B.2 CONTRACT ADMINISTRATION DATA - Veterans Affairs



PAGE 1 OF1. REQUISITION NO. 2. CONTRACT NO.3. AWARD/EFFECTIVE DATE4. ORDER NO.5. SOLICITATION NUMBER6. SOLICITATION ISSUE DATEa. NAMEb. TELEPHONE NO. (No Collect Calls)8. OFFER DUE DATE/LOCALTIME9. ISSUED BYCODE10. THIS ACQUISITION IS UNRESTRICTED ORSET ASIDE: % FOR:SMALL BUSINESSHUBZONE SMALLBUSINESSSERVICE-DISABLEDVETERAN-OWNEDSMALL BUSINESSWOMEN-OWNED SMALL BUSINESS(WOSB) ELIGIBLE UNDER THE WOMEN-OWNEDSMALL BUSINESS PROGRAMECONOMICALLY DISADVANTAGEDWOMEN-OWNED SMALL BUSINESS(EDWOSB)8(A)NAICS:SIZE STANDARD:11. DELIVERY FOR FOB DESTINA-TION UNLESS BLOCK ISMARKEDSEE SCHEDULE12. DISCOUNT TERMS 13a. THIS CONTRACT IS A RATED ORDER UNDERDPAS (15 CFR 700)13b. RATING14. METHOD OF SOLICITATIONRFQIFBRFP15. DELIVER TO CODE16. ADMINISTERED BYCODE17a. CONTRACTOR/OFFERORCODEFACILITY CODE18a. PAYMENT WILL BE MADE BYCODETELEPHONE NO.17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKEDSEE ADDENDUM19.20.21.22.23.24.ITEM NO.SCHEDULE OF SUPPLIES/SERVICESQUANTITYUNITUNIT PRICEAMOUNT(Use Reverse and/or Attach Additional Sheets as Necessary)25. ACCOUNTING AND APPROPRIATION DATA26. 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. ADDENDAAREARE NOT ATTACHED.27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDAAREARE NOT ATTACHED28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFERCOPIES 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 SPECIFIEDSET FORTH HEREIN IS ACCEPTED AS TO ITEMS:30a. SIGNATURE OF OFFEROR/CONTRACTOR31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT)30c. DATE SIGNED31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT)31c. DATE SIGNEDAUTHORIZED FOR LOCAL REPRODUCTION(REV. 5/2011)PREVIOUS EDITION IS NOT USABLEPrescribed by GSA - FAR (48 CFR) 53.2127. FOR SOLICITATIONINFORMATION CALL:STANDARD FORM 1449OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS 146VA260-12-R-0029Mark Erickson253-583-214712-16-201112:00 PM PSTDepartment of Veterans AffairsContracting Officer (10F-ACQ)VA Puget Sound Healthcare System9600 Veterans Drive SW, Bldg 17Tacoma WA 98493X622110$34.5 MillionXNet 30 days N/AXDepartment of Veterans AffairsAlaska VA Healthcare System1201 North Muldoon RoadAnchorage AK 99504Department of Veterans AffairsContracting Officer (10F-ACQ)VA Puget Sound Healthcare System9600 Veterans Drive SW, Bldg 17Tacoma WA 98493Department of Veterans AffairsFMS-VA-2(101)Financial Services CenterPO Box 149971Austin TX 78714-9971See CONTINUATION PageThe Alaska VA Healthcare System is soliciting forcompetitive offers to provide oncology chemotherapy servicesfor beneficiaries of the Veterans Healthcare Administrationin Alaska.Interested offerors are advised to pay special attention tothe Basis of Selection portion of this Request for Proposalsfor instructions on how to submit offers for evaluation.See CONTINUATION PageXXMark A. Ericksonmark.erickson3@ Table of ContentsSECTION A1A.1 SF 1449 SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL ITEMS1SECTION B - CONTINUATION OF SF 1449 BLOCKS2B.1 PRE-PROPOSAL CONFERENCE INFORMATION4B.2 CONTRACT ADMINISTRATION DATA5B.3 PERFORMANCE WORK STATEMENT6B.4 PRICE?COST SCHEDULE31B.5 PERIODS OF PERFORMANCE SCHEDULE87SECTION C - CONTRACT CLAUSES88C.1 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (JUN 2010)88C.2 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (AUG 2011)93C.3 52.216-18 ORDERING (OCT 1995)99C.4 52.216-19 ORDER LIMITATIONS (OCT 1995)99C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999)100C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000)100C.7 52.232-18 AVAILABILITY OF FUNDS (APR 1984)100C.8 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984)101C.9 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008)101C.10 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992)101C.11 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (DEC 2009)101C.12 VAAR 852.216-70 ESTIMATED QUANTITIES (APR 1984)102C.13 VAAR 852.219-71 VA MENTOR-PROT?G? PROGRAM (DEC 2009)102C.14 MANDATORY WRITTEN DISCLOSURES103C.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998)103SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS104D.1 QUALITY ASSURANCE SURVEILLANCE PLAN104D.2 WAGE DETERMINATION109SECTION E - SOLICITATION PROVISIONS118E.1 52.212-2 EVALUATION--COMMERCIAL ITEMS (JAN 1999)118E.2 ADDENDUM TO 52.212-2 BASIS OF SELECTION118E.3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-- COMMERCIAL ITEMS (MAY 2011)120E.4 52.203-2 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985)133E.5 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998)134E.6 52.204-5 WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS) (MAY 1999)136E.7 52.204-6 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (APR 2008)136E.8 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (MAY 2011)137E.9 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010)140E.10 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JAN 2011)142E.11 52.216-1 TYPE OF CONTRACT (APR 1984)143E.12 52.216-7 SINGLE OR MULTIPLE AWARDS (OCT 1995)143E.13 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999)144E.14 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984)144E.15 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008)144E.16 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998)145E.17 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY REFERENCE (JAN 2008)145E.18 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008)145E.19 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008)145E.20 VAAR 852.273-70 LATE OFFERS (JAN 2003)145E.21 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003)146SECTION B - CONTINUATION OF SF 1449 BLOCKSB.1 PRE-PROPOSAL CONFERENCE INFORMATION PRE-PROPOSAL CONFERENCEa. A pre-proposal conference will be held at the Alaska VA Healthcare System facility at 11:30 pm to 1:30 pm (Alaska Time) on 07 December 2011. Location of the conference is 1201 North Muldoon Road, the Director’s Suite, Room 2D-185, Anchorage, Alaska, 99504. The purpose of the pre-proposal conference is to eliminate any possible misunderstandings of the terms of the solicitation. Prospective offerors are urged to attend and to submit any questions they may have in advance in writing to the Contracting Officer, Mark Erickson, at mark.erickson3@ by close of business on 30 November 2011. Remarks and explanations at the conference shall not qualify the terms of the solicitation and specifications. Unless the solicitation is amended in writing, it will remain unchanged.b. Offerors must notify the Contracting Officer, Mark Erickson, at mark.erickson3@ by close of business on 30 November 2011 if attending the pre-proposal conference. If no response is received, the conference may be canceled. No other pre-proposal conference will be scheduled. Attendance is at the expense of the offerors.c. Offerors are advised that in no event shall failure to attend the pre-proposal conference constitute grounds for a claim after award of this contract.B.2 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:(To Be Determined) b. GOVERNMENT: Contracting Officer 00260Department of Veterans AffairsContracting Officer (10F-ACQ)VA Puget Sound Healthcare System9600 Veterans Drive SW, Bldg 17Tacoma WA 98493 2. CONTRACTOR REMITTANCE ADDRESS: All payments by the Government to the contractor will be made in accordance with: [X]52.232-34, Payment by Electronic Funds Transfer -Other than Central Contractor Registration, or []52.232-36, Payment by Third Party 3. INVOICES: Invoices shall be submitted in arrears: a. Quarterly[] b. Semi-Annually[] c. Other[Monthly] 4. GOVERNMENT INVOICE ADDRESS: All invoices from the contractor shall be mailed to the following address: Department of Veterans AffairsFMS-VA-2(101)Financial Services CenterPO Box 149971Austin TX 78714-9971 ACKNOWLEDGMENT OF AMENDMENTS: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows: AMENDMENT NO DATE ______________________________ _____________ ______________________________ _____________B.3 PERFORMANCE WORK STATEMENTONCOLOGY CHEMOTHERAPY/INFUSION SERVICESFOR THEALASKA VA HEALTHCARE SYSTEM (AVAHS)ANCHORAGE, ALASKA.1.0. GENERAL: The Alaska VA Healthcare System (AVAHS) seeks to contract for collaborative, comprehensive oncology (defined as treatment planning, and coordination of other related and authorized care) professional services to VA beneficiaries authorized and referred by the AVAHS. A single comprehensive contract is desired, however, multiple contracts may result from this solicitation. Short of a comprehensive proposal, the AVAHS desires proposals from contractors undertaking professional and direct patient care responsibilities for delivery of professional oncology services including the management of medical oncology patients and chemotherapy/infusion. Services will be provided at preferred hospital-based or free-standing service sites as defined by the AVAHS, or in the contractor’s facilities, as specifically authorized by VA. The provided care shall cover the range of professional oncology services normally provided including outpatient consultation and inpatient attending services. 2.0. SHARED DECISION MAKING: The contractor will involve the Veteran patient and designated professional representatives of VHA in shared decision making for planning, execution, and follow-up care. The process of shared decision making involves caregivers, patients, and experts as mutually respected participants in the formation of treatment plans. In the course of planning and in the ongoing management of patients, the contractor will consult with the VA as appropriate. The VA Puget Sound Healthcare System (VAPSHCS) and other VA resources, including the VAPSHCS multidisciplinary Tumor Board, will be available to the contractor for the purposes of treatment planning. VA and the Contractor shall work collaboratively to establish a process for VA peer review of care provided to Veterans by the Contractor under this agreement. This process will also involve open and informative discussions with patient or the designated power of attorney for health care. These discussions will be expected to include, among other things, benefits, risks, side effects, probability of response, impact on life style, and financial costs to VA. Alternative therapies, including, but not limited to, observation only, supportive care, and hospice care may be considered when deemed appropriate.3.0. SPECIFIC TASKS: The contractor shall perform authorized clinical services, which include, but are not limited to the following:3.1. Inpatient Consultation Service: Consult on VA inpatients admitted to the AVAHS preferred inpatient service provider or other treatment facilities as required by VA. Provide expert opinions on the care and management of the patients while in the hospital and recommendations for their care following discharge.3.2. Outpatient Consultation Service: Provide authorized outpatient oncology and related care and services as described herein, including oversight and administration of chemotherapy. 3.3. Workup Procedures:3.3.1 The contractor will utilize the range of workup procedures normally encountered according to generally accepted standards of care . Unless specifically authorized otherwise, outpatient laboratory and radiology services will be referred back to VA to be performed. 3.3.2. Workup process and procedures related to oncology services shall be developed and mutually agreed upon by the Contractor and AVAHS Contracting Officer’s Technical Representative (COTR) prior to commencing work under this contract.3.3.3. Specialized Imaging services including CT and Pet Scans must be pre-authorized by AVAHS ICS Department. Where available, VA or other Federal resources will be used.3.3.4. The Contractor may collaborate with AVAHS and/or VAPSHCS and affiliated academic partners to leverage available clinical expertise and resources for workup, treatment planning, and follow-up care. 3.4. Treatment Planning: 3.4.1. The provided care shall cover the range of oncology treatment options as authorized by the AVAHS and normally provided in a similar commercial healthcare facility including: a. Chemotherapy / Infusion Services; and b. Palliative Chemotherapy.3.4.2. The Contractor shall also recommend treatment options outside the scope of this contract as deemed clinically necessary to including but not limited to: a. Surgery; b. Multi-modality treatment pathways; and c. Any services falling outside the scope of the initial authorization for care shall require further pre-authorization, and may be referred back into the VA direct care system at the discretion of the AVAHS.3.4.3. Chemotherapy:3.4.3.1. Contractor shall provide chemotherapy services as authorized by AVAHS. The contractor will evaluate the patient’s appropriateness for chemotherapy, develop a treatment regimen which is communicated back to the AVAHS and schedule treatment for those patients deemed appropriate. Separate authorizations from AVAHS will be required for treatment. Authorizations for treatment will be issued only after a mutually agreed upon treatment plan has been established. 3.4.3.2. Contractor shall schedule review of VA referrals within 24 hours of receipt of authorization for evaluation. 3.4.3.3. Contractor shall evaluate authorized VA patients within 10 business days of consult receipt for routine requests and 1 day for emergent requests.3.4.3.4. Contractor shall transmit the proposed treatment plan to the AVAHS Oncology Nurse Case Manager within 72 hours of the initial evaluation for treatment.3.4.3.5. Contractor shall involve the patient and family in the decision-making process and education.3.4.3.6. Contractor’s proposed treatment regimen shall include diagnosis, choice of treatment modality/medications, number of treatments, a list of associated treatment CPT codes, location of tumor, whether proposed treatment is curative or palliative, proposed beginning and end of treatment regimen, and any potential concerns relating to this patient’s plan.3.4.3.7. Contractor shall provide clinically indicated treatment services including required medications and/or ancillary services associated with therapy as authorized by AVAHS. Processes and roles of each participant in this requirement will be defined in a post-award conference with the Contracting Officer’s Technical Representative (COTR).3.4.3.8. Contractor shall provide follow-up services as clinically indicated and medically necessary as authorized by AVAHS.3.4.3.10. VA payment for authorized services performed by the contractor represents payment in full. VA patients will not be balance billed for any services provided under this contract.3.4.3.11. The contractor will monitor the entire scope of the authorized VA beneficiary’s condition during the course of treatment, including, but not limited to, medication concerns and nutritional issues.3.4.3.12. Changes to the treatment plan must be communicated to the AVAHS Oncology Nurse Case Manager and must be approved by AVAHS. Payment will not be made for services rendered resulting from an unapproved or unauthorized treatment plan.3.4.3.13. Unusual or unanticipated services required during the course of treatment that are outside of the authorization and cannot be performed at the VA must be pre-authorized for payment by the AVAHS.3.4.3.14. Contractor shall refer the VA patient back to the VA upon completion of the treatment plan along with final summary progress notes. Discharge from oncology care shall be coordinated through AVAHS Oncology Nurse Case Manager.3.4.3.15. Contractor must provide access for Veteran outpatient during regular business hours Monday through Friday and be available for inpatient oncology services on a 24 hour, 7-day per week basis.3.4.3.16. The VA will not be responsible for services provided outside the normal course of treatment unless prior authorization is obtained from the AVAHS, except in the case of life threatening emergent situations.3.4.3.17. The VA shall provide the contractor with copies of all pertinent clinical information from the patient’s medical record at the time of referral.3.4.4. Radiation Therapy:3.4.4.1. The provided care shall cover the range of radiation therapy services normally provided in a similar commercial healthcare facility and as authorized by VA. Contract radiation therapy services will be initiated via pre-authorization from the AVAS Integrated Care Service (ICS). Prior to administering radiation therapy, the Contractor will evaluate the patient’s appropriateness for radiation therapy, develop a treatment plan, and submit it to VA through the Oncology Nurse Case Manager. The detailed treatment plan shall include pertinent clinical findings, a recommended plan of treatment and expected outcomes. The treatment plan will be provided to VA within three (3) working days of the evaluation. The Oncology Nurse Case Manager will coordinate the treatment plan within VA and will notify the Contractor when they are authorized to proceed. The Contractor shall not proceed with administering radiation therapy unless specifically authorized by the VA and as specified on the approved treatment plan. 3.4.4.2. In performing radiation therapy treatment, the contractor will provide all necessary complete palliative or curative treatments as needed when authorized by VA. A palliative course of treatment will include a simulation, dosimetry, daily treatments throughout the treatment course, port film verification, any required lab tests and follow-up. A curative course of treatment will include but is not limited to: 1) all items described under palliative treatment, 2) block setups, 3) computerized CT Planning, 4) other additional dosimetry and simulation as required, and follow-up. 3.4.4.3. Schedule review of VA referrals within 24 hours of receipt, for evaluation of treatment. 3.4.4.4. Evaluate the VA patient within 10 business days of authorization for routine requests and 1 day for emergent requests.3.4.4.5. Transmit the proposed treatment plan to the AVAHS Oncology Nurse Case Manager or designee within three (3) working days of the initial evaluation for treatment.3.4.4.6. Contractor shall involve the patient and family in the decision-making process and education.3.4.4.7. Contractor’s proposed treatment regimen shall include diagnosis, choice of treatment modality/medications, number of treatments, a list of associated treatment CPT codes, location of tumor, whether proposed treatment is curative or palliative, proposed beginning and end of treatment plan, and any potential concerns relating to this patient’s plan.3.4.4.8. Provide clinically indicated treatment services including required medications and/or ancillary services associated with therapy and according with the VA authorization. Ancillary services available at the VA will be provided by the VA.3.4.4.9. Provide follow-up services as clinically indicated, medically necessary, post therapy as authorized by VA.3.4.4.10. High end therapies (stereotactic radiosurgery , brachytherapy, intensity modulated radiation therapy and image guided radiation therapy) require pre-approval by the Chief of Staff, Alaska VA Healthcare System (or designee) and will be provided utilizing VA or VA contracted resources to the greatest extent possible, including use of VA operating rooms and inpatient accommodations. The VA shall not reimburse treatments provided prior to the issuance of an authorization. 