP |
| 5 |
| 0244 |
| #88346 & 88350 x4 |
| Cutaneous Direct immunofluorescences Assay (IFA) Biopsy |
| 10 |
| 0245 |
| #88346 & 88350 |
| Cutaneous Direct immunofluorescences Antibodies (IgG) Ser |
| 10 |
OPTION YEAR ONE:
| Item # |
| CPT CODE |
| Description |
| Qty |
| Price |
| Extended Amount |
| 1001 |
| #86618 |
| Lyme disease serology |
| 20 |
| 1002 |
| #86617 x 2 |
| Lyme blot (if appropriate) |
| 20 |
| 1003 |
| #88365 |
| Histoplasma-In-Situ Hybridization |
| 2 |
| 1004 |
| #87385 |
| Histoplasma Antigen, Serum |
| 2 |
| 1005 |
| #87385 |
| Histoplasma Antigen, Urine |
| 75 |
| 1006 |
| #87385 |
| Histoplasma Antigen, EIA, Bronchial Wash/Pericardial fluid |
| 2 |
| 1007 |
| #87385 |
| Histoplasma Antigen, Spinal fluid |
| 2 |
| 1008 |
| #85557 |
| Osmotic Fragility Erythrocytes |
| 5 |
| 1009 |
| #86790 x 2 |
| Hantavirus Antibody, IgG, IgM with Reflex to Confirmation |
| 4 |
| 1010 |
| #86790 |
| Hantavirus Antibody, IgG confirmation |
| 2 |
| 1011 |
| #86790 |
| Hantavirus Antibody, IgM Confirmation |
| 2 |
| 1012 |
| #86635 x 3 |
| Coccidioides Antibody, CSF |
| 2 |
| 1013 |
| #82657 |
| Thiopurine Methyltransferase, RBC |
| 100 |
| 1014 |
| #83520 |
| Anti-IgA,IgG, Serum |
| 6 |
| 1015 |
| #83520 |
| Neuron Specific Enolase, CSF |
| 5 |
| 1016 |
| #82525 |
| Copper, Liver tissue |
| 4 |
| 1017 |
| #83540 |
| Iron, Liver tissue |
| 5 |
| 1018 |
| #80323 |
| Nicotine and Metabolites, Urine |
| 10 |
| 1019 |
| #84305 |
| Insulin-Like Growth Factor 1, Serum |
| 2 |
| 1020 |
| #86335 |
| Beta-2 Transferrinin |
| 5 |
| 1021 |
| #85246 |
| Von Willebrands Factor Antigen |
| 15 |
| 1022 |
| #85397 |
| Von Willebrands Factor Activity |
| 15 |
| 1023 |
| #85245 |
| Reflex to Ristocetin if indicated |
| 15 |
| 1024 |
| #85247 |
| Von Willebrand Multimers (result ID 8844) |
| 7 |
| 1025 |
| #82024 |
| ACTH Adenocorticotropic Hormone, Plasma |
| 4 |
| 1026 |
| #82652 |
| 1,25 Dihydroxyvitamin D, serum |
| 100 |
| 1027 |
| #80299 |
| Infliximab Quant w Reflex to Antibodies to Infliximab,Serum |
| 100 |
| 1028 |
| #82657 |
| Acid Alpha-Glucosidase, Blood Spot |
| 3 |
| 1029 |
| #83021 |
| Hemoglobin Electrophoresis, A2 and F |
| 2 |
| 1030 |
| #83021 |
| Hemoglobin Electrophoresis, B |
| 2 |
| 1031 |
| #83020 |
| Quantitiation by Electrophoresis |
| 5 |
| 1032 |
| #83021 |
| Quantitiation by HPLC |
| 5 |
| 1033 |
| #82664 |
| IEF Confirms-Elecrophoresis,not Elsewhere specified |
| 5 |
| 1034 |
| #83068 |
| Hemoglobin, Unstable, Blood |
| 5 |
| 1035 |
| #83789 |
| Hemoglobin Variant by Mass Spectrometry (MS), Blood |
| 5 |
| 1036 |
| #81259 |
| Hemoglobin electrophoresis, Molecular HBA1/HBA2 |
| 5 |
| 1037 |
| #81364 |
| Hemoglobin Electrophoresis, Molecular HBB |
| 5 |
| 1038 |
| #81363 |
| Hemoglobin Electrophoresis, Molecular HBB |
| 5 |
| 1039 |
| #85660 |
| Hemoglobin S, Screen, Blood |
| 5 |
| 1040 |
| #88184 |
| Hemoglobin F, Red Blood Cell Distribution, Blood |
| 5 |
| 1041 |
| #87186 |
| Antimicrobial Sensitivity, Nocardia Species |
| 2 |
| 1042 |
| #88184 x 2 |
| Flow Cytometry/TC 1 Marker |
| 5 |
| 1043 |
| #88185 x 7 |
| Flow Cytometry/TC Add-on |