3.4.4.11. The contractor will monitor the entire scope of the VA beneficiary’s condition during the course of treatment, including, but not limited to, medication concerns and nutritional issues.3.4.4.12. Any changes to the treatment plan will be communicated to the Oncology Nurse Case Manager or designee and must be authorized prior to services being rendered. Contractor shall not be reimbursed for services related to unauthorized changes to the treatment plan.3.4.4.13. Unusual or unanticipated services required during the course of treatment, which cannot be performed at the VA, must be pre-authorized by VA Oncology Nurse Case Manager or designee.3.4.4.14. Contractor shall refer the VA patient back to the referring VA provider upon completion of their treatment along with final summary progress notes. Transfer back to the referring provider shall be coordinated through the Oncology Nurse Case Manager.3.4.4.15. Contractor shall schedule appointments for authorized Veteran patients during regular business hours Monday through Friday, and be available for services on a 24 hour, 7-day/week basis. Contractor may offer extended clinic hours and weekend appointment availability if mutually agreed upon by Contractor, VA, and the patient.3.4.4.16. The VA will not be responsible for services provided outside the scope of prior authorization except in the case of emergent situations. Claims for such services shall be subject to retrospective review by VA to determine appropriateness and may be reimbursed based on that review.3.4.4.17. The Oncology Nurse Case Manager shall provide the contractor with copies of all pertinent clinical information from the patient’s medical record at the time of referral. All clinical documentation received from Contractor will be forwarded to the Health Information Management Service (HIMS) to be scanned for patient(s) records.4.0. ABBREVIATIONS AND DEFINITIONS:4.1. Contracting Officer: The representative of the VA Northwest Network who has the authority to enter into, administer, terminate, modify, approve changes, or otherwise represent and bind the AVAHS in all matters arising under or relating to this contract.4.2. Contracting Officer’s Technical Representative (COTR): Individual(s) who furnishes technical guidance and advice or generally supervises the work performed under the contract. Designations will be in writing and will define the scope and limitation of the representative's authority. 4.3. Oncology Nurse Case Manager: Coordinates oncology referrals and care to provide quality, coordinated care while controlling costs and maintaining efficiency of clinical systems.4.4. Physician Consultant: The physician representative of VHA who will collaborate with contractor in shared decision making for planning, execution, and follow-up care. Will advise COTR concerning clinical issues related to this contract. 5.0. AUTHORIZATION INSTRUCTIONS:5.1. Pre-authorization is required for all non-emergent care. Prior to services being rendered under this contract, the Contractor shall be required to obtain authorization for non-emergent care and from the Fee Based Claims System a confirmation of the authorization will be provided to the contractor via fax for payment of services.5.2. Authorization may be obtained by contacting VA at (907) 257-6904 during work hours. 5.3. Payment will only be made for services authorized by the AVAHS on the individual fee-basis authorization form.6.0. EMERGENCY SERVICES: Contractor shall notify VA within 15 days of provision of emergency services to a VA beneficiary. Post-authorization for such care may be granted following clinical review focused on determining the appropriateness of utilization of emergency services for the care rendered. VA will not reimburse Contractor for non-emergent care unless it is pre-authorized as specified herein.7.0. BILLING INSTRUCTIONS:7.1. Contractor shall follow CMS Medicare billing guidelines.7.2. Clinical documentation as specified herein shall be submitted with claims for reimbursement.7.3. Contractor shall ensure appropriate assignment of CPT and HCPCS codes on reimbursement claims.7.4. VA payment shall be considered payment in full. No VA beneficiary shall be balance billed for any service authorized by VA.7.5. Claims must be submitted as either EDIs (for more information go to ), or the original red and white HCFA-1500 or UB-04 forms.? Black and white, faxed, or hand written claims will be returned as they cannot be processed within the claim processing software package.? Claims with incomplete or wrong information such as Veteran’s name, birth date, at least the last four of the SSAN, CPT codes, DOS, units, or vendor information will be returned.? Supporting documentation must also be provided with the claim.? Supporting documentation for EDI claims can be faxed to (907) 770-2033.?7.6. If submitting paper claims, Contractor shall submit paper claims to: Alaska VA Healthcare System 1201 North Muldoon Road (04Fee) Anchorage, AK?? 99504Contractor shall not under any circumstances charge VA beneficiaries or their insurance companies for services rendered by the contractor even if VA does not pay for those services. This provision shall survive the termination or ending of the contract.8.0. QUALITY ASSURANCE REQUIREMENTS:8.1. The Contractor and all affiliates or subsidiaries offering services through this contract shall provide proof of accreditation by The Joint Commission (TJC) or other appropriate accrediting body, as applicable. Contractor’s who are not accredited by TJC or other appropriate accrediting body may with proper justification request a waiver of this requirement. Such justification will include a complete description of the contractor’s quality assurance program. Any change in accreditation status during the contract period shall be immediately reported to VA.8.2. The Contractor and all affiliates or subsidiaries offering services through this contract shall provide proof of certification by CMS, as applicable. Any change in CMS Medicare certification status during the contract period shall be immediately reported to VA.8.3. The Contractor shall notify VA of any pending investigation, action, or sanction against it, any agent, or employee that materially affects the Contractor’s ability to meet any obligation under this contract.8.4. The Contractor shall maintain all necessary certifications and/or licensure for both its facility and staff.8.5. The Contractor shall meet or exceed the same standard of care, skill, and diligence as is customarily met by other community providers of like services within the community in which the contract services are performed, and at the same level of access that it provides to all patients.8.6. The Contractor shall immediately notify VA (within 3 business days) of any adverse actions such as malpractice claims or arbitration actions, or any adverse action otherwise involving the Contractor. The Contractor shall immediately notify VA (within 3 business days) of any adverse actions involving privileged staff providing services under this agreement, to include any reporting to the National Practitioner Data Bank (NPDB).8.7. The Contractor shall Partner with AVAHS and/or VA Puget Sound Healthcare System to care manage VA patients eligible for oncology services.8.8. The Contractor shall Actively participate in quality assurance activities related to this contract.8.9. The Contractor shall Maintain confidentiality of HSRO/QA information.9.0. CONTRACT PERFORMANCE MONITORING: 9.1. The Contractor’s performance shall be monitored by the COTR or designee.9.2. The Contractor shall be monitored through a variety of mechanisms, including: a. Quality management reports; b. Feedback from patients, staff, peers or other appropriate source; c. Performance measures as specified in the attached Quality Assurance Surveillance Plan (QASP); and d. Reviews performed by the VA Physician Consultant.10.0. OTHER REQUIREMENTS:10.1. The Contractor shall provide the services independent of VA supervision. 10.2. Services shall be provided for any Veteran determined eligible and authorized by VA regardless of race, color, religion, creed, sex, or national origin.10.3. Services shall be available 24 hours per day, 7 days per week, 365 days per year.10.4. The Contractor shall provide all services in strict conformance with the requirements of this solicitation.? 10.5. The Contractor shall not add or substitute any component or alter the requirements in any way without prior approval and written authority from the VA.? 10.6. The Contractor shall not be requested to perform services that are in violation of medical ethics, federal regulations, or Alaska State laws.9.7. The Contractor shall be enrolled as a current Medicaid provider. ? 10.8. Services shall be rendered in a manner consistent with the patient’s values, culture, and beliefs. 10.9. The Contractor shall obtain all appropriate patient consent prior to rendering services. 10.10. The Contractor shall have a process in place to handle patient complaints, and shall notify the VA of any complaints involving VA beneficiaries within three working days after such complaints are received by the Contractor.10.11. The Contractor shall provide necessary patient education in a manner consistent with the patient’s ability to understand.10.12. The Contractor shall provide services in a safe, functional, and effective environment for patients, staff, visitors, and family.10.13. The Contractor’s facility shall be maintained to protect the patient’s privacy, security, safety, and health.9.14. The Contractor shall engage in practices consistent with the safe control of hazardous materials and waste.10.15. The Contractor shall have a system to ensure appropriate maintenance for all medical equipment.10.16. The Contractor shall, at all times, seek appropriate authorization for care for all VA patients referred under this contract.10.17. The Contractor shall meet all requirements of the Emergency Medical Transfer and Active Labor Act (EMTALA).10.18. The Contractor shall accept payment according to the fee schedule established for this agreement as payment in full and shall not balance bill any VA beneficiary for services rendered under it.10.19. The Contractor represents and warrants that it has and shall continue to have the ability and capacity to render services described herein.? In the event the Contractor does not have the required ability or capacity, the burden of arranging for the required service(s), and assumption of any additional expenses related to those services, shall be borne entirely by the Contractor.11.0. PERSONNEL:? 11.1. Personnel assigned by the Contractor to perform services under this contract shall be licensed in the State, Territory, or Commonwealth in which they are performed.? All licenses or certifications held by personnel providing services under this contract shall be full and unrestricted.? The qualifications of personnel shall be subject to review by the VA.11.2. The Contractor shall ensure that all Contractor or sub-contractor personnel providing services to VA beneficiaries under this agreement are licensed or certified as applicable and in accordance with Alaska State law.???????? 11.3. The Contractor shall submit names and credentials to include certifications for all professionals and paraprofessional providing services under this contract.11.4. Credentialing changes, to include revocation or suspension of privileges, licensure, or certifications involving Contractor or Contractor appointed staff over the course of the contract shall be reported to VA.11.5. Credentialing files shall be made available to VA for review upon request as required by VA. Credentialing and privileging is to be done in accordance with VA Directive 1663 and in accordance with the provisions of VHA Handbook 1100.19 (October 2, 2007).12.0. INSURANCE: The Contractor shall provide evidence of insurance, documenting required insurance coverage to VA prior to commencement of services under this contract.? Minimum coverage shall be one million dollars ($1,000,000) per occurrence.13.0. INSPECTION:? The VA reserves the right to review the Contractor’s facilities and all administrative and clinical records pertaining to services provided to VA-authorized beneficiaries under this contract.? The Contractor shall make records available for concurrent and retrospective review.14.0. MARKETING:? The Contractor shall not mention its contract with VA for marketing or public relations purposes without prior written approval from VA.15.0. CLINICAL DOCUMENTATION:? 15.1. The Contractor shall be responsible for documenting care provided in the patient’s medical record.? The medical and administrative records of the patient are confidential and may not be disclosed by the Contractor except as authorized by law.? The medical record shall contain the following components as applicable to the service being provided: a. Appropriate patient identification to include name, sex, social security number, and date of birth; b. The patient’s medical history; c. Evidence of consent for care when such consent is required by law or organizational policy; d. Documentation of care planning activities based on the patient’s problems and needs; e. All appropriate diagnostic and therapeutic procedures, treatments, and tests and their results; f. The patient’s response to care or services; g. The patient’s vital signs, including assessment of pain; h. Findings of initial assessment and reassessment; i. The description of any safety measures required to protect the patient from injury; j. A description of the patient’s functional limitations related to the care or services provided; k. Specific and appropriate notes on the care or service provided; l. A description of the patient’s activity restrictions, if any, as related to the care or services provided; m. A statement of any change in the patient’s condition related to the care or services provided; n. Documentation of medication use and medication allergies or sensitivities; o. Legible and complete physician orders as appropriate and required by law or regulation; p. Transfer forms, summaries, or copies of any records received from the transferring organization; q. Documentation of patient and family education; r. Other individuals or organizations involved in the patient’s care; s. Documentation of any referrals to internal or external care providers and community agencies; and t. Any dietary restrictions.15.2. Copies of all documents forwarded to the VA, such as discharge summaries shall contain the patient’s name and social security number. ?Discharge summaries shall contain the final diagnosis and list all operations or procedures performed.16.0. SPECIAL CONTRACT REQUIREMENTS:16.1. National Provider Identifier:? The National provider identifier (NPI) is a standard, unique 10-digit numeric identifier required by HIPAA.?The Veterans Health Administration must use NPIs in all HIPAA-standard electronic transactions for individual (health care practitioners) and organizational entities (medical centers).?The contractor shall ensure that the health care practitioners and/or medical center providing service under the contract obtains a NPI and provides it to the contracting officer.16.2. Health and Human Services (HHS):? To ensure that the individuals providing services under?the contract have not engaged in fraud or abuse regarding Sections 1128 and 1128A of the Social Security Act regarding federal health care programs, the contractor is required to check the Health and Human Services – Office of Inspector General, List of excluded individuals/entities on the OIG Website (oig) for each person providing services under this contract. Further the contractor is required to certify in its proposal that all persons listed in the contractor’s proposal have been compared against the OIG list and are not listed.? During the performance of this contract the Contractor is prohibited from using any individual or business listed on the List of Excluded Individuals/Entities.16.3. Contractor must adhere to the 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). A business associate agreement is not required in this case.16.4. Contractor will provide health care to patients seeking such care from or through VA. As such, contractor is considered part of the Department health activity for purposes of the following statutes and the VA regulations implementing these statutes: the Privacy Act, 5.U.S.C. § 552a, and 38 U.S.C. §s 5701, 5705 and 7332. Contractor and its employees may have access to VA patient medical records to the extent necessary for the contract or to perform this contract. Notwithstanding any other provision of this contract, contractor and its employees may disclose patient treatment records only pursuant to explicit disclosure authority from VA. Contractor and its employees are subject to the penalties and liabilities provided statutes and regulations for unauthorized disclosures of such records and their contents.” “Records created by the contractor in the course of treating VA patients under this agreement are the property of the VA and shall not be accessed, released, transferred or destroyed except in accordance with applicable federal law and regulations.” Upon the expiration of this contract or termination of the contract, the contractor will promptly provide the VA with the individually identified VA patient treatment records.APPENDIX A - SPECIAL CONTRACT REQUIREMENTS1.0. INTRODUCTION: Under the authority of Public Law 104-262 and 38 USC 8153, the Contractor agrees to provide Health Care Resources in accordance with the terms and conditions stated herein, to furnish to the Department of Veterans Affairs Medical Center, Alaska VA Health Care System, the services and prices specified in the Section B.8, Schedule of Services of this contract. This is an Indefinite Delivery / Indefinite Quantity contract for commercial items. Award will be made for non-personal health care services, as defined in FAR 37.01, under which the Contractor is an independent Contractor, may be awarded from this Solicitation. The Government may evaluate the quality of professional and administrative services provided, but retains no control over the medical, professional aspects of services rendered (e.g., professional judgments, and/or diagnosis for specific treatment). North American Industry Classification System (NAICS) Code 622110 applies to this acquisition. See FAR clause titled 52.212-1 Instructions to Offerors- Commercial Items.2.0. SERVICES: 2.1. The services specified in the Special Contract Requirements and the Price/Cost Schedule, may be changed by written modifications in accordance with FAR Part 43.103, Types of Contract modifications. 2.2. The services to be performed by the Contractor at their facilities will be performed in accordance with the Contractor’s policies and procedures and the regulations of the medical staff by laws. 3.0. TERM OF CONTRACT: This contract is effective for one year from date of award plus four (4) one-year options that may be exercised by the VA. The contract is subject to the availability of funds. The VA will assign no new cases after September 30 of any year until the Contracting Officer exercises the renewal option and provides documentation of approved funding. 4.0. QUALIFICATIONS: Personnel assigned by the Contractor to perform the services covered by this contract shall be, when applicable, licensed in a State, Territory, or Commonwealth of the United States or the District of Columbia. All licenses held by the personnel working on this contract shall be full and unrestricted licenses.5.0. WORK HOURS: The services covered by this contract shall be furnished by the Contractor 24 hours per day, seven days per week including weekends and federal holidays.6.0. PERSONNEL POLICY: The Contractor shall be responsible for protecting the personnel furnishing services under this contract. To carry out this responsibility, the Contractor shall provide the following for these personnel: a. workers compensation; b. professional liability insurance; c. health examinations; d. income tax withholding; and e. social security payments. The parties agree that the Contractor, its employees, agents and sub-Contractors shall not be considered VA employees for any purpose. The parties agree the VA employees, agents and sub-Contractors shall not be considered employees of the Contractor for any purpose. 7.0. CONTRACT PERFORMANCE MONITORING: The Alaska VA Healthcare System Contracting Officer’s Technical Representative (COTR) appointed by the Contracting Officer (CO) will be the Government official responsible for monitoring Contractor compliance under this contract. After contract award, any incidents of Contractor noncompliance as evidenced by the monitoring procedures shall be forwarded immediately to the Contracting Officer. 8.0. KEY PERSONNEL AND TEMPORARY EMERGENCY SUBSTITUTIONS: The Contractor shall assign to this contract the following key personnel, as applicable: To Be Determined.8.1. During the first ninety (90) days of performance, the Contractor shall make NO substitutions of key personnel unless the substitution is necessitated by illness, death, or termination of employment. The Contractor shall notify the Contracting Officer, in writing, within 15 calendar days after the occurrence of any of these events and provide the information required by paragraph (b) below. After the initial 90-day period of the contract, the Contractor shall submit the information required by paragraph (b) to the Contracting Officer at least 15 days prior to making any permanent substitutions. 8.2. The Contractor shall provide a detailed explanation of the circumstances necessitating the proposed substitutions, complete resumes for the proposed substitutes, and any additional information requested by the Contracting Officer. Proposed substitutes shall have comparable qualifications to those of the persons being replaced. The contract will be modified to reflect any approved changes of key personnel. 8.3. The Contractor shall provide notification to the Contracting Officer of any action taken by the Contractor to suspend, revoke or allow the voluntary relinquishment of any medical staff membership or clinical privileges of the designated key health care personnel to render health care services to veteran patients, unless the action taken will last 30 days or less. 8.4. The National Provider Identifier (NPI) is a standard, unique 10 digit numeric identifier required by HIPAA. The VA must use NPIs in all HIPAA-standard electronic transactions for individuals (health care practitioners) and organizational entities (medical centers). The Contractor shall ensure the NPI for UWMC is provided to the Contracting Officer. 9.0. COMPLIANCE WITH VETS-100 REPORTNG REQUIREMENTS: In accordance with Public Law 105-359, section 1354 (enacted November 30, 1998); awards will not be made under this solicitation unless the Contracting Officer is able to confirm that the offeror is registered with the Department of Labor, VETS-100 certification and has complied with requirements to file a VETS-100 report for the preceding fiscal year under Title 38 Section 4212(d). The contracting officer may require the offeror to furnish evidence of filing. For questions and information on filing VETS-100 reports, contact the VETS-100 Processing Center at (703) 461-2460. NOTICE – Federal Acquisition Clause 52.222-37 Employment Reports on Disabled Veterans and Veterans of the Vietnam Era is incorporated by reference in this contract. Public Law (P.L.) 105-339, Section 1354 provides that no agency may enter into a contract with a Contractor who has not filed a VETS-100 report for the preceding year under Title 38 Section 4212(d). A contract can be placed with that Contractor as soon as the report required by Section 4212(d) for the fiscal year concern is filed with the Department of Labor. P.L. 105-339 also increased the threshold of covered contracts and subcontracts from $10,000 to $25,000. You are therefore strongly urged to complete this report as soon as possible to avoid delays in the contract award process. This can be done “on-line” at vets100.cudenver.edu/ 10.0. CONTRACT MODIFICATIONS: The Contracting Officer is the only person authorized to approve changes or modify any of the requirements under this contract. The Contractor shall communicate with the Contracting Officer on all matters pertaining to contract administration. Only the Contracting Officer is authorized to make commitments or issue changes that will affect price, quantity, or quality of performance of this contract. In the event the Contractor effects any such change at the direction of any person other than the Contracting Officer, the change shall be considered to have been made without authority and no adjustment will be made in contract price to cover any increase in prices incurred as a result thereof. The Contractor must obtain authorization from the Contracting Officer for any services required outside the scope of work provided herein. 11.0. MEDICAL RECORDS: 11.1. Medical records and other patient information shall be provided pursuant to VA policy and standards which are designed to protect the confidentiality of the patient’s medical records in accordance with applicable state and federal laws and recognized standards of professional practice. It will be the responsibility of the Alaska VA Healthcare System to obtain and provide evidence of patient’s written authorization prior to release of patient information to non VA physicians working on behalf of the Contractor. 11.2. When the patient is released from inpatient care, Contractor shall provide the VA with copies of all inpatient records, upon request and in compliance with Contractor’s policies and procedures related to release of information. 12.0. PAYMENT: 12.1. The Contractor shall provide individual claims which will include the contract number, date of services, patient’s name, patient number and charges; and forward such claims for payment. Claims shall be forwarded to the VA following the Contractors normal billing cycle. 12.2. The VA agrees to reimburse the Contractor according to the terms of the contract for resources furnished in this contract. 12.3. Sums due to the Contractor will be paid within 30 days of receipt of a properly prepared claim submitted by the Contractor. 12.4. Claims submitted by the Contractor to the VA for services rendered a VA beneficiary under the terms of this Contract shall be in full. Neither the beneficiary, his/her insurer or any other third party shall be billed by the Contractor. This provision shall survive the termination or completion of this Contract. 12.5. Refer to Title 42 Code of Federal Regulations (CFR) Sections 412.4, 415.170, 415.172, 415.178, 415.180 and 415.190 as conditions of payment. 13.0. CONTRACT MONITORING PROCEDURES: The Contracting Officer's Technical Representative (COTR) will be will be responsible for monitoring contract compliance. The COTR will represent the Contracting Officer (CO )in furnishing technical guidance and advice regarding the work being performed under this contract as well as monitoring contract compliance. The foregoing is not to be construed as authorization to interpret or furnish advice and information to the Contractor relative to the financial or legal aspects of the contract. Enforcement of these segments is vested in and is the responsibility of the Contracting Officer. The COTR shall also forward to the CO a completed healthcare Contractor performance report annually prior to the exercising of an option year. A Quality Assurance Surveillance Plan (QASP) will be required for this contract and will provide a systematic method to evaluate performance for the stated contract requirements. The QASP will explain the following: a. What will be monitored; b. How monitoring will take place; c. Who will conduct the monitoring; and d. How monitoring efforts and results will be documented. 14.0. HIPAA COMPLIANCE: In accordance with 45 C.F.R. Parts 160, 162 and 164 (Health Insurance Portability and Accountability Act) and 38 U.S.C. 5701, 38 U.S.C. 5705, 38 U.S.C. 7332,5 U.S.C. 552a (Privacy Act), the Parties agree to hold all individually identifiable health information as that term is defined in the Health Insurance Portability and Accountability Act and regulations promulgated there-under (collectively, “HIPAA”) shared with, transferred or transmitted to, or otherwise obtained by the Contractor on or from or on behalf of the VA in the course of the Contractor providing the services under this Contract (“Protected Health Information”) strictly confidential, and provide protections to prevent the unauthorized disclosure of such information, including, but not limited to the protection required by applicable federal, VA, state and local laws, policies and/or regulations regarding the security and the confidentiality of patient health care information including, but not limited to, HIPAA. Specifically, the Contractor agrees as follows: a. To maintain safeguards as necessary to ensure that the Protected Health Information is not used or disclosed except as required to perform its obligations under the Contract, as expressly permitted herein or as required or permitted by law; b. To ensure that any sub-Contractors or agents to whom it provides Protected Health Information agree to the same restrictions and conditions that apply with respect to such information; c. To make available its internal practices, books and records relating to the use and disclosure of Protected Health Information to the Department of Health and Human Services or its agents as required by HIPAA; d. To incorporate any amendments or corrections to Protected Health Information when notified by the VA that the information is inaccurate or incomplete; e. To, at termination of this Contract and as feasible, return or destroy all Protected Health Information that it still maintains or archive to meet the Contractor’s legal obligations related to retention of records; f. To ensure that, as to any Protected Health Information held by the Contractor, the Contractor policies are in place to allow access to that Protected Health Information by the subject of that information as required by HIPAA; g. To report to the VA any use or disclosure of Protected Health Information which is not allowed under the terms of the Contract. If at any time after the effective date of this Agreement it is determined that either party is in breach of this Section, the other party, in its sole discretion, may immediately terminate this Contract. 14.1. The VA has recognized the Contractor as an entity that does not require a Business Associate Agreement (BAA) with their Contractors as long as they are conducting health care on VA’s behalf. Hospital based healthcare services qualifies as a medical service. Therefore, no BAA is required. APPENDIX B - VA INFORMATION AND INFORMATION SYSTEM SECURITY/ PRIVACY:1.0. GENERAL: Contractors, contractor personnel, subcontractors, and subcontractor personnel shall be subject to the same Federal laws, regulations, standards, and VA Directives and Handbooks as VA and VA personnel regarding information and information system security.2.0. ACCESS TO VA INFORMATION AND VA INFORMATION SYSTEMS:2.1. A contractor/subcontractor shall request logical (technical) or physical access to VA information and VA information systems for their employees, subcontractors, and affiliates only to the extent necessary to perform the services specified in the contract, agreement, or task order.2.2. All contractors, subcontractors, and third-party servicers and associates working with VA information are subject to the same investigative requirements as those of VA appointees or employees who have access to the same types of information. The level and process of background security investigations for contractors must be in accordance with VA Directive and Handbook 0710, Personnel Suitability and Security Program. The Office for Operations, Security, and Preparedness is responsible for these policies and procedures.2.3. Contract personnel who require access to national security programs must have a valid security clearance. National Industrial Security Program (NISP) was established by Executive Order 12829 to ensure that cleared U.S. defense industry contract personnel safeguard the classified information in their possession while performing work on contracts, programs, bids, or research and development efforts. The Department of Veterans Affairs does not have a Memorandum of Agreement with Defense Security Service (DSS). Verification of a Security Clearance must be processed through the Special Security Officer located in the Planning and National Security Service within the Office of Operations, Security, and Preparedness.2.4. Custom software development and outsourced operations must be located in the U.S. to the maximum extent practical. If such services are proposed to be performed abroad and are not disallowed by other VA policy or mandates, the contractor/subcontractor must state where all non-U.S. services are provided and detail a security plan, deemed to be acceptable by VA, specifically to address mitigation of the resulting problems of communication, control, data protection, and so forth. Location within the U.S. may be an evaluation factor.2.5. The contractor or subcontractor must notify the Contracting Officer immediately when an employee working on a VA system or with access to VA information is reassigned or leaves the contractor or subcontractor’s employ. The Contracting Officer must also be notified immediately by the contractor or subcontractor prior to an unfriendly termination.3.0. VA INFORMATION CUSTODIAL LANGUAGE:3.1. Information made available to the contractor or subcontractor by VA for the performance or administration of this contract or information developed by the contractor/subcontractor in performance or administration of the contract shall be used only for those purposes and shall not be used in any other way without the prior written agreement of the VA. This clause expressly limits the contractor/subcontractor's rights to use data as described in Rights in Data - General, FAR 52.227-14(d) (1).3.2. VA information should not be co-mingled, if possible, with any other data on the contractors/subcontractor’s information systems or media storage systems in order to ensure VA requirements related to data protection and media sanitization can be met. If co-mingling must be allowed to meet the requirements of the business need, the contractor must ensure that VA’s information is returned to the VA or destroyed in accordance with VA’s sanitization requirements. VA reserves the right to conduct on site inspections of contractor and subcontractor IT resources to ensure data security controls, separation of data and job duties, and destruction/media sanitization procedures are in compliance with VA directive requirements.3.3. Prior to termination or completion of this contract, contractor/subcontractor must not destroy information received from VA, or gathered/created by the contractor in the course of performing this contract without prior written approval by the VA. Any data destruction done on behalf of VA by a contractor/subcontractor must be done in accordance with National Archives and Records Administration (NARA) requirements as outlined in VA Directive 6300, Records and Information Management and its Handbook 6300.1 Records Management Procedures, applicable VA Records Control Schedules, and VA Handbook 6500.1, Electronic Media Sanitization. Self-certification by the contractor that the data destruction requirements above have been met must be sent to the VA Contracting Officer within 30 days of termination of the contract.3.4. The contractor/subcontractor must receive, gather, store, back up, maintain, use, disclose and dispose of VA information only in compliance with the terms of the contract and applicable Federal and VA information confidentiality and security laws, regulations and policies. If Federal or VA information confidentiality and security laws, regulations and policies become applicable to the VA information or information systems after execution of the contract, or if NIST issues or updates applicable FIPS or Special Publications (SP) after execution of this contract, the parties agree to negotiate in good faith to implement the information confidentiality and security laws, regulations and policies in this contract.3.5. The following statement on all fax cover sheets be included: This fax is intended only for the use of the person or office to which it is addressed and may contain information that is privileged, confidential, or protected by law. All others are hereby notified that the receipt of this fax does not waive any applicable privilege or exemption for disclosure and that any dissemination, distribution, or copying of this communication is prohibited. if you have received this fax in error, please notify this office