| 5 |
| 1044 |
| #88188 |
| Flow Cytometry Interp, 9-15 Markers (Reflex Test) |
| 5 |
| 1046 |
| #88380 |
| Microdissection, Laser Capture |
| 6 |
| 1047 |
| #83605 |
| D-Lactate, Plasma |
| 2 |
| 1048 |
| #87207 |
| Microspidia Detection (Concentration) |
| 2 |
| 1049 |
| #87015 |
| Microsporidia Detection Stain |
| 2 |
| 1050 |
| #83970 |
| Parathyroid Hormone (PTH), Serum |
| 5 |
| 1051 |
| #84311 |
| Adenosine Deaminase, Pericardial Fluid |
| 2 |
| 1052 |
| #84439 |
| T4 (Thyroxine), Free, Serum |
| 2 |
| 1053 |
| #84443 |
| Thyroid-Stimulating Hormone-Sensitive (s-TSH), Serum |
| 2 |
| 1054 |
| #84442 |
| Thyroxine-Binding Globulin (TBG), Serum |
| 2 |
| 1055 |
| #87536 |
| HIV-1 RNA Detection and Quantification, Plasma |
| 10 |
| 1056 |
| #87538 |
| HIV-2 DNA/RNA Qualitative Real-Time PCR |
| 10 |
| 1057 |
| #86701 |
| HIV-1 Antibody |
| 5 |
| 1058 |
| #86702 |
| HIV-2 Antibody |
| 5 |
| 1059 |
| #86038 |
| Antinuclear antibodies (ANA) |
| 5 |
| 1060 |
| #86039 |
| if positive (if appropriate) |
| 5 |
| 1061 |
| #84402 |
| Testosterone, free |
| 2 |
| 1071 |
| #83516 |
| Anti-PM/Scl Ab |
| 1 |
| 1072 |
| #86235 |
| Anti-Jo 1 Ab |
| 1 |
| 1073 |
| #80375 |
| Azathioprine (Imuran) as 6-mercaptopurine |
| 3 |
| 1074 |
| #80299 |
| Quantification of Drug |
| 2 |
| 1075 |
| #83516 |
| Chemiluminescent Assay |
| 2 |
| 1076 |
| #82397 |
| Antibodies to Inliximab (Reflex Test) |
| 30 |
| 1077 |
| #88321 |
| Pathology Consultation, Outside case |
| 20 |
| 1078 |
| #88323 |
| Pathology Consult, with Slide Prep |
| 2 |
| 1079 |
| #88342 |
| Immunohistochemistry (each stain) |
| 10 |
| 1080 |
| #88312 |
| Stain Group I (each stain) |
| 2 |
| 1081 |
| #81301 |
| Microsatellite Instability Analysis |
| 4 |
| 1082 |
| #88341 |
| MLH-1, Immunostain |
| 2 |
| 1083 |
| #88341 |
| MLH-2 Immunostain |
| 2 |
| 1084 |
| #88341 |
| MSH-6 Immunostain |
| 2 |
| 1085 |
| #88342 |
| PMS-2 Immunostain |
| 2 |
| 1086 |
| #88381 |
| Microdissection, manual |
| 2 |
| 1087 |
| #83912 |
| Inerpretation and Report |
| 2 |
| 1088 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 1089 |
| #83900 x2 |
| Amp of pt nucleic acid, first 2 nucleic acid sequences |
| 4 |
| 1090 |
| #83901 x4 |
| Amp of pt nucleic acid, Each additional nucleic acid |
| 8 |
| 1091 |
| #83909 x6 |
| Separation/ID by High Resolution Technique |
| 12 |
| 1092 |
| #81340 |
| T-Cell antigen receptor, beta |
| 8 |
| 1093 |
| #83909 x6 |
| T-Cell receptor, gamma |
| 8 |
| Volage-Gated Potassium Channel (VGKC) Antibody |
| 5 |
| 1097 |
| #87902 |
| Hepatitis C Viral RNA NS5a Drug Resistance |
| 1 |
| 1098 |
| #87902 |
| Hepatitis C Viral Rna NS3 Genotype |
| 1 |
| 1099 |
| #83912 |
| Interpretation and Report |
| 2 |
| 1100 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 1101 |
| #83900 x2 |
| Amp of pt nucleic acid, first 2 nucleic acid sequences |
| 4 |
| 1102 |
| #83901 x4 |
| Amp of pt nucleic acid, EA add nucleic acid sequence |
| 8 |
| 1103 |
| #83909 x4 |
| Separation/ID by High Resolution Technique |
| 8 |
| 1104 |
| #83912 |
| Interpretation and Report |
| 2 |
| 1105 |
| #83891 |
| DNA Extraction, Highly purified (HPGDE) |
| 2 |
| 1106 |
| #83898 x2 |
| Amp of pt nucleic acid,Single primer pair Each primer pair |
| 4 |
| 1107 |
| #83909 x2 |
| Separation/ID by High Resolution Technique |
| 4 |
| 1108 |
| #81245 |
| FLT3 ITD mutation detection |
| 10 |
| 1110 |
| #83892 |
| Enzymatic digestion |
| 4 |
| 1111 |
| #83909 x2 |
| Separation/ID by High Resolution Technique |
| 8 |
| 1116 |
| #81275 |
| KRAS Gene, 7 Mutation Panel |
| 5 |
| 1117 |
| #88381 |
| KRAS Gene, 7 Mutation Panel |
| 5 |
| 1118 |
| #88291 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 1119 |
| #88271 x10 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 1120 |
| #88274 x2 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 1121 |
| #88275 |
| HER2 Amp Associated w Breast Cancer,FISH,Tissue |
| 10 |
| 1122 |
| #88361 |
| HER2, Breast,Quantitative Immunohistochemistry,Automated |
| 10 |
| 1123 |
| #88291 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 1124 |
| #88271 x10 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 1125 |
| #88274 x2 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 1126 |
| #88275 |
| HER2 Amp Associated w Gastroesophageal Cancer,FISH,Tissue |
| 36 |
| 1127 |
| #88630 |
| HER2 Gastric/Esophageal,semi quant. Immunhistochem,manu |
| 36 |
| 1128 |
| #88271 x2 |
| DNA probe, each; first probe set |
| 2 |
| 1129 |
| #88291 |
| Interpretation and report |
| 2 |
| 1130 |
| #88271 x2 |
| DNA probe,EA (multiplied by number of add probe sets) |
| 2 |
| 1131 |
| #88274 |
| Interphase in situ hybridization, less than 25 cells, EA probe |
| 2 |
| 1132 |
| #88274 |
| Interphase in situ hybridization, 25 to 99 cells, EA probe set |
| 2 |
| 1133 |
| #88275 |
| Interphase in situ hybridization, 100 to 300 cells, each probe |
| 2 |
| 1134 |
| #88630 |
| HER2,Gastric/Esophageal,semi quant Immunohistochemistry |
| 36 |
| 1135 |
| #88361 |
| HER2,breast,quantitative,immunohistochemistry, automated |
| 10 |
| 1137 |
| #88381 |
| Microdissection, manual |
| 2 |
| 1138 |
| #81401 |
| MYH Gene Analysis for Multiple Adenoma, Y165C and G382D |
| 1 |
| 1139 |
| #81403 x2 |
| IDH1/2, Mutation Analysis |
| 1 |
| 1140 |
| #83520 |
| Interleukin 2 Receptor (CD25), Soluble |
| 1 |
| 1141 |
| #88360 x2 |
| Estrogen/Progesterone Receptor, Semi Quant. Immunohisto |
| 10 |
| 1142 |
| #81401 |
| Hereditary Pancreatitis, Mutation (PRSS1) |
| 2 |
| 1143 |
| #81170 |
| BAKDM (BCR/ABL), Tyrosine Kinase Inhib. Resist., Kinase scre |
| 3 |
| 1144 |
| #81287 |
| MGMT(O-6-methylguanine-DNA methyltransferase |
| 2 |
| 1145 |
| #88381 |
| Slide Review |
| 2 |
| 1146 |
| #81445 |
| Melanoma Targeted Gene Panel by Next Generation, Tumor |
| 5 |
| 1147 |
| #88381 |
| Microdissection, manual |
| 5 |
| 1148 |
| #81315 |
| PML/RARA Quantitative, PCR |
| 7 |
| 1150 |
| #81228 |
| Cytogenomic constitutional (genome-wide) microarray analy |
| 1 |
| 1151 |
| #81228 |
| Hereditary Colon Cancer CGH Array |
| 1 |
| 1152 |
| #87798 x2 |
| Tick-Borne Panel, Molecular Detection PCR, Blood |
| 2 |
| 1153 |
| #87798 |
| Tropheryma whipplei, Molecular Dectection, PCR |
| 2 |
| 1154 |