immediately at the telephone number listed above.”3.6. The contractor/subcontractor shall not make copies of VA information except as authorized and necessary to perform the terms of the agreement or to preserve electronic information stored on contractor/subcontractor electronic storage media for restoration in case any electronic equipment or data used by the contractor/ subcontractor needs to be restored to an operating state. If copies are made for restoration purposes, after the restoration is complete, the copies must be appropriately destroyed.3.7. If VA determines that the contractor has violated any of the information confidentiality, privacy, and security provisions of the contract, it shall be sufficient grounds for VA to withhold payment to the contractor or third party or terminate the contract for default or terminate for cause under Federal Acquisition Regulation (FAR) part 12.3.8. If a VHA contract is terminated for cause, the associated BAA must also be terminated and appropriate actions taken in accordance with VHA Handbook 1600.01, Business Associate Agreements. Absent an agreement to use or disclose protected health information, there is no business associate relationship.3.9. The contractor/subcontractor must store, transport, or transmit VA sensitive information in an encrypted form, using VA-approved encryption tools that are, at a minimum, FIPS 140-2 validated.3.10. The contractor/subcontractor’s firewall and Web services security controls, if applicable, shall meet or exceed VA’s minimum requirements. VA Configuration Guidelines are available upon request.3.11. Except for uses and disclosures of VA information authorized by this contract for performance of the contract, the contractor/subcontractor may use and disclose VA information only in two other situations: (i) in response to a qualifying order of a court of competent jurisdiction, or (ii) with VA’s prior written approval. The contractor/subcontractor must refer all requests for, demands for production of, or inquiries about, VA information and information systems to the VA contracting officer for response.3.12. Notwithstanding the provision above, the contractor/subcontractor shall not release VA records protected by Title 38 U.S.C. 5705, confidentiality of medical quality assurance records and/or Title 38 U.S.C. 7332, confidentiality of certain health records pertaining to drug addiction, sickle cell anemia, alcoholism or alcohol abuse, or infection with human immunodeficiency virus. If the contractor/subcontractor is in receipt of a court order or other requests for the above mentioned information, that contractor/subcontractor shall immediately refer such court orders or other requests to the VA contracting officer for response.3.13. For service that involves the storage, generating, transmitting, or exchanging of VA sensitive information but does not require C&A or an MOU-ISA for system interconnection, the contractor/subcontractor must complete a Contractor Security Control Assessment (CSCA) on a yearly basis and provide it to the COTR.4.0. SECURITY INCIDENT INVESTIGATION:4.1. The term “security incident” means an event that has, or could have, resulted in unauthorized access to, loss or damage to VA assets, or sensitive information, or an action that breaches VA security procedures. The contractor/subcontractor shall immediately notify the COTR and simultaneously, the designated ISO and Privacy Officer for the contract of any known or suspected security/privacy incidents, or any unauthorized disclosure of sensitive information, including that contained in system(s) to which the contractor/subcontractor has access.4.2. To the extent known by the contractor/subcontractor, the contractor/subcontractor’s notice to VA shall identify the information involved, the circumstances surrounding the incident (including to whom, how, when, and where the VA information or assets were placed at risk or compromised), and any other information that the contractor/subcontractor considers relevant.4.3. With respect to unsecured protected health information, the business associate is deemed to have discovered a data breach when the business associate knew or should have known of a breach of such information. Upon discovery, the business associate must notify the covered entity of the breach. Notifications need to be made in accordance with the executed business associate agreement.4.4. In instances of theft or break-in or other criminal activity, the contractor/subcontractor must concurrently report the incident to the appropriate law enforcement entity (or entities) of jurisdiction, including the VA OIG and Security and Law Enforcement. The contractor, its employees, and its subcontractors and their employees shall cooperate with VA and any law enforcement authority responsible for the investigation and prosecution of any possible criminal law violation(s) associated with any incident. The contractor/subcontractor shall cooperate with VA in any civil litigation to recover VA information, obtain monetary or other compensation from a third party for damages arising from any incident, or obtain injunctive relief against any third party arising from, or related to, the incident.5.0. LIQUIDATED DAMAGES FOR DATA BREACH:5.1. Consistent with the requirements of 38 U.S.C. §5725, a contract may require access to sensitive personal information. If so, the contractor is liable to VA for liquidated damages in the event of a data breach or privacy incident involving any SPI the contractor/subcontractor processes or maintains under this contract.5.2. The contractor/subcontractor shall provide notice to VA of a “security incident” as set forth in the Security Incident Investigation section above. Upon such notification, VA must secure from a non-Department entity or the VA Office of Inspector General an independent risk analysis of the data breach to determine the level of risk associated with the data breach for the potential misuse of any sensitive personal information involved in the data breach. The term 'data breach' means the loss, theft, or other unauthorized access, or any access other than that incidental to the scope of employment, to data containing sensitive personal information, in electronic or printed form, that results in the potential compromise of the confidentiality or integrity of the data. Contractor shall fully cooperate with the entity performing the risk analysis. Failure to cooperate may be deemed a material breach and grounds for contract termination.5.3. Each risk analysis shall address all relevant information concerning the data breach, including the following: a. Nature of the event (loss, theft, unauthorized access); b. Description of the event, including: (1) date of occurrence; (2) data elements involved, including any PII, such as full name, social security number, date of birth, home address, account number, disability code; c. Number of individuals affected or potentially affected; d. Names of individuals or groups affected or potentially affected; e. Ease of logical data access to the lost, stolen or improperly accessed data in light of the degree of protection for the data, e.g., unencrypted, plain text; f. Amount of time the data has been out of VA control; g. The likelihood that the sensitive personal information will or has been compromised (made accessible to and usable by unauthorized persons); h. Known misuses of data containing sensitive personal information, if any; i. Assessment of the potential harm to the affected individuals; j. Data breach analysis as outlined in 6500.2 Handbook, Management of Security and Privacy Incidents, as appropriate; and k. Whether credit protection services may assist record subjects in avoiding or mitigating the results of identity theft based on the sensitive personal information that may have been compromised.5.4. Based on the determinations of the independent risk analysis, the contractor shall be responsible for paying to the VA liquidated damages in the amount of $37.50 with a 3% increase per year per affected individual to cover the cost of providing credit protection services to affected individuals consisting of the following: a. Notification; b. One year of credit monitoring services consisting of automatic daily monitoring of at least 3 relevant credit bureau reports; c. Data breach analysis; d. Fraud resolution services, including writing dispute letters, initiating fraud alerts and credit freezes, to assist affected individuals to bring matters to resolution; e. One year of identity theft insurance with $20,000.00 coverage at $0 deductible; and f. Necessary legal expenses the subjects may incur to repair falsified or damaged credit records, histories, or financial affairs.6.0. TRAINING:6.1. All contractor employees and subcontractor employees requiring access to VA information and VA information systems shall complete the following before being granted access to VA information and its systems: a. Sign and acknowledge (either manually or electronically) understanding of and responsibilities for compliance with the Contractor Rules of Behavior, relating to access to VA information and information systems; b. Successfully complete the VA Cyber Security Awareness and Rules of Behavior training and annually complete required security training; c. Successfully complete the appropriate VA privacy training and annually complete required privacy training; and d. Successfully complete any additional cyber security or privacy training, as required for VA personnel with equivalent information system access [to be defined by the VA program official and provided to the contracting officer for inclusion in the solicitation document – e.g., any role-based information security training required in accordance with NIST Special Publication 800- 16, Information Technology Security Training Requirements].6.2. The contractor shall provide to the contracting officer and/or the COTR a copy of the training certificates and certification of signing the Contractor Rules of Behavior for each applicable employee within 1 week of the initiation of the contract and annually thereafter, as required.6.3. Failure to complete the mandatory annual training and sign the Rules of Behavior annually, within the timeframe required, is grounds for suspension or termination of all physical or electronic access privileges and removal from work on the contract until such time as the training and documents are complete.APPENDIX C - CONTRACTOR EMPLOYEES LEGAL STATUS1.0. The Contractor certifies that the Contractor shall comply with any and all legal provisions contained in the Immigration and Nationality Act of 1952, As Amended; its related laws and regulations that are enforced by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor as these may relate to non-immigrant foreign nationals working under contract or subcontract for the Contractor while providing services to Department of Veterans Affairs patient referrals;2.0. While performing services for the Department of Veterans Affairs, the Contractor shall not knowingly employ, contract or subcontract with an illegal alien; foreign national non-immigrant who is in violation their status, as a result of their failure to maintain or comply with the terms and conditions of their admission into the United States.3.0. If the Contractor fails to comply with any requirements outlined in the preceding paragraphs or its Agency regulations, the Department of Veterans Affairs may, at its discretion, require that the foreign national who failed to maintain their legal status in the United States or otherwise failed to comply with the requirements of the laws administered by Homeland Security, Immigration and Customs Enforcement and the U.S Department of Labor, shall be prohibited from working at the Contractor’s place of business that services Department of Veterans Affairs patient referrals; or other place where the Contractor provides services to veterans who have been referred by the Department of Veterans Affairs; and shall form the basis for termination of this contract for breach.4.0. The Contractor agrees to obtain a similar certification from its subcontractors.Signature:????? ____________________________________________Date:?? ____________________________________________Typed Name and Title: ___________________________________Company Name:?? ______________________________________This certification concerns a matter within the jurisdiction of an agency of the United States and the making of a false, fictitious, or fraudulent certification may render the maker subject to prosecution under 18 U.S.C. 1001.B.4 PRICE/COST SCHEDULE (See schedule below)BASE YEAR CLIN SCHEDULE: 01 JANUARY 2012 THROUGH 31 DECEMBER 2012CLINPrice Schedule SourceDIAGNOSIS RELATED GROUP CODES*EST QTYProfessional Medicare Price/CodeTechnical Medicare Price/CodePercent of MedicareTotal Extended Cost (all cells)0001400 ANESTH SKIN EXT/PER/ATRUNK4$$%$000210060 DRAINAGE OF SKIN ABSCESS4$$%$000332421 THORACENTESIS FOR ASPIRATION4$$%$000436000 PLACE NEEDLE IN VEIN4$$%$000536415 ROUTINE VENIPUNCTURE388$$%$000636416 CAPILLARY BLOOD DRAW20$$%$000736430 BLOOD TRANSFUSION SERVICE24$$%$000836561 INSERT TUNNELED CV CATH12$$%$000936571 INSERT PICVAD CATH8$$%$001036590 REMOVAL TUNNELED CV CATH4$$%$001136591 DRAW BLOOD OFF VENOUS DEVICE4$$%$001236593 DECLOT VASCULAR DEVICE16$$%$001336598 INJ W/FLUOR EVAL CV DEVICE4$$%$001438220 BONE MARROW ASPIRATION8$$%$001538221 BONE MARROW BIOPSY24$$%$001649080 PUNCTURE PERITONEAL CAVITY8$$%$001751702 INSERT TEMP BLADDER CATH4$$%$001862310 INJECT SPINE C/T4$$%$001971010 CHEST X-RAY4$$%$002071020 CHEST X-RAY RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL28$$%$002171260 CT THORAX W/DYE RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL4$$%$002271270 CT THORAX W/O&W DYE COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)4$$%$002372074 X-RAY EXAM OF THORACIC SPINE4$$%$002474150 CT ABDOMEN W/O DYE RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF 4 VIEWS4$$%$002574240 X-RAY EXAM UPPER GI TRACT COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL4$$%$002676000 FLUOROSCOPE EXAMINATION RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUTDELAYED FILMS, WITHOUT KUB8$$%$002776942 ECHO GUIDE FOR BIOPSY FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHERTHAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)12$$%$002880048 METABOLIC PANEL TOTAL CA SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODYRADIATION, PER ORAL, ENDOCAVITARY OR INTRAOPERATIVE CONE IRRADIATION)12$$%$002980050 GENERAL HEALTH PANEL4$$%$003080053 COMPREHEN METABOLIC PANEL GENERAL HEALTH PANELTHIS PANEL MUST INCLUDE THE FOLLOWING:COMPREHENSIVE METABOLIC PANEL (80053)HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT (CBC) (85022) ORHEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETEDIFFERENTIAL WBC COUNT (CBC) (85025)THYROID STIMULATING HORMONE (TSH) (84443)580$$%$003180185 ASSAY OF PHENYTOIN TOTAL THIS PANEL MUST INCLUDE THE FOLLOWING:ALBUMIN (82040)BILIRUBIN, TOTAL (82247)CALCIUM, TOTAL (82310)CARBON DIOXIDE (BICARBONATE) (82374)CHLORIDE (82435)CREATININE (82565)GLUCOSE (82947)PHOSPHATASE, ALKALINE (84075)POTASSIUM (84132)PROTEIN, TOTAL (84155)SODIUM (84295)TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460)TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)UREA NITROGEN (BUN) (84520)52$$%$003280299 QUANTITATIVE ASSAY DRUG PHENYTOIN; TOTAL44$$%$003380502 LAB PATHOLOGY CONSULTATION QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED12$$%$003481001 URINALYSIS AUTO W/SCOPE CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTICPROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS12$$%$003581003 URINALYSIS AUTO W/O SCOPE URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITH MICROSCOPY8$$%$003682105 ALPHA-FETOPROTEIN SERUM URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITHOUT MICROSCOPY 4$$%$003782232 ASSAY OF BETA-2 PROTEIN ALPHA-FETOPROTEIN; SERUM8$$%$003882248 BILIRUBIN DIRECT BETA-2 MICROGLOBULIN152$$%$003982378 CARCINOEMBRYONIC ANTIGEN BILIRUBIN; DIRECT60$$%$004082607 VITAMIN B-1212$$%$004182728 ASSAY OF FERRITIN CYANOCOBALAMIN (VITAMIN B-12)12$$%$004282746 BLOOD FOLIC ACID SERUM; FERRITIN16$$%$004382784 ASSAY IGA/IGD/IGG/IGM EACH FOLIC ACID; SERUM16$$%$004482977 ASSAY OF GGT; GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH160$$%$004583540 ASSAY OF IRON; GLUTAMYLTRANSFERASE, GAMMA (GGT)12$$%$004683550 IRON BINDING TEST;IRON12$$%$004783615 LACTATE (LD) (LDH) ENZYME;IRON BINDING CAPACITY180$$%$004883625 ASSAY OF LDH ENZYMES LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION ANDQUANTITATION4$$%$004983735 ASSAY OF MAGNESIUM 48$$%$005083891 MOLECULE ISOLATE NUCLEIC MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIEDNUCLEIC ACID, EACH NUCLEIC ACID TYPE (IE, DNA OR RNA)12$$%$005183892 MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT12$$%$005283896 MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH16$$%$005383898 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE12$$%$005483900 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST 2 NUCLEICACID SEQUENCES4$$%$005583901 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEICACID SEQUENCE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARYPROCEDURE)4$$%$005683902 MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION4$$%$005783903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG,SINGLE STRAND CONFORMATIONAL POLYMORPHISMS [SSCP], HETERODUPLEX,DENATURING GRADIENT GEL ELECTROPHORESIS [DGGE], RNA'ASE A), SINGLESEGMENT, EACH8$$%$005883907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION(EG, STOOL SPECIMENS, PARAFFIN EMBEDDED TISSUE), EACH SPECIMEN4$$%$005983908 MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE8$$%$006083909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTIONTECHNIQUE (EG, CAPILLARY ELECTROPHORESIS), EACH NUCLEIC ACIDPREPARATION4$$%$006183912 GENETIC EXAMINATION MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT20$$%$006283921 ORGANIC ACID, SINGLE, QUANTITATIVE4$$%$006384100 ASSAY OF PHOSPHORUS PHOSPHORUS INORGANIC (PHOSPHATE);12$$%$006484153 ASSAY OF PSA TOTAL PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL12$$%$006584155 ASSAY OF PROTEIN SERUM PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD4$$%$006684157 ASSAY OF PROTEIN OTHER PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,CEREBROSPINAL FLUID) 4$$%$006784165 PROTEIN E-PHORESIS SERUM PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM 20$$%$006884403 ASSAY OF TOTAL TESTOSTERON8$$%$006984436 ASSAY OF TOTAL THYROXINE4$$%$007084439 ASSAY OF FREE THYROXINE4$$%$007184443 ASSAY THYROID STIM HORMONE8$$%$007284479 ASSAY OF THYROID (T3 OR T4) 8$$%$007384480 ASSAY TRIIODOTHYRONINE (T3) 4$$%$007484550 ASSAY OF BLOOD/URIC ACID144$$%$007585007 BL SMEAR W/DIFF WBC COUNT 8$$%$007685025 COMPLETE CBC W/AUTO DIFF WBC484$$%$007785027 COMPLETE CBC AUTOMATED BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT)184$$%$007885045 AUTOMATED RETICULOCYTE COUNT BLOOD COUNT; RETICULOCYTE, AUTOMATED24$$%$007985060 BLOOD SMEAR INTERPRETATION BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT36$$%$008085097 BONE MARROW INTERPRETATION BONE MARROW, SMEAR INTERPRETATION32$$%$008185610 PROTHROMBIN TIME 44$$%$008285652 RBC SED RATE AUTOMATED SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED64$$%$008385730 THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD12$$%$008486038 ANTINUCLEAR ANTIBODIES4$$%$008586300 IMMUNOASSAY TUMOR CA 15-3 16$$%$008686301 IMMUNOASSAY TUMOR CA 19-928$$%$008786304 IMMUNOASSAY TUMOR CA 12548$$%$008886334 IMMUNOFIX E-PHORESIS SERUM4$$%$008986850 RBC ANTIBODY SCREEN24$$%$009086880 COOMBS TEST DIRECT4$$%$009186900 BLOOD TYPING ABO24$$%$009286901 BLOOD TYPING RH (D) 24$$%$009386920 COMPATIBILITY TEST SPIN COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE24$$%$009487070 CULTURE BACTERIA OTHER CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITHISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES4$$%$009587077 CULTURE AEROBIC IDENTIFY CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FORDEFINITIVE IDENTIFICATION, EACH ISOLATE4$$%$009687186 MICROBE SUSCEPTIBLE MIC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGARDILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACHMULTI-ANTIMICROBIAL, PER PLATE4$$%$009787205 SMEAR GRAM STAIN SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FORBACTERIA, FUNGI, OR CELL TYPES4$$%$009888108 CYTOPATH CONCENTRATE TECH CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,SACCOMANNO TECHNIQUE)12$$%$009988184 FLOWCYTOMETRY/ TC 1 MARKER FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER32$$%$010088185 FLOWCYTOMETRY/TC ADD-ON FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 32$$%$010188189 FLOWCYTOMETRY/READ 16 & > 24$$%$010288237 TISSUE CULTURE BONE MARROW16$$%$010388264 CHROMOSOME ANALYSIS 20-25 16$$%$010488271 CYTOGENETICS DNA PROBE 4$$%$010588275 CYTOGENETICS 100-3004$$%$010688280 CHROMOSOME KARYOTYPE STUDY8$$%$010788291 CYTO/MOLECULAR REPORT8$$%$010888305 TISSUE EXAM BY PATHOLOGIST40$$%$010988311 DECALCIFY TISSUE40$$%$011088312 SPECIAL STAINS GROUP 14$$%$011188313 SPECIAL STAINS GROUP 236$$%$011288342 IMMUNOHISTOCHEMISTRY44$$%$011388367 INSITU HYBRIDIZATION AUTO12$$%$011488368 INSITU HYBRIDIZATION MANUAL4$$%$011588381 MICRODISSECTION MANUAL4$$%$011689051 BODY FLUID CELL COUNT CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT4$$%$011793000 ELECTROCARDIOGRAM COMPLETE4$$%$011893010 ELECTROCARDIOGRAM REPORT4$$%$011996360 HYDRATION IV INFUSION INIT 68$$%$012096361 HYDRATE IV INFUSION ADD-ON180$$%$012196365 THER/PROPH/DIAG IV INF INIT116$$%$012296366 THER/PROPH/DIAG IV INF ADDON 108$$%$012396367 TX/PROPH/DG ADDL SEQ IV INF 512$$%$012496368 THER/DIAG CONCURRENT INF24$$%$012596372 THER/PROPH/DIAG INJ SC/IM 92$$%$012696374 THER/PROPH/DIAG INJ IV PUSH140$$%$012796375 TX/PRO/DX INJ NEW DRUG ADDON 588$$%$012896401 CHEMO ANTI-NEOPL SQ/IM32$$%$012996402 CHEMO HORMON ANTINEOPL SQ/IM4$$%$013096409 CHEMO IV PUSH SNGL DRUG96$$%$013196411 CHEMO IV PUSH ADDL DRUG108$$%$013296413 CHEMO IV INFUSION 1 HR536$$%$013396415 CHEMO IV INFUSION ADDL HR104$$%$013496417 CHEMO IV INFUS EACH ADDL SEQ160$$%$013596423 CHEMO IA INFUSE EACH ADDL HR 8$$%$013696521 REFILL/MAINT PORTABLE PUMP 8$$%$013796523 IRRIG DRUG DELIVERY DEVICE8$$%$013896912 PHOTOCHEMOTHERAPY WITH UV-A4$$%$013997810 ACUPUNCT W/O STIMUL 15 MIN28$$%$014097811 ACUPUNCT W/O STIMUL ADDL 15M16$$%$014199070 SPECIAL SUPPLIES; SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIANOVER AND ABOVE THOSE USUALLY INCLUDED WITH THE OFFICE VISIT OR OTHERSERVICES RENDERED (LIST DRUGS, TRAYS, SUPPLIES, OR MATERIALS PROVIDED)24$$%$014299195 PHLEBOTOMY 44$$%$014371010TC RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL TECHNICAL COMPONENT8$$%$014471020 TC RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL;TECHNICAL COMPONENT20$$%$014574246 TC RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST,WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUTGLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB TECHNICAL COMPONENT4$$%$014676370 TC8$$%$014777003 TC FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE ORPARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL,SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION TECHNICAL COMPONENT4$$%$014885025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT12$$%$014988305 59TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONABORTION - SPONTANEOUS/MISSEDARTERY, BIOPSYBONE MARROW, BIOPSYBONE EXOSTOSISBRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTIONBREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGICAL MARGINSBREAST, REDUCTION MAMMOPLASTYBRONCHUS, BIOPSYCELL BLOCK, ANY SOURCECERVIX, BIOPSYCOLON, BIOPSYDUODENUM, BIOPSYENDOCERVIX, CURETTINGS/BIOPSYENDOMETRIUM, CURETTINGS/BIOPSYESOPHAGUS, BIOPSYEXTREMITY, AMPUTATION, TRAUMATICFALLOPIAN TUBE, BIOPSYFALLOPIAN TUBE, ECTOPIC PREGNANCYFEMORAL HEAD, FRACTURE FINGERS/TOES, AMPUTATION, NON-TRAUMATICGINGIVA/ORAL MUCOSA, BIOPSYHEART VALVEJOINT, RESECTIONKIDNEY, BIOPSYLARYNX, BIOPSYLEIOMYOMA(S), UTERINE MYOMECTOMY - WITHOUT UTERUSLIP, BIOPSY/WEDGE RESECTIONLUNG, TRANSBRONCHIAL BIOPSYLYMPH NODE, BIOPSYMUSCLE, BIOPSYNASAL MUCOSA, BIOPSYNASOPHARYNX/OROPHARYNX, BIOPSYNERVE, BIOPSYODONTOGENIC/DENTAL CYSTOMENTUM, BIOPSYOVARY WITH OR WITHOUT TUBE, NON-NEOPLASTICOVARY, BIOPSY/WEDGE RESECTIONPARATHYROID GLANDPERITONEUM, BIOPSYPITUITARY TUMORPLACENTA, OTHER THAN THIRD TRIMESTERPLEURA/PERICARDIUM - BIOPSY/TISSUE POLYP, CERVICAL/ENDOMETRIALPOLYP, COLORECTALPOLYP, STOMACH/SMALL INTESTINEPROSTATE, NEEDLE BIOPSYPROSTATE, TURSALIVARY GLAND, BIOPSYSINUS, PARANASAL BIOPSYSKIN, OTHER THAN CYST/TAG/DEBRIDEMENT/PLASTIC REPAIRSMALL INTESTINE, BIOPSYSOFT TISSUE, OTHER THAN TUMOR/MASS/LIPOMA/DEBRIDEMENTSPLEENSTOMACH, BIOPSYSYNOVIUMTESTIS, OTHER THAN TUMOR/BIOPSY/CASTRATIONTHYROGLOSSAL DUCT/BRACHIAL CLEFT CYSTTONGUE, BIOPSYTONSIL, BIOPSYTRACHEA, BIOPSYURETER, BIOPSYURETHRA, BIOPSYURINARY BLADDER, BIOPSYUTERUS, WITH OR WITHOUT TUBES AND OVARIES, FOR PROLAPSEVAGINA, BIOPSYVULVA/LABIA, BIOPSY DISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$015088311 TC DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FORSURGICAL PATHOLOGY EXAMINATION)TECHNICAL COMPONENT4$$%$015188313 59TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACHDISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$015288313 TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACH TECHNICAL COMPONENT4$$%$0153A4300 CATH IMPL VASC ACCESS PORTAL 4$$%$0154A4314 CATH W/DRAINAGE 2-WAY LATEX4$$%$0155A4550 SURGICAL TRAYS16$$%$0156C1751 CATH, INF, PER/CENT/MIDLINE 8$$%$0157C1788 PORT, INDWELLING, IMP4$$%$0158J0461 ATROPINE SULFATE INJECTION 12$$%$0159J0640 LEUCOVORIN CALCIUM INJECTION76$$%$0160J0690 CEFAZOLIN SODIUM INJECTION4$$%$0161J0696 CEFTRIAXONE SODIUM INJECTION8$$%$0162J0780 PROCHLORPERAZINE INJECTION16$$%$0163J0881 DARBEPOETIN ALFA, NON-ESRD12$$%$0164J1040 METHYLPREDNISOLONE 80 MG INJ4$$%$0165J1080 TESTOSTERONE CYPIONAT 200 MG 4$$%$0166J1100 DEXAMETHASONE SODIUM PHOS620$$%$0167J1170 HYDROMORPHONE INJECTION12$$%$0168J1200 DIPHENHYDRAMINE HCL INJECTIO52$$%$0169J1260 DOLASETRON MESYLATE24$$%$0170J1440 FILGRASTIM 300 MCG INJECITON20$$%$0171J1453 FOSAPREPITANT INJECTION 188$$%$0172J1626 GRANISETRON HCL INJECTION48$$%$0173J1642 INJ HEPARIN SODIUM PER 10 U 248$$%$0174J1644 INJ HEPARIN SODIUM PER 1000U 8$$%$0175J1720 HYDROCORTISONE SODIUM SUCC I 20$$%$0176J1756 IRON SUCROSE INJECTION 48$$%$0177J1940 FUROSEMIDE INJECTION 40$$%$0178J2001 LIDOCAINE INJECTION 8$$%$0179J2060 LORAZEPAM INJECTION116$$%$0180J2150 MANNITOL INJECTION32$$%$0181J2250 INJ MIDAZOLAM HYDROCHLORIDE 12$$%$0182J2353 OCTREOTIDE INJECTION, DEPOT32$$%$0183J2405 ONDANSETRON HCL INJECTION 56$$%$0184J2469 PALONOSETRON HCL456$$%$0185J2505 INJECTION, PEGFILGRASTIM 6MG64$$%$0186J2550 PROMETHAZINE HCL INJECTION4$$%$0187J2765 METOCLOPRAMIDE HCL INJECTION 8$$%$0188J2780 METOCLOPRAMIDE HCL INJECTION 144$$%$0189J2916 NA FERRIC GLUCONATE COMPLEX 40$$%$0190J2930 METHYLPREDNISOLONE INJECTION 4$$%$0191J2997 ALTEPLASE RECOMBINANT 16$$%$0192J3010 FENTANYL CITRATE INJECITON 4$$%$0193J3370 VANCOMYCIN HCL INJECITON 4$$%$0194J3420 VITAMIN B12 INJECTION 16$$%$0195J3475 INJ MAGNESIUM SULFATE 92$$%$0196J3480 INJ POTASSIUM CHLORIDE100$$%$0197J3487 ZOLEDRONIC ACID 68$$%$0198J3488 RECLAST INJECTION 4$$%$0199J3490 DRUGS UNCLASSIFIED INJECTION24$$%$0200J7030 NORMAL SALINE SOLUTION INFUS224$$%$0201J7040 NORMAL SALINE SOLUTION INFUS76$$%$0202J7042 5% DEXTROSE/NORMAL SALINE20$$%$0203J7050NORMAL SALINE SOLUTION INFUS120$$%$0204J7060 5% DEXTROSE/WATER 4$$%$0205J7070 D5W INFUSION8$$%$0206J7120 RINGERS LACTATE INFUSION8$$%$0207J7130 HYPERTONIC SALINE SOLUTION4$$%$0208J9000 DOXORUBICIN HCL INJECTION80$$%$0209J9035 BEVACIZUMAB INJECTION60$$%$0210J9040 BLEOMYCIN SULFATE INJECTION20$$%$0211J9041 BORTEZOMIB INJECTION36$$%$0212J9045 CARBOPLATIN INJECTION104$$%$0213J9060 CISPLATIN 10 MG INJECTION 120$$%$0214J9070 CYCLOPHOSPHAMIDE 100 MG INJ44$$%$0215J9130 DACARBAZINE 100 MG INJ12$$%$0216J9171 DOCETAXEL INJECTION48$$%$0217J9181 ETOPOSIDE INJECTION104$$%$0218J9185 FLUDARABINE PHOSPHATE INJ 36$$%$0219J9190 FLUOROURACIL INJECTION 96$$%$0220J9201 GEMCITABINE HCL INJECTION32$$%$0221J9206 IRINOTECAN INJECTION 12$$%$0222J9217 LEUPROLIDE ACETATE SUSPNSION4$$%$0223J9263 OXALIPLATIN 44$$%$0224J9265 PACLITAXEL INJECTION 48$$%$0225J9305 PEMETREXED INJECTION 36$$%$0226J9310 RITUXIMAB INJECTION32$$%$0227J9355 TRASTUZUMAB INJECTION20$$%$$0228J9360 VINBLASTINE SULFATE INJ12$$%$0229J9370 VINCRISTINE SULFATE 1 MG INJ 24$$%$0230P9016 RBC LEUKOCYTES REDUCED 28$$%$0231P9035 PLATELET PHERES LEUKOREDUCED4$$%$0232P9047 ALBUMIN (HUMAN), 25%, 50ML 4$$%$0233S0020 INJECTION, BUPIVICAINE HYDRO4$$%$0234S0028 INJECTION, FAMOTIDINE, 20 MG24$$%$ESTIMATED TOTAL FOR ALL CELLS:$1st OPTION YEAR CLIN SCHEDULE: 01 JANUARY 2013 THROUGH 31 DECEMBER 2013CLINPrice Schedule SourceDIAGNOSIS RELATED GROUP CODES*EST QTYProfessional Medicare Price/CodeTechnical Medicare Price/CodePercent of MedicareTotal Extended Cost (all cells)1001400 ANESTH SKIN EXT/PER/ATRUNK4$$%$100210060 DRAINAGE OF SKIN ABSCESS4$$%$100332421 THORACENTESIS FOR ASPIRATION4$$%$100436000 PLACE NEEDLE IN VEIN4$$%$100536415 ROUTINE VENIPUNCTURE388$$%$100636416 CAPILLARY BLOOD DRAW20$$%$100736430 BLOOD TRANSFUSION SERVICE24$$%$100836561 INSERT TUNNELED CV CATH12$$%$100936571 INSERT PICVAD CATH8$$%$101036590 REMOVAL TUNNELED CV CATH4$$%$101136591 DRAW BLOOD OFF VENOUS DEVICE4$$%$101236593 DECLOT VASCULAR DEVICE16$$%$101336598 INJ W/FLUOR EVAL CV DEVICE4$$%$101438220 BONE MARROW ASPIRATION8$$%$101538221 BONE MARROW BIOPSY24$$%$101649080 PUNCTURE PERITONEAL CAVITY8$$%$101751702 INSERT TEMP BLADDER CATH4$$%$101862310 INJECT SPINE C/T4$$%$101971010 CHEST X-RAY4$$%$102071020 CHEST X-RAY RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL28$$%$102171260 CT THORAX W/DYE RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL4$$%$102271270 CT THORAX W/O&W DYE COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)4$$%$102372074 X-RAY EXAM OF THORACIC SPINE4$$%$102474150 CT ABDOMEN W/O DYE RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF 4 VIEWS4$$%$102574240 X-RAY EXAM UPPER GI TRACT COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL4$$%$102676000 FLUOROSCOPE EXAMINATION RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUTDELAYED FILMS, WITHOUT KUB8$$%$102776942 ECHO GUIDE FOR BIOPSY FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHERTHAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)12$$%$102880048 METABOLIC PANEL TOTAL CA SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODYRADIATION, PER ORAL, ENDOCAVITARY OR INTRAOPERATIVE CONE IRRADIATION)12$$%$102980050 GENERAL HEALTH PANEL4$$%$103080053 COMPREHEN METABOLIC PANEL GENERAL HEALTH PANELTHIS PANEL MUST INCLUDE THE FOLLOWING:COMPREHENSIVE METABOLIC PANEL (80053)HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT (CBC) (85022) ORHEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETEDIFFERENTIAL WBC COUNT (CBC) (85025)THYROID STIMULATING HORMONE (TSH) (84443)580$$%$103180185 ASSAY OF PHENYTOIN TOTAL THIS PANEL MUST INCLUDE THE FOLLOWING:ALBUMIN (82040)BILIRUBIN, TOTAL (82247)CALCIUM, TOTAL (82310)CARBON DIOXIDE (BICARBONATE) (82374)CHLORIDE (82435)CREATININE (82565)GLUCOSE (82947)PHOSPHATASE, ALKALINE (84075)POTASSIUM (84132)PROTEIN, TOTAL (84155)SODIUM (84295)TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460)TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)UREA NITROGEN (BUN) (84520)52$$%$103280299 QUANTITATIVE ASSAY DRUG PHENYTOIN; TOTAL44$$%$103380502 LAB PATHOLOGY CONSULTATION QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED12$$%$103481001 URINALYSIS AUTO W/SCOPE CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTICPROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS12$$%$103581003 URINALYSIS AUTO W/O SCOPE URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITH MICROSCOPY8$$%$103682105 ALPHA-FETOPROTEIN SERUM URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITHOUT MICROSCOPY 4$$%$103782232 ASSAY OF BETA-2 PROTEIN ALPHA-FETOPROTEIN; SERUM8$$%$103882248 BILIRUBIN DIRECT BETA-2 MICROGLOBULIN152$$%$103982378 CARCINOEMBRYONIC ANTIGEN BILIRUBIN; DIRECT60$$%$104082607 VITAMIN B-1212$$%$104182728 ASSAY OF FERRITIN CYANOCOBALAMIN (VITAMIN B-12)12$$%$104282746 BLOOD FOLIC ACID SERUM; FERRITIN16$$%$104382784 ASSAY IGA/IGD/IGG/IGM EACH FOLIC ACID; SERUM16$$%$104482977 ASSAY OF GGT; GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH160$$%$104583540 ASSAY OF IRON; GLUTAMYLTRANSFERASE, GAMMA (GGT)12$$%$104683550 IRON BINDING TEST;IRON12$$%$104783615 LACTATE (LD) (LDH) ENZYME;IRON BINDING CAPACITY180$$%$104883625 ASSAY OF LDH ENZYMES LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION ANDQUANTITATION4$$%$104983735 ASSAY OF MAGNESIUM 48$$%$105083891 MOLECULE ISOLATE NUCLEIC MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIEDNUCLEIC ACID, EACH NUCLEIC ACID TYPE (IE, DNA OR RNA)12$$%$105183892 MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT12$$%$105283896 MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH16$$%$105383898 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE12$$%$105483900 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST 2 NUCLEICACID SEQUENCES4$$%$105583901 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEICACID SEQUENCE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARYPROCEDURE)4$$%$105683902 MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION4$$%$105783903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG,SINGLE STRAND CONFORMATIONAL POLYMORPHISMS [SSCP], HETERODUPLEX,DENATURING GRADIENT GEL ELECTROPHORESIS [DGGE], RNA'ASE A), SINGLESEGMENT, EACH8$$%$105883907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION(EG, STOOL SPECIMENS, PARAFFIN EMBEDDED TISSUE), EACH SPECIMEN4$$%$105983908 MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE8$$%$106083909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTIONTECHNIQUE (EG, CAPILLARY ELECTROPHORESIS), EACH NUCLEIC ACIDPREPARATION4$$%$106183912 GENETIC EXAMINATION MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT20$$%$106283921 ORGANIC ACID, SINGLE, QUANTITATIVE4$$%$106384100 ASSAY OF PHOSPHORUS PHOSPHORUS INORGANIC (PHOSPHATE);12$$%$106484153 ASSAY OF PSA TOTAL PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL12$$%$106584155 ASSAY OF PROTEIN SERUM PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD4$$%$106684157 ASSAY OF PROTEIN OTHER PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,CEREBROSPINAL FLUID) 4$$%$106784165 PROTEIN E-PHORESIS SERUM PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM 20$$%$106884403 ASSAY OF TOTAL TESTOSTERON8$$%$106984436 ASSAY OF TOTAL THYROXINE4$$%$107084439 ASSAY OF FREE THYROXINE4$$%$107184443 ASSAY THYROID STIM HORMONE8$$%$107284479 ASSAY OF THYROID (T3 OR T4) 8$$%$107384480 ASSAY TRIIODOTHYRONINE (T3) 4$$%$107484550 ASSAY OF BLOOD/URIC ACID144$$%$107585007 BL SMEAR W/DIFF WBC COUNT 8$$%$107685025 COMPLETE CBC W/AUTO DIFF WBC484$$%$107785027 COMPLETE CBC AUTOMATED BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT)184$$%$107885045 AUTOMATED RETICULOCYTE COUNT BLOOD COUNT; RETICULOCYTE, AUTOMATED24$$%$ 107985060 BLOOD SMEAR INTERPRETATION BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT36$$%$ 108085097 BONE MARROW INTERPRETATION BONE MARROW, SMEAR INTERPRETATION32$$%$108185610 PROTHROMBIN TIME 44$$%$108285652 RBC SED RATE AUTOMATED SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED64$$%$108385730 THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD12$$%$108486038 ANTINUCLEAR ANTIBODIES4$$%$108586300 IMMUNOASSAY TUMOR CA 15-3 16$$%$108686301 IMMUNOASSAY TUMOR CA 19-928$$%$108786304 IMMUNOASSAY TUMOR CA 12548$$%$108886334 IMMUNOFIX E-PHORESIS SERUM4$$%$108986850 RBC ANTIBODY SCREEN24$$%$109086880 COOMBS TEST DIRECT4$$%$109186900 BLOOD TYPING ABO24$$%$109286901 BLOOD TYPING RH (D) 24$$%$109386920 COMPATIBILITY TEST SPIN COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE24$$%$109487070 CULTURE BACTERIA OTHER CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITHISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES4$$%$109587077 CULTURE AEROBIC IDENTIFY CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FORDEFINITIVE IDENTIFICATION, EACH ISOLATE4$$%$109687186 MICROBE SUSCEPTIBLE MIC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGARDILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACHMULTI-ANTIMICROBIAL, PER PLATE4$$%$109787205 SMEAR GRAM STAIN SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FORBACTERIA, FUNGI, OR CELL TYPES4$$%$109888108 CYTOPATH CONCENTRATE TECH CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,SACCOMANNO TECHNIQUE)12$$%$109988184 FLOWCYTOMETRY/ TC 1 MARKER FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER32$$%$110088185 FLOWCYTOMETRY/TC ADD-ON FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 32$$%$110188189 FLOWCYTOMETRY/READ 16 & > 24$$%$110288237 TISSUE CULTURE BONE MARROW16$$%$110388264 CHROMOSOME ANALYSIS 20-25 16$$%$110488271 CYTOGENETICS DNA PROBE 4$$%$110588275 CYTOGENETICS 100-3004$$%$110688280 CHROMOSOME KARYOTYPE STUDY8$$%$110788291 CYTO/MOLECULAR REPORT8$$%$110888305 TISSUE EXAM BY PATHOLOGIST40$$%$110988311 DECALCIFY TISSUE40$$%$111088312 SPECIAL STAINS GROUP 14$$%$111188313 SPECIAL STAINS GROUP 236$$%$111288342 IMMUNOHISTOCHEMISTRY44$$%$111388367 INSITU HYBRIDIZATION AUTO12$$%$111488368 INSITU HYBRIDIZATION MANUAL4$$%$111588381 MICRODISSECTION MANUAL4$$%$111689051 BODY FLUID CELL COUNT CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT4$$%$111793000 ELECTROCARDIOGRAM COMPLETE4$$%$111893010 ELECTROCARDIOGRAM REPORT4$$%$111996360 HYDRATION IV INFUSION INIT 68$$%$112096361 HYDRATE IV INFUSION