| #86255 |
| Antineuronal Nuc Aby, Type 1 |
| 10 |
| 1155 |
| #86255 |
| Antineuronal Nuc Aby, Type 2 |
| 10 |
| 1156 |
| #86255 |
| Antineuronal Nuc Aby, Type 3 |
| 10 |
| 1157 |
| #86255 |
| Anti-Glial Nuc Aby, Type 1 |
| 10 |
| 1158 |
| #86255 |
| Purkinje Cell Cyto Aby, Type 1 |
| 10 |
| 1159 |
| #86255 |
| Purkinje Cell Cyto Aby, Type 2 |
| 10 |
| 1160 |
| #86256 |
| Purkinje Cell Aby, Type TR |
| 10 |
| 1161 |
| #86256 |
| Amphiphysin Aby, S |
| 10 |
| 1162 |
| #86256 |
| CRMP-5-IgG |
| 10 |
| 1163 |
| #83520 |
| Striational Muscle Aby |
| 10 |
| 1164 |
| #83519 |
| P/Q Type Calcium Channel Aby |
| 10 |
| 1165 |
| #83519 |
| N-Type Calcium Channel Aby |
| 8 |
| 1166 |
| #83519 |
| Acetylcholine Receptor Binding Aby |
| 8 |
| 1167 |
| #83519 |
| AChR Ganglinoic Neuronal Aby S |
| 8 |
| 1168 |
| #83519 |
| Neuronal (V-G) K+ Channel Aby |
| 8 |
| 1169 |
| #84182 |
| Ach recptor (muscle) modulating antibodies (if appropriate) |
| 2 |
| 1170 |
| #84182 |
| CRMP-5-IgG Western Blot (if appropriate) |
| 4 |
| 1171 |
| #84182 |
| Amphiphysin Western Blot confirmation (if appropriate) |
| 2 |
| 1172 |
| #84182 |
| Paraneoplastic autoantibody Western Blot confirmation |
| 2 |
| 1173 |
| #86255 |
| Neuromyelitis Optica (NMO) Autoantibody IgG, Serum |
| 2 |
| 1174 |
| #86341 |
| GAD65 antibody assay (if appropriate) |
| 2 |
| 1176 |
| #86255 |
| Amphiphysin |
| 2 |
| 1184 |
| #86256 |
| Antineuronal Nuc Aby, Type 1 |
| 10 |
| 1185 |
| #86256 |
| Antineuronal Nuc Aby, Type 2 |
| 10 |
| 1186 |
| #86256 |
| Anti-Glial Nuc Aby, Type 1 |
| 10 |
| 1187 |
| #86256 |
| Purkinje Cell Cyto Aby, Type 1 |
| 10 |
| 1188 |
| #86256 |
| Purkinje Cell Aby, Type 2 |
| 10 |
| 1189 |
| #86256 |
| Purkinje Cell Aby, Type TR |
| 10 |
| 1190 |
| #86256 |
| Amphiphysin Aby, S |
| 10 |
| 1191 |
| #86256 |
| CRMP-5-IgG |
| 10 |
| 1192 |
| #84182 |
| Amphiphysin Western Blot confirmation (if appropriate) |
| 2 |
| 1193 |
| #83520 |
| 14-3-3 Protein, CSF |
| 5 |
| 1194 |
| #83519 |
| Ach receptor (muscle) binding antibody |
| 4 |
| 1195 |
| #83519 |
| AChR Ganglinoic Neuronal Antibody |
| 4 |
| 1196 |
| #83519 |
| Neuronal VGKC anutoantibody |
| 4 |
| 1197 |
| #83519 |
| N-type calcium channel antibody |
| 4 |
| 1198 |
| #83519 |
| P/Q-type calcium channel antibody |
| 4 |
| 1200 |
| #82656 |
| Amphiphysin |
| 4 |
| 1204 |
| #83519 |
| Ach receptor (muscle) binding antibody |
| 2 |
| 1205 |
| #83519 |
| AChR ganglinoic neuronal antibody |
| 2 |
| 1206 |
| #83519 |
| Neuronal VGKC anutoantibody |
| 2 |
| 1207 |
| #83519 |
| N-type calcium channel antibody |
| 2 |
| 1208 |
| #83519 |
| P/Q Type Calcium Channel Aby |
| 2 |
| 1210 |
| #86255 |
| Amphiphysin |
| 2 |
| 1217 |
| #83519 |
| Neuronal VGKC autoantibody |
| 1 |
| 1219 |
| #86256 |
| Amphiphysin |
| 1 |
| 1220 |
| #84182 |
| Amphiphysin Western Blot |
| 1 |
| 1221 |
| #84182 |
| CRMP - Western blot confirmation |
| 1 |
| 1222 |
| #86255 |
| NMO/AQP4-IgG CBA |
| 1 |
| 1223 |
| #86256 |
| AMPAR-Ab titer |
| 1 |
| 1224 |
| #86256 |
| GABAR-Ab titer |
| 1 |
| 1225 |
| #86256 |
| NMDAR-Ab titer |
| 1 |
| 1227 |
| #81310 |
| Nucleophosmin (NPM1) Mutation Analysis |
| 1 |
| 1228 |
| #81218 |
| CEBPA CEPBA Mutations Gene Sequencing |
| 5 |
| 1229 |
| #81450 |
| NGAML Next Generation Sequencing AML 8-gene panel |
| 5 |
| 1230 |
| #81219 |
| CALR Calreticuling Mutation Analysis, Myeloproliferative Neo |
| 5 |
| 1231 |
| #81403 |
| MPL Exon 10 Mutation Detection Varies |
| 5 |
| 1232 |
| #0027U |
| JAKXB Jak2 Exon 12 Other Non-V617F Mutation Dectection |
| 2 |
| 1233 |
| #88300 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1234 |
| #88302 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1235 |
| #88304 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1236 |
| #88305 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1237 |
| #88307 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1238 |
| #88309 |
| ANPAT - Anatomic Pathology Consultation, Wet Tissue (eye) |
| 1 |
| 1239 |
| #81272 & #88381 |
| KIT11 |
| 0 |
| 1240 |
| #81272 & #88381 |
| KIT13 |
| 0 |
| 1241 |
| #81272 & #88381 |
| KIT17 |
| 0 |
| 1242 |
| GIST |
| GIST-Targeted Gene Panel by Next Gen Sequencing test code |
| 1 |
| 1243 |
| MELP |
| Melanoma panel test code MELP |
| 5 |
| 1244 |
| #88346 & 88350 x4 |
| Cutaneous Direct immunofluorescences Assay (IFA) Biopsy |
| 10 |
| 1245 |
| #88346 & 88350 |
| Cutaneous Direct immunofluorescences Antibodies (IgG) Ser |
| 10 |
SCHEDULE NOTES
Additional Tests It may occur that the VAMC laboratory will require a test not listed in the Schedule of Items but that is available from the contractor’s catalog of tests, or a new test becomes available that is not listed in the Schedule of Items. If a test is required that is not listed in the Schedule of Items, the VA and the contractor will negotiate a firm fixed price. The new tests will be added to the contract accordingly via a contract modification. These tests will be considered as part of the overall contract value and together with the other tests cannot exceed the total estimated contract value.
2. Estimated Quantities The quantities as listed in the “Schedule of Items” are estimated requirements for a twelve (12) month contract period with one (1) possible twelve (12) month options. The Government estimates, but does not guarantee, that the volume of purchases under this contract will be an estimated ceiling amount $985,000.00 for the entire 2-year contract period. The VAMC attempts to be as accurate as possible when providing estimated quantities, however, actual quantities required may vary from the quantities listed. The Government is obligated only to the extent of the minimum contract guarantee. During the period specified in FAR clause 52.216-18, ORDERING, the Government shall place orders totaling a minimum of $50,000.00 for a 12-month contract period.
3. Multiple Award It would be most advantageous to the Government to award to a contractor who can provide all of the line items as requested in the Schedule of Items. The Government may establish a single contract award for ALL line items in lieu of multiple contracts or may establish multiple contracts, whichever provides the best value to the VAMC.