ADD-ON180$$%$112196365 THER/PROPH/DIAG IV INF INIT116$$%$112296366 THER/PROPH/DIAG IV INF ADDON 108$$%$112396367 TX/PROPH/DG ADDL SEQ IV INF 512$$%$112496368 THER/DIAG CONCURRENT INF24$$%$112596372 THER/PROPH/DIAG INJ SC/IM 92$$%$112696374 THER/PROPH/DIAG INJ IV PUSH140$$%$112796375 TX/PRO/DX INJ NEW DRUG ADDON 588$$%$112896401 CHEMO ANTI-NEOPL SQ/IM32$$%$112996402 CHEMO HORMON ANTINEOPL SQ/IM4$$%$113096409 CHEMO IV PUSH SNGL DRUG96$$%$113196411 CHEMO IV PUSH ADDL DRUG108$$%$113296413 CHEMO IV INFUSION 1 HR536$$%$113396415 CHEMO IV INFUSION ADDL HR104$$%$113496417 CHEMO IV INFUS EACH ADDL SEQ160$$%$113596423 CHEMO IA INFUSE EACH ADDL HR 8$$%$113696521 REFILL/MAINT PORTABLE PUMP 8$$%$113796523 IRRIG DRUG DELIVERY DEVICE8$$%$113896912 PHOTOCHEMOTHERAPY WITH UV-A4$$%$113997810 ACUPUNCT W/O STIMUL 15 MIN28$$%$114097811 ACUPUNCT W/O STIMUL ADDL 15M16$$%$114199070 SPECIAL SUPPLIES; SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIANOVER AND ABOVE THOSE USUALLY INCLUDED WITH THE OFFICE VISIT OR OTHERSERVICES RENDERED (LIST DRUGS, TRAYS, SUPPLIES, OR MATERIALS PROVIDED)24$$%$114299195 PHLEBOTOMY 44$$%$114371010TC RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL TECHNICAL COMPONENT8$$%$114471020 TC RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL;TECHNICAL COMPONENT20$$%$114574246 TC RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST,WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUTGLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB TECHNICAL COMPONENT4$$%$114676370 TC8$$%$114777003 TC FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE ORPARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL,SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION TECHNICAL COMPONENT4$$%$114885025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT12$$%$114988305 59TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONABORTION - SPONTANEOUS/MISSEDARTERY, BIOPSYBONE MARROW, BIOPSYBONE EXOSTOSISBRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTIONBREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGICAL MARGINSBREAST, REDUCTION MAMMOPLASTYBRONCHUS, BIOPSYCELL BLOCK, ANY SOURCECERVIX, BIOPSYCOLON, BIOPSYDUODENUM, BIOPSYENDOCERVIX, CURETTINGS/BIOPSYENDOMETRIUM, CURETTINGS/BIOPSYESOPHAGUS, BIOPSYEXTREMITY, AMPUTATION, TRAUMATICFALLOPIAN TUBE, BIOPSYFALLOPIAN TUBE, ECTOPIC PREGNANCYFEMORAL HEAD, FRACTURE FINGERS/TOES, AMPUTATION, NON-TRAUMATICGINGIVA/ORAL MUCOSA, BIOPSYHEART VALVEJOINT, RESECTIONKIDNEY, BIOPSYLARYNX, BIOPSYLEIOMYOMA(S), UTERINE MYOMECTOMY - WITHOUT UTERUSLIP, BIOPSY/WEDGE RESECTIONLUNG, TRANSBRONCHIAL BIOPSYLYMPH NODE, BIOPSYMUSCLE, BIOPSYNASAL MUCOSA, BIOPSYNASOPHARYNX/OROPHARYNX, BIOPSYNERVE, BIOPSYODONTOGENIC/DENTAL CYSTOMENTUM, BIOPSYOVARY WITH OR WITHOUT TUBE, NON-NEOPLASTICOVARY, BIOPSY/WEDGE RESECTIONPARATHYROID GLANDPERITONEUM, BIOPSYPITUITARY TUMORPLACENTA, OTHER THAN THIRD TRIMESTERPLEURA/PERICARDIUM - BIOPSY/TISSUE POLYP, CERVICAL/ENDOMETRIALPOLYP, COLORECTALPOLYP, STOMACH/SMALL INTESTINEPROSTATE, NEEDLE BIOPSYPROSTATE, TURSALIVARY GLAND, BIOPSYSINUS, PARANASAL BIOPSYSKIN, OTHER THAN CYST/TAG/DEBRIDEMENT/PLASTIC REPAIRSMALL INTESTINE, BIOPSYSOFT TISSUE, OTHER THAN TUMOR/MASS/LIPOMA/DEBRIDEMENTSPLEENSTOMACH, BIOPSYSYNOVIUMTESTIS, OTHER THAN TUMOR/BIOPSY/CASTRATIONTHYROGLOSSAL DUCT/BRACHIAL CLEFT CYSTTONGUE, BIOPSYTONSIL, BIOPSYTRACHEA, BIOPSYURETER, BIOPSYURETHRA, BIOPSYURINARY BLADDER, BIOPSYUTERUS, WITH OR WITHOUT TUBES AND OVARIES, FOR PROLAPSEVAGINA, BIOPSYVULVA/LABIA, BIOPSY DISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$115088311 TC DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FORSURGICAL PATHOLOGY EXAMINATION)TECHNICAL COMPONENT4$$%$115188313 59TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACHDISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$115288313 TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACH TECHNICAL COMPONENT4$$%$1153A4300 CATH IMPL VASC ACCESS PORTAL 4$$%$1154A4314 CATH W/DRAINAGE 2-WAY LATEX4$$%$1155A4550 SURGICAL TRAYS16$$%$1156C1751 CATH, INF, PER/CENT/MIDLINE 8$$%$1157C1788 PORT, INDWELLING, IMP4$$%$1158J0461 ATROPINE SULFATE INJECTION 12$$%$1159J0640 LEUCOVORIN CALCIUM INJECTION76$$%$1160J0690 CEFAZOLIN SODIUM INJECTION4$$%$1161J0696 CEFTRIAXONE SODIUM INJECTION8$$%$1162J0780 PROCHLORPERAZINE INJECTION16$$%$1163J0881 DARBEPOETIN ALFA, NON-ESRD12$$%$1164J1040 METHYLPREDNISOLONE 80 MG INJ4$$%$1165J1080 TESTOSTERONE CYPIONAT 200 MG 4$$%$1166J1100 DEXAMETHASONE SODIUM PHOS620$$%$1167J1170 HYDROMORPHONE INJECTION12$$%$1168J1200 DIPHENHYDRAMINE HCL INJECTIO52$$%$1169J1260 DOLASETRON MESYLATE24$$%$1170J1440 FILGRASTIM 300 MCG INJECITON20$$%$1171J1453 FOSAPREPITANT INJECTION 188$$%$1172J1626 GRANISETRON HCL INJECTION48$$%$1173J1642 INJ HEPARIN SODIUM PER 10 U 248$$%$1174J1644 INJ HEPARIN SODIUM PER 1000U 8$$%$1175J1720 HYDROCORTISONE SODIUM SUCC I 20$$%$1176J1756 IRON SUCROSE INJECTION 48$$%$1177J1940 FUROSEMIDE INJECTION 40$$%$1178J2001 LIDOCAINE INJECTION 8$$%$1179J2060 LORAZEPAM INJECTION116$$%$1180J2150 MANNITOL INJECTION32$$%$1181J2250 INJ MIDAZOLAM HYDROCHLORIDE 12$$%$1182J2353 OCTREOTIDE INJECTION, DEPOT32$$%$1183J2405 ONDANSETRON HCL INJECTION 56$$%$1184J2469 PALONOSETRON HCL456$$%$1185J2505 INJECTION, PEGFILGRASTIM 6MG64$$%$1186J2550 PROMETHAZINE HCL INJECTION4$$%$1187J2765 METOCLOPRAMIDE HCL INJECTION 8$$%$1188J2780 METOCLOPRAMIDE HCL INJECTION 144$$%$1189J2916 NA FERRIC GLUCONATE COMPLEX 40$$%$1190J2930 METHYLPREDNISOLONE INJECTION 4$$%$1191J2997 ALTEPLASE RECOMBINANT 16$$%$1192J3010 FENTANYL CITRATE INJECITON 4$$%$1193J3370 VANCOMYCIN HCL INJECITON 4$$%$1194J3420 VITAMIN B12 INJECTION 16$$%$1195J3475 INJ MAGNESIUM SULFATE 92$$%$1196J3480 INJ POTASSIUM CHLORIDE100$$%$1197J3487 ZOLEDRONIC ACID 68$$%$1198J3488 RECLAST INJECTION 4$$%$1199J3490 DRUGS UNCLASSIFIED INJECTION24$$%$1200J7030 NORMAL SALINE SOLUTION INFUS224$$%$1201J7040 NORMAL SALINE SOLUTION INFUS76$$%$1202J7042 5% DEXTROSE/NORMAL SALINE20$$%$1203J7050NORMAL SALINE SOLUTION INFUS120$$%$1204J7060 5% DEXTROSE/WATER 4$$%$1205J7070 D5W INFUSION8$$%$1206J7120 RINGERS LACTATE INFUSION8$$%$1207J7130 HYPERTONIC SALINE SOLUTION4$$%$1208J9000 DOXORUBICIN HCL INJECTION80$$%$1209J9035 BEVACIZUMAB INJECTION60$$%$1210J9040 BLEOMYCIN SULFATE INJECTION20$$%$1211J9041 BORTEZOMIB INJECTION36$$%$1212J9045 CARBOPLATIN INJECTION104$$%$1213J9060 CISPLATIN 10 MG INJECTION 120$$%$1214J9070 CYCLOPHOSPHAMIDE 100 MG INJ44$$%$1215J9130 DACARBAZINE 100 MG INJ12$$%$1216J9171 DOCETAXEL INJECTION48$$%$1217J9181 ETOPOSIDE INJECTION104$$%$1218J9185 FLUDARABINE PHOSPHATE INJ 36$$%$1219J9190 FLUOROURACIL INJECTION 96$$%$1220J9201 GEMCITABINE HCL INJECTION32$$%$1221J9206 IRINOTECAN INJECTION 12$$%$1222J9217 LEUPROLIDE ACETATE SUSPNSION4$$%$1223J9263 OXALIPLATIN 44$$%$1224J9265 PACLITAXEL INJECTION 48$$%$1225J9305 PEMETREXED INJECTION 36$$%$1226J9310 RITUXIMAB INJECTION32$$%$1227J9355 TRASTUZUMAB INJECTION20$$%$1228J9360 VINBLASTINE SULFATE INJ12$$%$1229J9370 VINCRISTINE SULFATE 1 MG INJ 24$$%$1230P9016 RBC LEUKOCYTES REDUCED 28$$%$1231P9035 PLATELET PHERES LEUKOREDUCED4$$%$1232P9047 ALBUMIN (HUMAN), 25%, 50ML 4$$%$1233S0020 INJECTION, BUPIVICAINE HYDRO4$$%$1234S0028 INJECTION, FAMOTIDINE, 20 MG24$$%$ESTIMATED TOTAL FOR ALL CELLS:$2nd OPTION YEAR CLIN SCHEDULE: 01 JANUARY 2016 THROUGH 31 DECEMBER 20162LINPrice Schedule SourceDIAGNOSIS RELATED GROUP CODES*EST QTYProfessional Medicare Price/CodeTechnical Medicare Price/CodePercent of MedicareTotal Extended Cost (all cells)2001400 ANESTH SKIN EXT/PER/ATRUNK4$$%$200210060 DRAINAGE OF SKIN ABSCESS4$$%$200332421 THORACENTESIS FOR ASPIRATION4$$%$200436000 PLACE NEEDLE IN VEIN4$$%$200536415 ROUTINE VENIPUNCTURE388$$%$200636416 CAPILLARY BLOOD DRAW20$$%$200736430 BLOOD TRANSFUSION SERVICE24$$%$200836561 INSERT TUNNELED CV CATH12$$%$200936571 INSERT PICVAD CATH8$$%$201036590 REMOVAL TUNNELED CV CATH4$$%$201136591 DRAW BLOOD OFF VENOUS DEVICE4$$%$201236593 DECLOT VASCULAR DEVICE16$$%$201336598 INJ W/FLUOR EVAL CV DEVICE4$$%$201438220 BONE MARROW ASPIRATION8$$%$201538221 BONE MARROW BIOPSY24$$%$201649080 PUNCTURE PERITONEAL CAVITY8$$%$201751702 INSERT TEMP BLADDER CATH4$$%$201862310 INJECT SPINE C/T4$$%$201971010 CHEST X-RAY4$$%$202071020 CHEST X-RAY RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL28$$%$202171260 CT THORAX W/DYE RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL4$$%$202271270 CT THORAX W/O&W DYE COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)4$$%$202372074 X-RAY EXAM OF THORACIC SPINE4$$%$202474150 CT ABDOMEN W/O DYE RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF 4 VIEWS4$$%$202574240 X-RAY EXAM UPPER GI TRACT COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL4$$%$202676000 FLUOROSCOPE EXAMINATION RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUTDELAYED FILMS, WITHOUT KUB8$$%$202776942 ECHO GUIDE FOR BIOPSY FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHERTHAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)12$$%$202880048 METABOLIC PANEL TOTAL CA SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODYRADIATION, PER ORAL, ENDOCAVITARY OR INTRAOPERATIVE CONE IRRADIATION)12$$%$202980050 GENERAL HEALTH PANEL4$$%$203080053 COMPREHEN METABOLIC PANEL GENERAL HEALTH PANELTHIS PANEL MUST INCLUDE THE FOLLOWING:COMPREHENSIVE METABOLIC PANEL (80053)HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT (CBC) (85022) ORHEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETEDIFFERENTIAL WBC COUNT (CBC) (85025)THYROID STIMULATING HORMONE (TSH) (84443)580$$%$203180185 ASSAY OF PHENYTOIN TOTAL THIS PANEL MUST INCLUDE THE FOLLOWING:ALBUMIN (82040)BILIRUBIN, TOTAL (82247)CALCIUM, TOTAL (82310)CARBON DIOXIDE (BICARBONATE) (82374)CHLORIDE (82435)CREATININE (82565)GLUCOSE (82947)PHOSPHATASE, ALKALINE (84075)POTASSIUM (84132)PROTEIN, TOTAL (84155)SODIUM (84295)TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460)TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)UREA NITROGEN (BUN) (84520)52$$%$203280299 QUANTITATIVE ASSAY DRUG PHENYTOIN; TOTAL44$$%$203380502 LAB PATHOLOGY CONSULTATION QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED12$$%$203481001 URINALYSIS AUTO W/SCOPE CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTICPROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS12$$%$203581003 URINALYSIS AUTO W/O SCOPE URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITH MICROSCOPY8$$%$203682105 ALPHA-FETOPROTEIN SERUM URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITHOUT MICROSCOPY 4$$%$203782232 ASSAY OF BETA-2 PROTEIN ALPHA-FETOPROTEIN; SERUM8$$%$203882248 BILIRUBIN DIRECT BETA-2 MICROGLOBULIN152$$%$203982378 CARCINOEMBRYONIC ANTIGEN BILIRUBIN; DIRECT60$$%$204082607 VITAMIN B-1212$$%$204182728 ASSAY OF FERRITIN CYANOCOBALAMIN (VITAMIN B-12)12$$%$204282746 BLOOD FOLIC ACID SERUM; FERRITIN16$$%$204382784 ASSAY IGA/IGD/IGG/IGM EACH FOLIC ACID; SERUM16$$%$ 204482977 ASSAY OF GGT; GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH160$$%$204583540 ASSAY OF IRON; GLUTAMYLTRANSFERASE, GAMMA (GGT)12$$%$204683550 IRON BINDING TEST;IRON12$$%$204783615 LACTATE (LD) (LDH) ENZYME;IRON BINDING CAPACITY180$$%$204883625 ASSAY OF LDH ENZYMES LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION ANDQUANTITATION4$$%$204983735 ASSAY OF MAGNESIUM 48$$%$205083891 MOLECULE ISOLATE NUCLEIC MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIEDNUCLEIC ACID, EACH NUCLEIC ACID TYPE (IE, DNA OR RNA)12$$%$205183892 MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT12$$%$205283896 MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH16$$%$205383898 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE12$$%$205483900 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST 2 NUCLEICACID SEQUENCES4$$%$205583901 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEICACID SEQUENCE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARYPROCEDURE)4$$%$205683902 MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION4$$%$205783903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG,SINGLE STRAND CONFORMATIONAL POLYMORPHISMS [SSCP], HETERODUPLEX,DENATURING GRADIENT GEL ELECTROPHORESIS [DGGE], RNA'ASE A), SINGLESEGMENT, EACH8$$%$205883907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION(EG, STOOL SPECIMENS, PARAFFIN EMBEDDED TISSUE), EACH SPECIMEN4$$%$205983908 MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE8$$%$206083909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTIONTECHNIQUE (EG, CAPILLARY ELECTROPHORESIS), EACH NUCLEIC ACIDPREPARATION4$$%$206183912 GENETIC EXAMINATION MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT20$$%$206283921 ORGANIC ACID, SINGLE, QUANTITATIVE4$$%$206384100 ASSAY OF PHOSPHORUS PHOSPHORUS INORGANIC (PHOSPHATE);12$$%$206484153 ASSAY OF PSA TOTAL PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL12$$%$206584155 ASSAY OF PROTEIN SERUM PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD4$$%$206684157 ASSAY OF PROTEIN OTHER PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,CEREBROSPINAL FLUID) 4$$%$206784165 PROTEIN E-PHORESIS SERUM PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM 20$$%$206884403 ASSAY OF TOTAL TESTOSTERON8$$%$206984436 ASSAY OF TOTAL THYROXINE4$$%$207084439 ASSAY OF FREE THYROXINE4$$%$207184443 ASSAY THYROID STIM HORMONE8$$%$207284479 ASSAY OF THYROID (T3 OR T4) 8$$%$207384480 ASSAY TRIIODOTHYRONINE (T3) 4$$%$207484550 ASSAY OF BLOOD/URIC ACID144$$%$207585007 BL SMEAR W/DIFF WBC COUNT 8$$%$207685025 COMPLETE CBC W/AUTO DIFF WBC484$$%$207785027 COMPLETE CBC AUTOMATED BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT)184$$%$207885045 AUTOMATED RETICULOCYTE COUNT BLOOD COUNT; RETICULOCYTE, AUTOMATED24$$%$207985060 BLOOD SMEAR INTERPRETATION BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT36$$%$208085097 BONE MARROW INTERPRETATION BONE MARROW, SMEAR INTERPRETATION32$$%$208185610 PROTHROMBIN TIME 44$$%$208285652 RBC SED RATE AUTOMATED SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED64$$%$208385730 THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD12$$%$208486038 ANTINUCLEAR ANTIBODIES4$$%$208586300 IMMUNOASSAY TUMOR CA 15-3 16$$%$208686301 IMMUNOASSAY TUMOR CA 19-928$$%$208786304 IMMUNOASSAY TUMOR CA 12548$$%$208886334 IMMUNOFIX E-PHORESIS SERUM4$$%$208986850 RBC ANTIBODY SCREEN24$$%$209086880 COOMBS TEST DIRECT4$$%$209186900 BLOOD TYPING ABO24$$%$209286901 BLOOD TYPING RH (D) 24$$%$209386920 COMPATIBILITY TEST SPIN COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE24$$%$209487070 CULTURE BACTERIA OTHER CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITHISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES4$$%$209587077 CULTURE AEROBIC IDENTIFY CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FORDEFINITIVE IDENTIFICATION, EACH ISOLATE4$$%$209687186 MICROBE SUSCEPTIBLE MIC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGARDILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACHMULTI-ANTIMICROBIAL, PER PLATE4$$%$209787205 SMEAR GRAM STAIN SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FORBACTERIA, FUNGI, OR CELL TYPES4$$%$209888108 CYTOPATH CONCENTRATE TECH CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,SACCOMANNO TECHNIQUE)12$$%$209988184 FLOWCYTOMETRY/ TC 1 MARKER FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER32$$%$210088185 FLOWCYTOMETRY/TC ADD-ON FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 32$$%$210188189 FLOWCYTOMETRY/READ 16 & > 24$$%$210288237 TISSUE CULTURE BONE MARROW16$$%$210388264 CHROMOSOME ANALYSIS 20-25 16$$%$210488271 CYTOGENETICS DNA PROBE 4$$%$210588275 CYTOGENETICS 100-3004$$%$210688280 CHROMOSOME KARYOTYPE STUDY8$$%$210788291 CYTO/MOLECULAR REPORT8$$%$210888305 TISSUE EXAM BY PATHOLOGIST40$$%$210988311 DECALCIFY TISSUE40$$%$211088312 SPECIAL STAINS GROUP 14$$%$211188313 SPECIAL STAINS GROUP 236$$%$211288342 IMMUNOHISTOCHEMISTRY44$$%$211388367 INSITU HYBRIDIZATION AUTO12$$%$211488368 INSITU HYBRIDIZATION MANUAL4$$%$211588381 MICRODISSECTION MANUAL4$$%$211689051 BODY FLUID CELL COUNT CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT4$$%$211793000 ELECTROCARDIOGRAM COMPLETE4$$%$211893010 ELECTROCARDIOGRAM REPORT4$$%$211996360 HYDRATION IV INFUSION INIT 68$$%$212096361 HYDRATE IV INFUSION ADD-ON180$$%$212196365 THER/PROPH/DIAG IV INF INIT116$$%$212296366 THER/PROPH/DIAG IV INF ADDON 108$$%$212396367 TX/PROPH/DG ADDL SEQ IV INF 512$$%$212496368 THER/DIAG CONCURRENT INF24$$%$212596372 THER/PROPH/DIAG INJ SC/IM 92$$%$212696374 THER/PROPH/DIAG INJ IV PUSH140$$%$212796375 TX/PRO/DX INJ NEW DRUG ADDON 588$$%$212896401 CHEMO ANTI-NEOPL SQ/IM32$$%$212996402 CHEMO HORMON ANTINEOPL SQ/IM4$$%$213096409 CHEMO IV PUSH SNGL DRUG96$$%$213196411 CHEMO IV PUSH ADDL DRUG108$$%$213296413 CHEMO IV INFUSION 1 HR536$$%$213396415 CHEMO IV INFUSION ADDL HR104$$%$213496417 CHEMO IV INFUS EACH ADDL SEQ160$$%$213596423 CHEMO IA INFUSE EACH ADDL HR 8$$%$213696521 REFILL/MAINT PORTABLE PUMP 8$$%$213796523 IRRIG DRUG DELIVERY DEVICE8$$%$213896912 PHOTOCHEMOTHERAPY WITH UV-A4$$%$213997810 ACUPUNCT W/O STIMUL 15 MIN28$$%$214097811 ACUPUNCT W/O STIMUL ADDL 15M16$$%$214199070 SPECIAL SUPPLIES; SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIANOVER AND ABOVE THOSE USUALLY INCLUDED WITH THE OFFICE VISIT OR OTHERSERVICES RENDERED (LIST DRUGS, TRAYS, SUPPLIES, OR MATERIALS PROVIDED)24$$%$214299195 PHLEBOTOMY 44$$%$214371010TC RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL TECHNICAL COMPONENT8$$%$214471020 TC RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL;TECHNICAL COMPONENT20$$%$214574246 TC RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST,WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUTGLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB TECHNICAL COMPONENT4$$%$214676370 TC8$$%$214777003 TC FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE ORPARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL,SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION TECHNICAL COMPONENT4$$%$214885025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT12$$%$214988305 59TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONABORTION - SPONTANEOUS/MISSEDARTERY, BIOPSYBONE MARROW, BIOPSYBONE EXOSTOSISBRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTIONBREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGICAL MARGINSBREAST, REDUCTION MAMMOPLASTYBRONCHUS, BIOPSYCELL BLOCK, ANY SOURCECERVIX, BIOPSYCOLON, BIOPSYDUODENUM, BIOPSYENDOCERVIX, CURETTINGS/BIOPSYENDOMETRIUM, CURETTINGS/BIOPSYESOPHAGUS, BIOPSYEXTREMITY, AMPUTATION, TRAUMATICFALLOPIAN TUBE, BIOPSYFALLOPIAN TUBE, ECTOPIC PREGNANCYFEMORAL HEAD, FRACTURE FINGERS/TOES, AMPUTATION, NON-TRAUMATICGINGIVA/ORAL MUCOSA, BIOPSYHEART VALVEJOINT, RESECTIONKIDNEY, BIOPSYLARYNX, BIOPSYLEIOMYOMA(S), UTERINE MYOMECTOMY - WITHOUT UTERUSLIP, BIOPSY/WEDGE RESECTIONLUNG, TRANSBRONCHIAL BIOPSYLYMPH NODE, BIOPSYMUSCLE, BIOPSYNASAL MUCOSA, BIOPSYNASOPHARYNX/OROPHARYNX, BIOPSYNERVE, BIOPSYODONTOGENIC/DENTAL CYSTOMENTUM, BIOPSYOVARY WITH OR WITHOUT