B.5 STATEMENT OF WORK
1. SCOPE OF WORK
The US Department of Veterans Affairs Health Care System, Minneapolis, MN, hereinafter referred to as MVAHCS or VA, intends to issue a contract for “Complex Case Consultation and Testing for Anatomic Pathology, Neurology, and Infectious Disease” services for the Pathology and Laboratory Medicine Service (P&LMS) located at MVAHCS, One Veterans Drive, Minneapolis, MN 55417. All services provided shall be in accordance with the prices, terms and conditions of this contract.
Testing needs may consist of, but are not limited to, serological and in situ hybridization-based tests for infectious disease; quantitative tissue analysis for copper and iron; specialized neurological testing; screening for hereditary disorders such as hereditary non-polyposis colon carcinoma syndrome; hemoglobin electrophoresis; determination of erythrocyte, CSF, and serum enzyme levels; and consultation on complex anatomic pathology cases, including ophthalmologic, pulmonary and urologic pathology.
These services require a comprehensive academic medical center with extensive expertise across a wide range of surgical pathology disciplines and organ systems. The pathology department must include nationally recognized experts in a variety of areas of anatomic pathology, such as urologic, gastrointestinal, pulmonary, and soft tissue/ orthopedic pathology. In addition, the medical center must include a division or subdivision of ophthalmologic pathology, with specialized ophthalmologic pathologists.
The laboratory must be able to provide specialized neurology testing to include the following assays:
Neuromyelitis optica (NMO) Autoantibody, IgG, Serum Antineuronal Nuc Aby, Type 1 Antineuronal Nuc Aby, Type 2 Antineuronal Nuc Aby, Type 3 Anti-Glial Nuc Aby, Type 1 Purkinje Cell Cyto Aby, Type 1 Purkinje Cell Aby, Type 2 Purkinje Cell Aby, Type TR Amphiphysin Aby, S CRMP-6-IgG Striational Muscle Aby P/Q Type Calcium Channel Aby N-Type Calcium Channel Aby Acetylcholine Receptor Binding Aby AChR Ganglionic Neuronal Aby, S Neuronal (V-G) K+ Channel Aby CRMP-5-IgG Western Blot The contractor must be able to offer specialized testing for infectious disease, including in situ hybridization for histoplasma in tissue, and urinary histoplasma antigen.
Contractor shall provide laboratory testing services to include: List of tests with reference ranges, specimen requirements, processing and analysis of the specimen; and reporting of specimen results. Consultation regarding test selection, collection, transportation and result interpretation shall also be provided when required. The contractor must provide the following services:
Provide the following for transport of the specimens to include:
Lab test request forms (it is possible that vendor may need to customize forms to include information required by the VA).
Special instructions for handling of specimen.
Specimen collection supplies for specialized testing.
Analyze samples.
Contractor shall provide a monthly billing for tests provided each month following the month in which the service was delivered.
Contractor shall consult with VA Laboratory on test results by telephone as needed.
Provide the VA Laboratory with a means of communication to permit immediate inquiry regarding the status of a pending test.
A Laboratory User’s Manual or similar documentation will be provided to the VA Laboratory.
The manual shall include a list of all tests that the Contractor can provide along with the testing methodology used for each test, test reference ranges, length of time of testing, which days the test is run, and specimen requirements and any special handling required.
Provide the courier service for transport of specimens.
The MVAHCS Laboratory reserves the right to request the results of any proficiency testing that the contractor subscribes.
Licensing and Accreditation The Contractor’s shall assure compliance of all procedures and practices by the following accrediting agencies, and the facility and employees shall have all licenses, permits, accreditation, professional certifications and qualifications required by federal and state law to provide laboratory testing and consult services. This includes:
Accreditation by the College of American Pathologists (CAP) Accreditation by the Centers for Prevention and Disease Control (CDC) Contractor Qualification Requirements The pathologists for interpretive reports must have an unrestricted license to practice medicine in one of the states or territories of the United States of District of Columbia.
A division or subdivision of ophthalmologic pathology must exist within the medical center, with Ophthalmologic Pathologists on staff who have fellowship experience or other specialized training in eye pathology.
Expert consultant pathologists must have national reputations in their areas of specialization, as evidenced by ongoing publication in academic journals and/or presentations at national pathology meetings. Special attention will be paid to expertise in male genitourinary, soft tissue/bone, gastrointestinal, and pulmonary pathology. Sponsorship of subspecialty fellowships in adult surgical pathology, such as gastrointestinal, pulmonary, genitourinary, or bone and soft tissue fellowships, is also desirable.
The qualifications of such personnel shall also be subject to review by VA Medical Center Laboratory Director. VA reserves the right to approve the assignment of individual personnel furnished by the Contractor to perform the functions specified in the contract.
Test Sample Preparation The VA laboratory shall be responsible to provide laboratory specimens prepared in accordance with the contractor’s Laboratory User’s Manual. All specimens will be properly identified and labeled for testing. The contractor shall provide an adequate supply of requisition forms, special instructions and a current list of tests with reference ranges and specimen requirements. These requirements shall be defined in the laboratory user’s manual.
Transport of Specimens Vendor will work with the Minneapolis VA laboratory to arrange the transport of samples.
Turn Around Time Contractor shall provide a faxed report on anatomic pathology consultation cases within 4 working days of receipt of specimen, unless additional testing such as immunohistochemistry or molecular gene rearrangement studies is required.
Urinary histoplasma antigen shall be reported within 8 working days. Specialized neurological testing shall be reported within 14-17 working days.
Reporting of Test Results A report is defined as a printed final copy of pathology interpretive consult. Consult reports shall be sent by contractor to secured VAMC Laboratory FAX # 612-725-2079 located in the VAMC Pathology & Laboratory Medicine Service office. If results are telephoned prior to sending, the written report must include the name of the individual notified of the results, date and time of telephone report. Each consult report shall at a minimum indicate the following information:
Patient’s name and identification code Physician’s name (if supplied) VA Medical Center name Patient’s location, e.g. clinic, ward (if supplied) Test ordered Date/time of specimen collection (when available) Date/time specimen received in Reference Lab Date test completed Test result Flag abnormal results Reference Range Toxic and/or therapeutic range where applicable Name of testing laboratory (contractor and/or subcontractor) Testing laboratory specimen number Type of specimen Comments related to the test provided by the submitting lab Information that may indicate a questionable validity of test results Unsatisfactory specimen shall be reported with reason as to its unsuitability for testing Quality Control To ensure proper handling and test performance, the contractor shall provide the following updated information upon request during the life of the contract:
For quality purposes, tests routinely performed in duplicate should be indicated.
Coefficient of variation of quality control samples of all tests or specified tests the laboratory performs.
Proficiency testing data shall include a list of tests outside of the ± 2 SD range for the past two years. Contractor shall notify the laboratory of any test falling outside ± 2 SD range during the contract period.
Contractor shall provide address of processing sites under contract, including subcontracted testing location sites.
The contractor(s) facilities, methodologies (defined as the principal of the method and references), and quality control procedures may be examined by representatives of the VA at any time during the life of the contract.
Contractor agrees to maintain the minimum acceptable service, reporting systems and quality controls as specified herein. Immediate (within 24 hours) notification must be given to VA upon adverse action by a regulatory agency.
Testing Summaries Contractor shall provide the Minneapolis VA Laboratory a testing summary report each month following the month in which the testing service was provided. At the end of each contract year a cumulative (year-to-date) report shall be submitted to the VA providing the name of test ordered, price of test, cumulative totals and a total of all funds spent by that VA facility on laboratory testing services.
Testing Changes The Contractor shall advise the VA of any changes in assay methodology, procedures, reference ranges and any new tests introduced.
In the event that the contractor changes the assay procedures or a critically important component of an assay (e.g., an antibody, purified antigen, etc.) the contractor shall notify the VA Contracting Office and the VA Laboratory Director prior to the intended change. He shall provide documentation that the quality and efficacy of the test will remain unchanged or be improved.
Changes in the assay material, testing procedures or methodology that have not been reviewed and pre-approved by VA Laboratory Director and mutually agreed upon in writing between the contractor and the VA Contracting Officer, may be sufficient cause for the VA to use an alternate contractor for that specific test for the duration of the contract.
Contractor Telephone Numbers Contractor shall provide telephone number(s) and contact person(s) to be used by the VA Pathology & Laboratory Medicine Service for specimen inquiries, and Lab Technical/Pathologist consultation. There must be someone available at the number(s) provided at all times including weekends and holidays.