TUBE, NON-NEOPLASTICOVARY, BIOPSY/WEDGE RESECTIONPARATHYROID GLANDPERITONEUM, BIOPSYPITUITARY TUMORPLACENTA, OTHER THAN THIRD TRIMESTERPLEURA/PERICARDIUM - BIOPSY/TISSUE POLYP, CERVICAL/ENDOMETRIALPOLYP, COLORECTALPOLYP, STOMACH/SMALL INTESTINEPROSTATE, NEEDLE BIOPSYPROSTATE, TURSALIVARY GLAND, BIOPSYSINUS, PARANASAL BIOPSYSKIN, OTHER THAN CYST/TAG/DEBRIDEMENT/PLASTIC REPAIRSMALL INTESTINE, BIOPSYSOFT TISSUE, OTHER THAN TUMOR/MASS/LIPOMA/DEBRIDEMENTSPLEENSTOMACH, BIOPSYSYNOVIUMTESTIS, OTHER THAN TUMOR/BIOPSY/CASTRATIONTHYROGLOSSAL DUCT/BRACHIAL CLEFT CYSTTONGUE, BIOPSYTONSIL, BIOPSYTRACHEA, BIOPSYURETER, BIOPSYURETHRA, BIOPSYURINARY BLADDER, BIOPSYUTERUS, WITH OR WITHOUT TUBES AND OVARIES, FOR PROLAPSEVAGINA, BIOPSYVULVA/LABIA, BIOPSY DISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$215088311 TC DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FORSURGICAL PATHOLOGY EXAMINATION)TECHNICAL COMPONENT4$$%$215188313 59TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACHDISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$215288313 TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACH TECHNICAL COMPONENT4$$%$2153A4300 CATH IMPL VASC ACCESS PORTAL 4$$%$2154A4314 CATH W/DRAINAGE 2-WAY LATEX4$$%$2155A4550 SURGICAL TRAYS16$$%$2156C1751 CATH, INF, PER/CENT/MIDLINE 8$$%$2157C1788 PORT, INDWELLING, IMP4$$%$2158J0461 ATROPINE SULFATE INJECTION 12$$%$2159J0640 LEUCOVORIN CALCIUM INJECTION76$$%$2160J0690 CEFAZOLIN SODIUM INJECTION4$$%$2161J0696 CEFTRIAXONE SODIUM INJECTION8$$%$2162J0780 PROCHLORPERAZINE INJECTION16$$%$2163J0881 DARBEPOETIN ALFA, NON-ESRD12$$%$2164J1040 METHYLPREDNISOLONE 80 MG INJ4$$%$2165J1080 TESTOSTERONE CYPIONAT 200 MG 4$$%$2166J1100 DEXAMETHASONE SODIUM PHOS620$$%$2167J1170 HYDROMORPHONE INJECTION12$$%$2168J1200 DIPHENHYDRAMINE HCL INJECTIO52$$%$2169J1260 DOLASETRON MESYLATE24$$%$2170J1440 FILGRASTIM 300 MCG INJECITON20$$%$2171J1453 FOSAPREPITANT INJECTION 188$$%$2172J1626 GRANISETRON HCL INJECTION48$$%$2173J1642 INJ HEPARIN SODIUM PER 10 U 248$$%$2174J1644 INJ HEPARIN SODIUM PER 1000U 8$$%$2175J1720 HYDROCORTISONE SODIUM SUCC I 20$$%$2176J1756 IRON SUCROSE INJECTION 48$$%$2177J1940 FUROSEMIDE INJECTION 40$$%$2178J2001 LIDOCAINE INJECTION 8$$%$2179J2060 LORAZEPAM INJECTION116$$%$2180J2150 MANNITOL INJECTION32$$%$2181J2250 INJ MIDAZOLAM HYDROCHLORIDE 12$$%$2182J2353 OCTREOTIDE INJECTION, DEPOT32$$%$2183J2405 ONDANSETRON HCL INJECTION 56$$%$2184J2469 PALONOSETRON HCL456$$%$2185J2505 INJECTION, PEGFILGRASTIM 6MG64$$%$2186J2550 PROMETHAZINE HCL INJECTION4$$%$2187J2765 METOCLOPRAMIDE HCL INJECTION 8$$%$2188J2780 METOCLOPRAMIDE HCL INJECTION 144$$%$2189J2916 NA FERRIC GLUCONATE COMPLEX 40$$%$2190J2930 METHYLPREDNISOLONE INJECTION 4$$%$2191J2997 ALTEPLASE RECOMBINANT 16$$%$2192J3010 FENTANYL CITRATE INJECITON 4$$%$2193J3370 VANCOMYCIN HCL INJECITON 4$$%$2194J3420 VITAMIN B12 INJECTION 16$$%$2195J3475 INJ MAGNESIUM SULFATE 92$$%$2196J3480 INJ POTASSIUM CHLORIDE100$$%$2197J3487 ZOLEDRONIC ACID 68$$%$2198J3488 RECLAST INJECTION 4$$%$2199J3490 DRUGS UNCLASSIFIED INJECTION24$$%$2200J7030 NORMAL SALINE SOLUTION INFUS224$$%$2201J7040 NORMAL SALINE SOLUTION INFUS76$$%$2202J7042 5% DEXTROSE/NORMAL SALINE20$$%$2203J7050NORMAL SALINE SOLUTION INFUS120$$%$2204J7060 5% DEXTROSE/WATER 4$$%$2205J7070 D5W INFUSION8$$%$2206J7120 RINGERS LACTATE INFUSION8$$%$2207J7130 HYPERTONIC SALINE SOLUTION4$$%$2208J9000 DOXORUBICIN HCL INJECTION80$$%$2209J9035 BEVACIZUMAB INJECTION60$$%$2210J9040 BLEOMYCIN SULFATE INJECTION20$$%$2211J9041 BORTEZOMIB INJECTION36$$%$2212J9045 CARBOPLATIN INJECTION104$$%$2213J9060 CISPLATIN 10 MG INJECTION 120$$%$2214J9070 CYCLOPHOSPHAMIDE 100 MG INJ44$$%$2215J9130 DACARBAZINE 100 MG INJ12$$%$2216J9171 DOCETAXEL INJECTION48$$%$2217J9181 ETOPOSIDE INJECTION104$$%$2218J9185 FLUDARABINE PHOSPHATE INJ 36$$%$2219J9190 FLUOROURACIL INJECTION 96$$%$2220J9201 GEMCITABINE HCL INJECTION32$$%$2221J9206 IRINOTECAN INJECTION 12$$%$2222J9217 LEUPROLIDE ACETATE SUSPNSION4$$%$2223J9263 OXALIPLATIN 44$$%$2224J9265 PACLITAXEL INJECTION 48$$%$2225J9305 PEMETREXED INJECTION 36$$%$2226J9310 RITUXIMAB INJECTION32$$%$2227J9355 TRASTUZUMAB INJECTION20$$%$$2228J9360 VINBLASTINE SULFATE INJ12$$%$2229J9370 VINCRISTINE SULFATE 1 MG INJ 24$$%$2230P9016 RBC LEUKOCYTES REDUCED 28$$%$2231P9035 PLATELET PHERES LEUKOREDUCED4$$%$2232P9047 ALBUMIN (HUMAN), 25%, 50ML 4$$%$2233S0020 INJECTION, BUPIVICAINE HYDRO4$$%$2234S0028 INJECTION, FAMOTIDINE, 20 MG24$$%$ESTIMATED TOTAL FOR ALL CELLS:$3rd OPTION YEAR CLIN SCHEDULE: 01 JANUARY 2015 THROUGH 31 DECEMBER 2015CLINPrice Schedule SourceDIAGNOSIS RELATED GROUP CODES*EST QTYProfessional Medicare Price/CodeTechnical Medicare Price/CodePercent of MedicareTotal Extended Cost (all cells)3001400 ANESTH SKIN EXT/PER/ATRUNK4$$%$300210060 DRAINAGE OF SKIN ABSCESS4$$%$300332421 THORACENTESIS FOR ASPIRATION4$$%$300436000 PLACE NEEDLE IN VEIN4$$%$300536415 ROUTINE VENIPUNCTURE388$$%$300636416 CAPILLARY BLOOD DRAW20$$%$300736430 BLOOD TRANSFUSION SERVICE24$$%$300836561 INSERT TUNNELED CV CATH12$$%$300936571 INSERT PICVAD CATH8$$%$301036590 REMOVAL TUNNELED CV CATH4$$%$301136591 DRAW BLOOD OFF VENOUS DEVICE4$$%$301236593 DECLOT VASCULAR DEVICE16$$%$301336598 INJ W/FLUOR EVAL CV DEVICE4$$%$301438220 BONE MARROW ASPIRATION8$$%$301538221 BONE MARROW BIOPSY24$$%$301649080 PUNCTURE PERITONEAL CAVITY8$$%$301751702 INSERT TEMP BLADDER CATH4$$%$301862310 INJECT SPINE C/T4$$%$301971010 CHEST X-RAY4$$%$302071020 CHEST X-RAY RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL28$$%$302171260 CT THORAX W/DYE RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL4$$%$302271270 CT THORAX W/O&W DYE COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)4$$%$302372074 X-RAY EXAM OF THORACIC SPINE4$$%$302474150 CT ABDOMEN W/O DYE RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF 4 VIEWS4$$%$302574240 X-RAY EXAM UPPER GI TRACT COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL4$$%$302676000 FLUOROSCOPE EXAMINATION RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUTDELAYED FILMS, WITHOUT KUB8$$%$302776942 ECHO GUIDE FOR BIOPSY FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHERTHAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)12$$%$302880048 METABOLIC PANEL TOTAL CA SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODYRADIATION, PER ORAL, ENDOCAVITARY OR INTRAOPERATIVE CONE IRRADIATION)12$$%$302980050 GENERAL HEALTH PANEL4$$%$303080053 COMPREHEN METABOLIC PANEL GENERAL HEALTH PANELTHIS PANEL MUST INCLUDE THE FOLLOWING:COMPREHENSIVE METABOLIC PANEL (80053)HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT (CBC) (85022) ORHEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETEDIFFERENTIAL WBC COUNT (CBC) (85025)THYROID STIMULATING HORMONE (TSH) (84443)580$$%$303180185 ASSAY OF PHENYTOIN TOTAL THIS PANEL MUST INCLUDE THE FOLLOWING:ALBUMIN (82040)BILIRUBIN, TOTAL (82247)CALCIUM, TOTAL (82310)CARBON DIOXIDE (BICARBONATE) (82374)CHLORIDE (82435)CREATININE (82565)GLUCOSE (82947)PHOSPHATASE, ALKALINE (84075)POTASSIUM (84132)PROTEIN, TOTAL (84155)SODIUM (84295)TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460)TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)UREA NITROGEN (BUN) (84520)52$$%$303280299 QUANTITATIVE ASSAY DRUG PHENYTOIN; TOTAL44$$%$303380502 LAB PATHOLOGY CONSULTATION QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED12$$%$303481001 URINALYSIS AUTO W/SCOPE CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTICPROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS12$$%$303581003 URINALYSIS AUTO W/O SCOPE URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITH MICROSCOPY8$$%$303682105 ALPHA-FETOPROTEIN SERUM URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITHOUT MICROSCOPY 4$$%$303782232 ASSAY OF BETA-2 PROTEIN ALPHA-FETOPROTEIN; SERUM8$$%$303882248 BILIRUBIN DIRECT BETA-2 MICROGLOBULIN152$$%$303982378 CARCINOEMBRYONIC ANTIGEN BILIRUBIN; DIRECT60$$%$304082607 VITAMIN B-1212$$%$304182728 ASSAY OF FERRITIN CYANOCOBALAMIN (VITAMIN B-12)12$$%$304282746 BLOOD FOLIC ACID SERUM; FERRITIN16$$%$304382784 ASSAY IGA/IGD/IGG/IGM EACH FOLIC ACID; SERUM16$$%$304482977 ASSAY OF GGT; GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH160$$%$304583540 ASSAY OF IRON; GLUTAMYLTRANSFERASE, GAMMA (GGT)12$$%$304683550 IRON BINDING TEST;IRON12$$%$304783615 LACTATE (LD) (LDH) ENZYME;IRON BINDING CAPACITY180$$%$304883625 ASSAY OF LDH ENZYMES LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION ANDQUANTITATION4$$%$304983735 ASSAY OF MAGNESIUM 48$$%$305083891 MOLECULE ISOLATE NUCLEIC MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIEDNUCLEIC ACID, EACH NUCLEIC ACID TYPE (IE, DNA OR RNA)12$$%$305183892 MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT12$$%$305283896 MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH16$$%$305383898 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE12$$%$305483900 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST 2 NUCLEICACID SEQUENCES4$$%$305583901 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEICACID SEQUENCE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARYPROCEDURE)4$$%$305683902 MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION4$$%$305783903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG,SINGLE STRAND CONFORMATIONAL POLYMORPHISMS [SSCP], HETERODUPLEX,DENATURING GRADIENT GEL ELECTROPHORESIS [DGGE], RNA'ASE A), SINGLESEGMENT, EACH8$$%$305883907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION(EG, STOOL SPECIMENS, PARAFFIN EMBEDDED TISSUE), EACH SPECIMEN4$$%$305983908 MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE8$$%$306083909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTIONTECHNIQUE (EG, CAPILLARY ELECTROPHORESIS), EACH NUCLEIC ACIDPREPARATION4$$%$306183912 GENETIC EXAMINATION MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT20$$%$306283921 ORGANIC ACID, SINGLE, QUANTITATIVE4$$%$306384100 ASSAY OF PHOSPHORUS PHOSPHORUS INORGANIC (PHOSPHATE);12$$%$306484153 ASSAY OF PSA TOTAL PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL12$$%$306584155 ASSAY OF PROTEIN SERUM PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD4$$%$306684157 ASSAY OF PROTEIN OTHER PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,CEREBROSPINAL FLUID) 4$$%$306784165 PROTEIN E-PHORESIS SERUM PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM 20$$%$306884403 ASSAY OF TOTAL TESTOSTERON8$$%$306984436 ASSAY OF TOTAL THYROXINE4$$%$307084439 ASSAY OF FREE THYROXINE4$$%$307184443 ASSAY THYROID STIM HORMONE8$$%$307284479 ASSAY OF THYROID (T3 OR T4) 8$$%$307384480 ASSAY TRIIODOTHYRONINE (T3) 4$$%$307484550 ASSAY OF BLOOD/URIC ACID144$$%$307585007 BL SMEAR W/DIFF WBC COUNT 8$$%$307685025 COMPLETE CBC W/AUTO DIFF WBC484$$%$307785027 COMPLETE CBC AUTOMATED BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT)184$$%$307885045 AUTOMATED RETICULOCYTE COUNT BLOOD COUNT; RETICULOCYTE, AUTOMATED24$$%$307985060 BLOOD SMEAR INTERPRETATION BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT36$$%$308085097 BONE MARROW INTERPRETATION BONE MARROW, SMEAR INTERPRETATION32$$%$308185610 PROTHROMBIN TIME 44$$%$308285652 RBC SED RATE AUTOMATED SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED64$$%$308385730 THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD12$$%$308486038 ANTINUCLEAR ANTIBODIES4$$%$308586300 IMMUNOASSAY TUMOR CA 15-3 16$$%$308686301 IMMUNOASSAY TUMOR CA 19-928$$%$308786304 IMMUNOASSAY TUMOR CA 12548$$%$308886334 IMMUNOFIX E-PHORESIS SERUM4$$%$308986850 RBC ANTIBODY SCREEN24$$%$309086880 COOMBS TEST DIRECT4$$%$309186900 BLOOD TYPING ABO24$$%$309286901 BLOOD TYPING RH (D) 24$$%$309386920 COMPATIBILITY TEST SPIN COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE24$$%$309487070 CULTURE BACTERIA OTHER CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITHISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES4$$%$309587077 CULTURE AEROBIC IDENTIFY CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FORDEFINITIVE IDENTIFICATION, EACH ISOLATE4$$%$309687186 MICROBE SUSCEPTIBLE MIC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGARDILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACHMULTI-ANTIMICROBIAL, PER PLATE4$$%$309787205 SMEAR GRAM STAIN SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FORBACTERIA, FUNGI, OR CELL TYPES4$$%$309888108 CYTOPATH CONCENTRATE TECH CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,SACCOMANNO TECHNIQUE)12$$%$309988184 FLOWCYTOMETRY/ TC 1 MARKER FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER32$$%$310088185 FLOWCYTOMETRY/TC ADD-ON FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 32$$%$310188189 FLOWCYTOMETRY/READ 16 & > 24$$%$310288237 TISSUE CULTURE BONE MARROW16$$%$310388264 CHROMOSOME ANALYSIS 20-25 16$$%$310488271 CYTOGENETICS DNA PROBE 4$$%$310588275 CYTOGENETICS 100-3004$$%$310688280 CHROMOSOME KARYOTYPE STUDY8$$%$310788291 CYTO/MOLECULAR REPORT8$$%$310888305 TISSUE EXAM BY PATHOLOGIST40$$%$310988311 DECALCIFY TISSUE40$$%$311088312 SPECIAL STAINS GROUP 14$$%$311188313 SPECIAL STAINS GROUP 236$$%$311288342 IMMUNOHISTOCHEMISTRY44$$%$311388367 INSITU HYBRIDIZATION AUTO12$$%$311488368 INSITU HYBRIDIZATION MANUAL4$$%$311588381 MICRODISSECTION MANUAL4$$%$311689051 BODY FLUID CELL COUNT CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT4$$%$311793000 ELECTROCARDIOGRAM COMPLETE4$$%$311893010 ELECTROCARDIOGRAM REPORT4$$%$311996360 HYDRATION IV INFUSION INIT 68$$%$312096361 HYDRATE IV INFUSION ADD-ON180$$%$312196365 THER/PROPH/DIAG IV INF INIT116$$%$312296366 THER/PROPH/DIAG IV INF ADDON 108$$%$312396367 TX/PROPH/DG ADDL SEQ IV INF 512$$%$312496368 THER/DIAG CONCURRENT INF24$$%$312596372 THER/PROPH/DIAG INJ SC/IM 92$$%$312696374 THER/PROPH/DIAG INJ IV PUSH140$$%$312796375 TX/PRO/DX INJ NEW DRUG ADDON 588$$%$312896401 CHEMO ANTI-NEOPL SQ/IM32$$%$312996402 CHEMO HORMON ANTINEOPL SQ/IM4$$%$313096409 CHEMO IV PUSH SNGL DRUG96$$%$313196411 CHEMO IV PUSH ADDL DRUG108$$%$313296413 CHEMO IV INFUSION 1 HR536$$%$313396415 CHEMO IV INFUSION ADDL HR104$$%$313496417 CHEMO IV INFUS EACH ADDL SEQ160$$%$313596423 CHEMO IA INFUSE EACH ADDL HR 8$$%$313696521 REFILL/MAINT PORTABLE PUMP 8$$%$313796523 IRRIG DRUG DELIVERY DEVICE8$$%$313896912 PHOTOCHEMOTHERAPY WITH UV-A4$$%$313997810 ACUPUNCT W/O STIMUL 15 MIN28$$%$314097811 ACUPUNCT W/O STIMUL ADDL 15M16$$%$314199070 SPECIAL SUPPLIES; SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIANOVER AND ABOVE THOSE USUALLY INCLUDED WITH THE OFFICE VISIT OR OTHERSERVICES RENDERED (LIST DRUGS, TRAYS, SUPPLIES, OR MATERIALS PROVIDED)24$$%$314299195 PHLEBOTOMY 44$$%$314371010TC RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL TECHNICAL COMPONENT8$$%$314471020 TC RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL;TECHNICAL COMPONENT20$$%$314574246 TC RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST,WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUTGLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB TECHNICAL COMPONENT4$$%$314676370 TC8$$%$314777003 TC FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE ORPARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL,SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION TECHNICAL COMPONENT4$$%$314885025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT12$$%$314988305 59TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONABORTION - SPONTANEOUS/MISSEDARTERY, BIOPSYBONE MARROW, BIOPSYBONE EXOSTOSISBRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTIONBREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGICAL MARGINSBREAST, REDUCTION MAMMOPLASTYBRONCHUS, BIOPSYCELL BLOCK, ANY SOURCECERVIX, BIOPSYCOLON, BIOPSYDUODENUM, BIOPSYENDOCERVIX, CURETTINGS/BIOPSYENDOMETRIUM, CURETTINGS/BIOPSYESOPHAGUS, BIOPSYEXTREMITY, AMPUTATION, TRAUMATICFALLOPIAN TUBE, BIOPSYFALLOPIAN TUBE, ECTOPIC PREGNANCYFEMORAL HEAD, FRACTURE FINGERS/TOES, AMPUTATION, NON-TRAUMATICGINGIVA/ORAL MUCOSA, BIOPSYHEART VALVEJOINT, RESECTIONKIDNEY, BIOPSYLARYNX, BIOPSYLEIOMYOMA(S), UTERINE MYOMECTOMY - WITHOUT UTERUSLIP, BIOPSY/WEDGE RESECTIONLUNG, TRANSBRONCHIAL BIOPSYLYMPH NODE, BIOPSYMUSCLE, BIOPSYNASAL MUCOSA, BIOPSYNASOPHARYNX/OROPHARYNX, BIOPSYNERVE, BIOPSYODONTOGENIC/DENTAL CYSTOMENTUM, BIOPSYOVARY WITH OR WITHOUT TUBE, NON-NEOPLASTICOVARY, BIOPSY/WEDGE RESECTIONPARATHYROID GLANDPERITONEUM, BIOPSYPITUITARY TUMORPLACENTA, OTHER THAN THIRD TRIMESTERPLEURA/PERICARDIUM - BIOPSY/TISSUE POLYP, CERVICAL/ENDOMETRIALPOLYP, COLORECTALPOLYP, STOMACH/SMALL INTESTINEPROSTATE, NEEDLE BIOPSYPROSTATE, TURSALIVARY GLAND, BIOPSYSINUS, PARANASAL BIOPSYSKIN, OTHER THAN CYST/TAG/DEBRIDEMENT/PLASTIC REPAIRSMALL INTESTINE, BIOPSYSOFT TISSUE, OTHER THAN TUMOR/MASS/LIPOMA/DEBRIDEMENTSPLEENSTOMACH, BIOPSYSYNOVIUMTESTIS, OTHER THAN TUMOR/BIOPSY/CASTRATIONTHYROGLOSSAL DUCT/BRACHIAL CLEFT CYSTTONGUE, BIOPSYTONSIL, BIOPSYTRACHEA, BIOPSYURETER, BIOPSYURETHRA, BIOPSYURINARY BLADDER, BIOPSYUTERUS, WITH OR WITHOUT TUBES AND OVARIES, FOR PROLAPSEVAGINA, BIOPSYVULVA/LABIA, BIOPSY DISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$315088311 TC DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FORSURGICAL PATHOLOGY EXAMINATION)TECHNICAL COMPONENT4$$%$315188313 59TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACHDISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$315288313 TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACH TECHNICAL COMPONENT4$$%$3153A4300 CATH IMPL VASC ACCESS PORTAL 4$$%$3154A4314 CATH W/DRAINAGE 2-WAY LATEX4$$%$3155A4550 SURGICAL TRAYS16$$%$3156C1751 CATH, INF, PER/CENT/MIDLINE 8$$%$3157C1788 PORT, INDWELLING, IMP4$$%$3158J0461 ATROPINE SULFATE INJECTION 12$$%$3159J0640 LEUCOVORIN CALCIUM INJECTION76$$%$3160J0690 CEFAZOLIN SODIUM INJECTION4$$%$3161J0696 CEFTRIAXONE SODIUM INJECTION8$$%$3162J0780 PROCHLORPERAZINE INJECTION16$$%$3163J0881 DARBEPOETIN ALFA, NON-ESRD12$$%$3164J1040 METHYLPREDNISOLONE 80 MG INJ4$$%$3165J1080 TESTOSTERONE CYPIONAT 200 MG 4$$%$3166J1100 DEXAMETHASONE SODIUM PHOS620$$%$3167J1170 HYDROMORPHONE INJECTION12$$%$3168J1200 DIPHENHYDRAMINE HCL INJECTIO52$$%$3169J1260 DOLASETRON MESYLATE24$$%$3170J1440 FILGRASTIM 300 MCG INJECITON20$$%$3171J1453 FOSAPREPITANT INJECTION 188$$%$3172J1626 GRANISETRON HCL INJECTION48$$%$3173J1642 INJ HEPARIN SODIUM PER 10 U 248$$%$3174J1644 INJ HEPARIN SODIUM PER 1000U 8$$%$3175J1720 HYDROCORTISONE SODIUM SUCC I 20$$%$3176J1756 IRON SUCROSE INJECTION 48$$%$3177J1940 FUROSEMIDE INJECTION 40$$%$3178J2001 LIDOCAINE INJECTION 8$$%$3179J2060 LORAZEPAM INJECTION116$$%$3180J2150 MANNITOL INJECTION32$$%$3181J2250 INJ MIDAZOLAM HYDROCHLORIDE 12$$%$3182J2353 OCTREOTIDE INJECTION, DEPOT32$$%$3183J2405 ONDANSETRON HCL INJECTION 56$$%$3184J2469 PALONOSETRON HCL456$$%$3185J2505 INJECTION, PEGFILGRASTIM 6MG64$$%$3186J2550 PROMETHAZINE HCL INJECTION4$$%$3187J2765 METOCLOPRAMIDE HCL INJECTION 8$$%$3188J2780 METOCLOPRAMIDE HCL INJECTION 144$$%$3189J2916 NA FERRIC GLUCONATE COMPLEX 40$$%$3190J2930 METHYLPREDNISOLONE INJECTION 4$$%$3191J2997 ALTEPLASE RECOMBINANT 16$$%$3192J3010 