Phone Number Specimen Inquiries: __________________________
Lab Technical Director/Pathologists: __________________________
4. SUBCONTRACTING APPROVAL
If Contractor intends to use a subcontractor to provide any of the testing required under this contract, Contractor shall be responsible for finding a subcontractor laboratory with appropriate licensure and accreditation. Contractor shall notify the VA Contracting Office of any plan to use a subcontractor or make a subcontractor change, and request a prior acceptance and approval from VA.
Contractor will use the following subcontractor(s):
5. CHANGES
Changes in the terms and conditions of this contract may be made only by written agreement of both parties. Contractor must submit requests for changes in writing to the VA Contracting Office. Any and all modifications to this contract must be approved and prepared by the VA Contracting Officer for signature.
6. QUALITY ASSURANCE
The government will evaluate the Contractor’s performance under this contract and the Contractor performance will be monitored to determine if it meets the contract standards. A variety of methods may be used. Nonperformance or substandard task performance will be documented if and when it occurs. The Technical Representative will follow the methods of surveillance specified in the Performance Measures.
Performance Measures The following performance measures will be regularly tracked and monitored throughout the effective period of this contract by the Technical Representative and reported to the Contracting Officer. Acceptable performance on these measures, along with other factors, will be primary indices of contractor performance and a key consideration in contract renewal decisions.
Performance will be monitored using the following criteria:
| Action/Test/Report |
| Turnaround time (TAT) |
| Acceptable Performance |
| Final surgical pathology consultation report completion |
| Within 4 working days of specimen receipt for cases not requiring additional studies. |
| 80% of all consults submitted |
| Urinary histoplasma antigen result |
| Within 8 working days of specimen receipt. |
| 80% of all tests submitted |
| Results of specialized neurology testing |
| Within 10-14 working days of specimen receipt. |
| 80% of all tests |
submitted
| Molecular Testing |
| Within 7 working days of specimen receipt |
| 80% of all tests |
submitted
Government Roles and Responsibilities The MVAHCS Contracting Officer shall designate a Technical Representative to coordinate and monitor the work to be completed under this contract. Amy Colbaugh, COR has been designated as the representative to coordinate these services. Her contact information is listed below.
Technical Representative:
Amy Colbaugh, COR Minneapolis VA Health Care System One Veterans Drive, P&LMS (113) Minneapolis, MN 55417
(612) 467-5989 amy.colbaugh@va.gov
7. ORDERING PROCEDURES
This contract does not obligate any funding; therefore, the Contractor shall provide services under this contract only as directed in task orders. Task orders for bulk dollar amounts will be issued during the contract period. Any warranted VA Contracting Officer is authorized to issue task orders under this contract. The Minneapolis laboratory personnel may place verbal orders with the contractor to meet their testing needs, up to the bulk task order total. The contractor will be required to inform the VA contract specialist or contracting officer when each task order reaches 80% of the total bulk dollar amount.
In accordance with FAR 16.505, each task order will include the following: (i) Date of order (ii) Contract number and order number (iii) Contract item number and description, quantity, and unit price or estimated cost or fee (iv) Delivery or performance date (v) Place of delivery or performance (including consignee) (vi) Packaging, packing, and shipping instructions, if any (vii) Accounting and appropriation data (viii) Method of payment and payment office, if not specified in the contract (ix) Any other pertinent information.
VA Electronic Invoice Presentment and Payment System: The VA Financial Services Center (FSC) uses a third-party contractor, OB10, to transition vendors from paper to electronic invoice submission. Please go to this website: http://ob10.com/us/en/veterans-affairs-us/ to begin submitting electronic invoices, free of charge. Contact Tungsten/OB10 at the phone numbers or email listed below for assistance:
Tungsten/OB10 Support & setup Information: 1-877-489-6135 Tungsten/OB10 e-Invoice email: VA.Resgistration@tungsten-network.com Tungsten/OB10 Client Services: 1-877-752-0900, option 1
Contractor must furnish a designated point of contact for placing orders. Orders for laboratory testing services shall be sent to Contractor through the contact person listed below at the following address:
(Offeror to complete)
Vendor’s Contact Person: ____________________ Telephone Number: _______________ FAX Number: ______________ Address: _____________________
8. SAFETY AND SECURITY REQUIREMENTS
HIPAA Compliance and Requirements Contractor will adhere to the applicable provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI). As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security, use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA). As defined in the Health Insurance Portability and Accountability Act (HIPAA) Public Law 104-191, your company may be required to execute a Business Associate Agreement.
If contractor’s facility is an entity that is not covered under the…
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