FENTANYL CITRATE INJECITON 4$$%$3193J3370 VANCOMYCIN HCL INJECITON 4$$%$3194J3420 VITAMIN B12 INJECTION 16$$%$3195J3475 INJ MAGNESIUM SULFATE 92$$%$3196J3480 INJ POTASSIUM CHLORIDE100$$%$3197J3487 ZOLEDRONIC ACID 68$$%$3198J3488 RECLAST INJECTION 4$$%$3199J3490 DRUGS UNCLASSIFIED INJECTION24$$%$3200J7030 NORMAL SALINE SOLUTION INFUS224$$%$3201J7040 NORMAL SALINE SOLUTION INFUS76$$%$3202J7042 5% DEXTROSE/NORMAL SALINE20$$%$3203J7050NORMAL SALINE SOLUTION INFUS120$$%$3204J7060 5% DEXTROSE/WATER 4$$%$3205J7070 D5W INFUSION8$$%$3206J7120 RINGERS LACTATE INFUSION8$$%$3207J7130 HYPERTONIC SALINE SOLUTION4$$%$3208J9000 DOXORUBICIN HCL INJECTION80$$%$3209J9035 BEVACIZUMAB INJECTION60$$%$3210J9040 BLEOMYCIN SULFATE INJECTION20$$%$3211J9041 BORTEZOMIB INJECTION36$$%$3212J9045 CARBOPLATIN INJECTION104$$%$3213J9060 CISPLATIN 10 MG INJECTION 120$$%$3214J9070 CYCLOPHOSPHAMIDE 100 MG INJ44$$%$3215J9130 DACARBAZINE 100 MG INJ12$$%$3216J9171 DOCETAXEL INJECTION48$$%$3217J9181 ETOPOSIDE INJECTION104$$%$3218J9185 FLUDARABINE PHOSPHATE INJ 36$$%$3219J9190 FLUOROURACIL INJECTION 96$$%$3220J9201 GEMCITABINE HCL INJECTION32$$%$3221J9206 IRINOTECAN INJECTION 12$$%$3222J9217 LEUPROLIDE ACETATE SUSPNSION4$$%$3223J9263 OXALIPLATIN 44$$%$3224J9265 PACLITAXEL INJECTION 48$$%$3225J9305 PEMETREXED INJECTION 36$$%$3226J9310 RITUXIMAB INJECTION32$$%$3227J9355 TRASTUZUMAB INJECTION20$$%$$3228J9360 VINBLASTINE SULFATE INJ12$$%$3229J9370 VINCRISTINE SULFATE 1 MG INJ 24$$%$3230P9016 RBC LEUKOCYTES REDUCED 28$$%$3231P9035 PLATELET PHERES LEUKOREDUCED4$$%$3232P9047 ALBUMIN (HUMAN), 25%, 50ML 4$$%$3233S0020 INJECTION, BUPIVICAINE HYDRO4$$%$3234S0028 INJECTION, FAMOTIDINE, 20 MG24$$%$ESTIMATED TOTAL FOR ALL CELLS:$4th OPTION YEAR CLIN SCHEDULE: 01 JANUARY 2012 THROUGH 31 DECEMBER 2012CLINPrice Schedule SourceDIAGNOSIS RELATED GROUP CODES*EST QTYProfessional Medicare Price/CodeTechnical Medicare Price/CodePercent of MedicareTotal Extended Cost (all cells)4001400 ANESTH SKIN EXT/PER/ATRUNK4$$%$400210060 DRAINAGE OF SKIN ABSCESS4$$%$400332421 THORACENTESIS FOR ASPIRATION4$$%$400436000 PLACE NEEDLE IN VEIN4$$%$400536415 ROUTINE VENIPUNCTURE388$$%$400636416 CAPILLARY BLOOD DRAW20$$%$400736430 BLOOD TRANSFUSION SERVICE24$$%$400836561 INSERT TUNNELED CV CATH12$$%$400936571 INSERT PICVAD CATH8$$%$401036590 REMOVAL TUNNELED CV CATH4$$%$401136591 DRAW BLOOD OFF VENOUS DEVICE4$$%$401236593 DECLOT VASCULAR DEVICE16$$%$401336598 INJ W/FLUOR EVAL CV DEVICE4$$%$401438220 BONE MARROW ASPIRATION8$$%$401538221 BONE MARROW BIOPSY24$$%$401649080 PUNCTURE PERITONEAL CAVITY8$$%$401751702 INSERT TEMP BLADDER CATH4$$%$401862310 INJECT SPINE C/T4$$%$401971010 CHEST X-RAY4$$%$402071020 CHEST X-RAY RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL28$$%$402171260 CT THORAX W/DYE RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL4$$%$402271270 CT THORAX W/O&W DYE COMPUTED TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S)4$$%$402372074 X-RAY EXAM OF THORACIC SPINE4$$%$402474150 CT ABDOMEN W/O DYE RADIOLOGIC EXAMINATION, SPINE; THORACIC, MINIMUM OF 4 VIEWS4$$%$402574240 X-RAY EXAM UPPER GI TRACT COMPUTED TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL4$$%$402676000 FLUOROSCOPE EXAMINATION RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUTDELAYED FILMS, WITHOUT KUB8$$%$402776942 ECHO GUIDE FOR BIOPSY FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHERTHAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY)12$$%$402880048 METABOLIC PANEL TOTAL CA SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODYRADIATION, PER ORAL, ENDOCAVITARY OR INTRAOPERATIVE CONE IRRADIATION)12$$%$402980050 GENERAL HEALTH PANEL4$$%$403080053 COMPREHEN METABOLIC PANEL GENERAL HEALTH PANELTHIS PANEL MUST INCLUDE THE FOLLOWING:COMPREHENSIVE METABOLIC PANEL (80053)HEMOGRAM, AUTOMATED, AND MANUAL DIFFERENTIAL WBC COUNT (CBC) (85022) ORHEMOGRAM AND PLATELET COUNT, AUTOMATED, AND AUTOMATED COMPLETEDIFFERENTIAL WBC COUNT (CBC) (85025)THYROID STIMULATING HORMONE (TSH) (84443)580$$%$403180185 ASSAY OF PHENYTOIN TOTAL THIS PANEL MUST INCLUDE THE FOLLOWING:ALBUMIN (82040)BILIRUBIN, TOTAL (82247)CALCIUM, TOTAL (82310)CARBON DIOXIDE (BICARBONATE) (82374)CHLORIDE (82435)CREATININE (82565)GLUCOSE (82947)PHOSPHATASE, ALKALINE (84075)POTASSIUM (84132)PROTEIN, TOTAL (84155)SODIUM (84295)TRANSFERASE, ALANINE AMINO (ALT) (SGPT) (84460)TRANSFERASE, ASPARTATE AMINO (AST) (SGOT) (84450)UREA NITROGEN (BUN) (84520)52$$%$403280299 QUANTITATIVE ASSAY DRUG PHENYTOIN; TOTAL44$$%$403380502 LAB PATHOLOGY CONSULTATION QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED12$$%$403481001 URINALYSIS AUTO W/SCOPE CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTICPROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS12$$%$403581003 URINALYSIS AUTO W/O SCOPE URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITH MICROSCOPY8$$%$403682105 ALPHA-FETOPROTEIN SERUM URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN, GLUCOSE,HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFICGRAVITY, UROBILINOGEN, ANY NUMBER OF THESE CONSTITUENTS; AUTOMATED,WITHOUT MICROSCOPY 4$$%$403782232 ASSAY OF BETA-2 PROTEIN ALPHA-FETOPROTEIN; SERUM8$$%$403882248 BILIRUBIN DIRECT BETA-2 MICROGLOBULIN152$$%$403982378 CARCINOEMBRYONIC ANTIGEN BILIRUBIN; DIRECT60$$%$404082607 VITAMIN B-1212$$%$404182728 ASSAY OF FERRITIN CYANOCOBALAMIN (VITAMIN B-12)12$$%$404282746 BLOOD FOLIC ACID SERUM; FERRITIN16$$%$404382784 ASSAY IGA/IGD/IGG/IGM EACH FOLIC ACID; SERUM16$$%$404482977 ASSAY OF GGT; GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH160$$%$404583540 ASSAY OF IRON; GLUTAMYLTRANSFERASE, GAMMA (GGT)12$$%$404683550 IRON BINDING TEST;IRON12$$%$404783615 LACTATE (LD) (LDH) ENZYME;IRON BINDING CAPACITY180$$%$404883625 ASSAY OF LDH ENZYMES LACTATE DEHYDROGENASE (LD), (LDH); ISOENZYMES, SEPARATION ANDQUANTITATION4$$%$404983735 ASSAY OF MAGNESIUM 48$$%$405083891 MOLECULE ISOLATE NUCLEIC MOLECULAR DIAGNOSTICS; ISOLATION OR EXTRACTION OF HIGHLY PURIFIEDNUCLEIC ACID, EACH NUCLEIC ACID TYPE (IE, DNA OR RNA)12$$%$405183892 MOLECULAR DIAGNOSTICS; ENZYMATIC DIGESTION, EACH ENZYME TREATMENT12$$%$405283896 MOLECULAR DIAGNOSTICS; NUCLEIC ACID PROBE, EACH16$$%$405383898 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, EACH NUCLEIC ACID SEQUENCE12$$%$405483900 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, FIRST 2 NUCLEICACID SEQUENCES4$$%$405583901 MOLECULAR DIAGNOSTICS; AMPLIFICATION, TARGET, MULTIPLEX, EACH ADDITIONAL NUCLEICACID SEQUENCE BEYOND 2 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARYPROCEDURE)4$$%$405683902 MOLECULAR DIAGNOSTICS; REVERSE TRANSCRIPTION4$$%$405783903 MOLECULAR DIAGNOSTICS; MUTATION SCANNING, BY PHYSICAL PROPERTIES (EG,SINGLE STRAND CONFORMATIONAL POLYMORPHISMS [SSCP], HETERODUPLEX,DENATURING GRADIENT GEL ELECTROPHORESIS [DGGE], RNA'ASE A), SINGLESEGMENT, EACH8$$%$405883907 MOLECULAR DIAGNOSTICS; LYSIS OF CELLS PRIOR TO NUCLEIC ACID EXTRACTION(EG, STOOL SPECIMENS, PARAFFIN EMBEDDED TISSUE), EACH SPECIMEN4$$%$405983908 MOLECULAR DIAGNOSTICS; AMPLIFICATION, SIGNAL, EACH NUCLEIC ACID SEQUENCE8$$%$406083909 MOLECULAR DIAGNOSTICS; SEPARATION AND IDENTIFICATION BY HIGH RESOLUTIONTECHNIQUE (EG, CAPILLARY ELECTROPHORESIS), EACH NUCLEIC ACIDPREPARATION4$$%$406183912 GENETIC EXAMINATION MOLECULAR DIAGNOSTICS; INTERPRETATION AND REPORT20$$%$406283921 ORGANIC ACID, SINGLE, QUANTITATIVE4$$%$406384100 ASSAY OF PHOSPHORUS PHOSPHORUS INORGANIC (PHOSPHATE);12$$%$406484153 ASSAY OF PSA TOTAL PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL12$$%$406584155 ASSAY OF PROTEIN SERUM PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; SERUM, PLASMA OR WHOLE BLOOD4$$%$406684157 ASSAY OF PROTEIN OTHER PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; OTHER SOURCE (EG, SYNOVIAL FLUID,CEREBROSPINAL FLUID) 4$$%$406784165 PROTEIN E-PHORESIS SERUM PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION, SERUM 20$$%$406884403 ASSAY OF TOTAL TESTOSTERON8$$%$406984436 ASSAY OF TOTAL THYROXINE4$$%$407084439 ASSAY OF FREE THYROXINE4$$%$407184443 ASSAY THYROID STIM HORMONE8$$%$407284479 ASSAY OF THYROID (T3 OR T4) 8$$%$407384480 ASSAY TRIIODOTHYRONINE (T3) 4$$%$407484550 ASSAY OF BLOOD/URIC ACID144$$%$407585007 BL SMEAR W/DIFF WBC COUNT 8$$%$407685025 COMPLETE CBC W/AUTO DIFF WBC484$$%$407785027 COMPLETE CBC AUTOMATED BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT)184$$%$407885045 AUTOMATED RETICULOCYTE COUNT BLOOD COUNT; RETICULOCYTE, AUTOMATED24$$%$407985060 BLOOD SMEAR INTERPRETATION BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT36$$%$408085097 BONE MARROW INTERPRETATION BONE MARROW, SMEAR INTERPRETATION32$$%$408185610 PROTHROMBIN TIME 44$$%$408285652 RBC SED RATE AUTOMATED SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED64$$%$408385730 THROMBOPLASTIN TIME PARTIAL THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD12$$%$408486038 ANTINUCLEAR ANTIBODIES4$$%$408586300 IMMUNOASSAY TUMOR CA 15-3 16$$%$408686301 IMMUNOASSAY TUMOR CA 19-928$$%$408786304 IMMUNOASSAY TUMOR CA 12548$$%$408886334 IMMUNOFIX E-PHORESIS SERUM4$$%$408986850 RBC ANTIBODY SCREEN24$$%$409086880 COOMBS TEST DIRECT4$$%$409186900 BLOOD TYPING ABO24$$%$409286901 BLOOD TYPING RH (D) 24$$%$409386920 COMPATIBILITY TEST SPIN COMPATIBILITY TEST EACH UNIT; IMMEDIATE SPIN TECHNIQUE24$$%$409487070 CULTURE BACTERIA OTHER CULTURE, BACTERIAL; ANY OTHER SOURCE EXCEPT URINE, BLOOD OR STOOL, AEROBIC, WITHISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES4$$%$409587077 CULTURE AEROBIC IDENTIFY CULTURE, BACTERIAL; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FORDEFINITIVE IDENTIFICATION, EACH ISOLATE4$$%$409687186 MICROBE SUSCEPTIBLE MIC SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; MICRODILUTION OR AGARDILUTION (MINIMUM INHIBITORY CONCENTRATION [MIC] OR BREAKPOINT), EACHMULTI-ANTIMICROBIAL, PER PLATE4$$%$409787205 SMEAR GRAM STAIN SMEAR, PRIMARY SOURCE WITH INTERPRETATION; GRAM OR GIEMSA STAIN FORBACTERIA, FUNGI, OR CELL TYPES4$$%$409888108 CYTOPATH CONCENTRATE TECH CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG,SACCOMANNO TECHNIQUE)12$$%$409988184 FLOWCYTOMETRY/ TC 1 MARKER FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; FIRST MARKER32$$%$410088185 FLOWCYTOMETRY/TC ADD-ON FLOW CYTOMETRY, CELL SURFACE, CYTOPLASMIC, OR NUCLEAR MARKER, TECHNICAL COMPONENT ONLY; EACH ADDITIONAL MARKER (LIST SEPARATELY IN ADDITION TO CODE FOR FIRST MARKER) 32$$%$410188189 FLOWCYTOMETRY/READ 16 & > 24$$%$410288237 TISSUE CULTURE BONE MARROW16$$%$410388264 CHROMOSOME ANALYSIS 20-25 16$$%$410488271 CYTOGENETICS DNA PROBE 4$$%$410588275 CYTOGENETICS 100-3004$$%$410688280 CHROMOSOME KARYOTYPE STUDY8$$%$410788291 CYTO/MOLECULAR REPORT8$$%$410888305 TISSUE EXAM BY PATHOLOGIST40$$%$410988311 DECALCIFY TISSUE40$$%$411088312 SPECIAL STAINS GROUP 14$$%$411188313 SPECIAL STAINS GROUP 236$$%$411288342 IMMUNOHISTOCHEMISTRY44$$%$411388367 INSITU HYBRIDIZATION AUTO12$$%$411488368 INSITU HYBRIDIZATION MANUAL4$$%$411588381 MICRODISSECTION MANUAL4$$%$411689051 BODY FLUID CELL COUNT CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CEREBROSPINAL FLUID, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT4$$%$411793000 ELECTROCARDIOGRAM COMPLETE4$$%$411893010 ELECTROCARDIOGRAM REPORT4$$%$411996360 HYDRATION IV INFUSION INIT 68$$%$412096361 HYDRATE IV INFUSION ADD-ON180$$%$412196365 THER/PROPH/DIAG IV INF INIT116$$%$412296366 THER/PROPH/DIAG IV INF ADDON 108$$%$412396367 TX/PROPH/DG ADDL SEQ IV INF 512$$%$412496368 THER/DIAG CONCURRENT INF24$$%$412596372 THER/PROPH/DIAG INJ SC/IM 92$$%$412696374 THER/PROPH/DIAG INJ IV PUSH140$$%$412796375 TX/PRO/DX INJ NEW DRUG ADDON 588$$%$412896401 CHEMO ANTI-NEOPL SQ/IM32$$%$412996402 CHEMO HORMON ANTINEOPL SQ/IM4$$%$413096409 CHEMO IV PUSH SNGL DRUG96$$%$413196411 CHEMO IV PUSH ADDL DRUG108$$%$413296413 CHEMO IV INFUSION 1 HR536$$%$413396415 CHEMO IV INFUSION ADDL HR104$$%$413496417 CHEMO IV INFUS EACH ADDL SEQ160$$%$413596423 CHEMO IA INFUSE EACH ADDL HR 8$$%$413696521 REFILL/MAINT PORTABLE PUMP 8$$%$413796523 IRRIG DRUG DELIVERY DEVICE8$$%$413896912 PHOTOCHEMOTHERAPY WITH UV-A4$$%$413997810 ACUPUNCT W/O STIMUL 15 MIN28$$%$414097811 ACUPUNCT W/O STIMUL ADDL 15M16$$%$414199070 SPECIAL SUPPLIES; SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIANOVER AND ABOVE THOSE USUALLY INCLUDED WITH THE OFFICE VISIT OR OTHERSERVICES RENDERED (LIST DRUGS, TRAYS, SUPPLIES, OR MATERIALS PROVIDED)24$$%$414299195 PHLEBOTOMY 44$$%$414371010TC RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL TECHNICAL COMPONENT8$$%$414471020 TC RADIOLOGIC EXAMINATION, CHEST, 2 VIEWS, FRONTAL AND LATERAL;TECHNICAL COMPONENT20$$%$414574246 TC RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST,WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUTGLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB TECHNICAL COMPONENT4$$%$414676370 TC8$$%$414777003 TC FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE ORPARASPINOUS DIAGNOSTIC OR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL,SUBARACHNOID, OR SACROILIAC JOINT), INCLUDING NEUROLYTIC AGENT DESTRUCTION TECHNICAL COMPONENT4$$%$414885025 BLOOD COUNT; COMPLETE (CBC), AUTOMATED (HGB, HCT, RBC, WBC AND PLATELETCOUNT) AND AUTOMATED DIFFERENTIAL WBC COUNT12$$%$414988305 59TC LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATIONABORTION - SPONTANEOUS/MISSEDARTERY, BIOPSYBONE MARROW, BIOPSYBONE EXOSTOSISBRAIN/MENINGES, OTHER THAN FOR TUMOR RESECTIONBREAST, BIOPSY, NOT REQUIRING MICROSCOPIC EVALUATION OF SURGICAL MARGINSBREAST, REDUCTION MAMMOPLASTYBRONCHUS, BIOPSYCELL BLOCK, ANY SOURCECERVIX, BIOPSYCOLON, BIOPSYDUODENUM, BIOPSYENDOCERVIX, CURETTINGS/BIOPSYENDOMETRIUM, CURETTINGS/BIOPSYESOPHAGUS, BIOPSYEXTREMITY, AMPUTATION, TRAUMATICFALLOPIAN TUBE, BIOPSYFALLOPIAN TUBE, ECTOPIC PREGNANCYFEMORAL HEAD, FRACTURE FINGERS/TOES, AMPUTATION, NON-TRAUMATICGINGIVA/ORAL MUCOSA, BIOPSYHEART VALVEJOINT, RESECTIONKIDNEY, BIOPSYLARYNX, BIOPSYLEIOMYOMA(S), UTERINE MYOMECTOMY - WITHOUT UTERUSLIP, BIOPSY/WEDGE RESECTIONLUNG, TRANSBRONCHIAL BIOPSYLYMPH NODE, BIOPSYMUSCLE, BIOPSYNASAL MUCOSA, BIOPSYNASOPHARYNX/OROPHARYNX, BIOPSYNERVE, BIOPSYODONTOGENIC/DENTAL CYSTOMENTUM, BIOPSYOVARY WITH OR WITHOUT TUBE, NON-NEOPLASTICOVARY, BIOPSY/WEDGE RESECTIONPARATHYROID GLANDPERITONEUM, BIOPSYPITUITARY TUMORPLACENTA, OTHER THAN THIRD TRIMESTERPLEURA/PERICARDIUM - BIOPSY/TISSUE POLYP, CERVICAL/ENDOMETRIALPOLYP, COLORECTALPOLYP, STOMACH/SMALL INTESTINEPROSTATE, NEEDLE BIOPSYPROSTATE, TURSALIVARY GLAND, BIOPSYSINUS, PARANASAL BIOPSYSKIN, OTHER THAN CYST/TAG/DEBRIDEMENT/PLASTIC REPAIRSMALL INTESTINE, BIOPSYSOFT TISSUE, OTHER THAN TUMOR/MASS/LIPOMA/DEBRIDEMENTSPLEENSTOMACH, BIOPSYSYNOVIUMTESTIS, OTHER THAN TUMOR/BIOPSY/CASTRATIONTHYROGLOSSAL DUCT/BRACHIAL CLEFT CYSTTONGUE, BIOPSYTONSIL, BIOPSYTRACHEA, BIOPSYURETER, BIOPSYURETHRA, BIOPSYURINARY BLADDER, BIOPSYUTERUS, WITH OR WITHOUT TUBES AND OVARIES, FOR PROLAPSEVAGINA, BIOPSYVULVA/LABIA, BIOPSY DISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$415088311 TC DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FORSURGICAL PATHOLOGY EXAMINATION)TECHNICAL COMPONENT4$$%$415188313 59TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACHDISTINCT PROCEDURAL SERVICE TECHNICAL COMPONENT4$$%$415288313 TC SPECIAL STAINS; GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPTIMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, INCLUDING INTERPRETATION ANDREPORT, EACH TECHNICAL COMPONENT4$$%$4153A4300 CATH IMPL VASC ACCESS PORTAL 4$$%$4154A4314 CATH W/DRAINAGE 2-WAY LATEX4$$%$4155A4550 SURGICAL TRAYS16$$%$4156C1751 CATH, INF, PER/CENT/MIDLINE 8$$%$4157C1788 PORT, INDWELLING, IMP4$$%$4158J0461 ATROPINE SULFATE INJECTION 12$$%$4159J0640 LEUCOVORIN CALCIUM INJECTION76$$%$4160J0690 CEFAZOLIN SODIUM INJECTION4$$%$4161J0696 CEFTRIAXONE SODIUM INJECTION8$$%$4162J0780 PROCHLORPERAZINE INJECTION16$$%$4163J0881 DARBEPOETIN ALFA, NON-ESRD12$$%$4164J1040 METHYLPREDNISOLONE 80 MG INJ4$$%$4165J1080 TESTOSTERONE CYPIONAT 200 MG 4$$%$4166J1100 DEXAMETHASONE SODIUM PHOS620$$%$4167J1170 HYDROMORPHONE INJECTION12$$%$4168J1200 DIPHENHYDRAMINE HCL INJECTIO52$$%$4169J1260 DOLASETRON MESYLATE24$$%$4170J1440 FILGRASTIM 300 MCG INJECITON20$$%$4171J1453 FOSAPREPITANT INJECTION 188$$%$4172J1626 GRANISETRON HCL INJECTION48$$%$4173J1642 INJ HEPARIN SODIUM PER 10 U 248$$%$4174J1644 INJ HEPARIN SODIUM PER 1000U 8$$%$4175J1720 HYDROCORTISONE SODIUM SUCC I 20$$%$4176J1756 IRON SUCROSE INJECTION 48$$%$4177J1940 FUROSEMIDE INJECTION 40$$%$4178J2001 LIDOCAINE INJECTION 8$$%$4179J2060 LORAZEPAM INJECTION116$$%$4180J2150 MANNITOL INJECTION32$$%$4181J2250 INJ MIDAZOLAM HYDROCHLORIDE 12$$%$4182J2353 OCTREOTIDE INJECTION, DEPOT32$$%$4183J2405 ONDANSETRON HCL INJECTION 56$$%$4184J2469 PALONOSETRON HCL456$$%$4185J2505 INJECTION, PEGFILGRASTIM 6MG64$$%$4186J2550 PROMETHAZINE HCL INJECTION4$$%$4187J2765 METOCLOPRAMIDE HCL INJECTION 8$$%$4188J2780 METOCLOPRAMIDE HCL INJECTION 144$$%$4189J2916 NA FERRIC GLUCONATE COMPLEX 40$$%$4190J2930 METHYLPREDNISOLONE INJECTION 4$$%$4191J2997 ALTEPLASE RECOMBINANT 16$$%$4192J3010 FENTANYL CITRATE INJECITON 4$$%$4193J3370 VANCOMYCIN HCL INJECITON 4$$%$4194J3420 VITAMIN B12 INJECTION 16$$%$4195J3475 INJ MAGNESIUM SULFATE 92$$%$4196J3480 INJ POTASSIUM CHLORIDE100$$%$4197J3487 ZOLEDRONIC ACID 68$$%$4198J3488 RECLAST INJECTION 4$$%$4199J3490 DRUGS UNCLASSIFIED INJECTION24$$%$4200J7030 NORMAL SALINE SOLUTION INFUS224$$%$4201J7040 NORMAL SALINE SOLUTION INFUS76$$%$4202J7042 5% DEXTROSE/NORMAL SALINE20$$%$4203J7050NORMAL SALINE SOLUTION INFUS120$$%$4204J7060 5% DEXTROSE/WATER 4$$%$4205J7070 D5W INFUSION8$$%$4206J7120 RINGERS LACTATE INFUSION8$$%$4207J7130 HYPERTONIC SALINE SOLUTION4$$%$4208J9000 DOXORUBICIN HCL INJECTION80$$%$4209J9035 BEVACIZUMAB INJECTION60$$%$4210J9040 BLEOMYCIN SULFATE INJECTION20$$%$4211J9041 BORTEZOMIB INJECTION36$$%$4212J9045 CARBOPLATIN INJECTION104$$%$4213J9060 CISPLATIN 10 MG INJECTION 120$$%$4214J9070 CYCLOPHOSPHAMIDE 100 MG INJ44$$%$4215J9130 DACARBAZINE 100 MG INJ12$$%$4216J9171 DOCETAXEL INJECTION48$$%$4217J9181 ETOPOSIDE INJECTION104$$%$4218J9185 FLUDARABINE PHOSPHATE INJ 36$$%$4219J9190 FLUOROURACIL INJECTION 96$$%$4220J9201 GEMCITABINE HCL INJECTION32$$%$4221J9206 IRINOTECAN INJECTION 12$$%$4222J9217 LEUPROLIDE ACETATE SUSPNSION4$$%$4223J9263 OXALIPLATIN 44$$%$4224J9265 PACLITAXEL INJECTION 48$$%$4225J9305 PEMETREXED INJECTION 36$$%$4226J9310 RITUXIMAB INJECTION32$$%$4227J9355 TRASTUZUMAB INJECTION20$$%$$4228J9360 VINBLASTINE SULFATE INJ12$$%$4229J9370 VINCRISTINE SULFATE 1 MG INJ 24$$%$4230P9016 RBC LEUKOCYTES REDUCED 28$$%$4231P9035 PLATELET PHERES LEUKOREDUCED4$$%$4232P9047 ALBUMIN (HUMAN), 25%, 50ML 4$$%$4233S0020 INJECTION, BUPIVICAINE HYDRO4$$%$4234S0028 INJECTION, FAMOTIDINE, 20 MG24$$%$ESTIMATED TOTAL FOR ALL CELLS:$ESTIMATED GRAND TOTAL FOR A BASE + FOUR (4) OPTION YEARS OF SERVICES: $___________________ B.5 PERIOD OF PERFORMANCE SCHEDULE ITEM NUMBERS QUANTITY PERIOD OF PERFORMANCE 0001- 0134 (as specified) 01/01/2012-12/31/2012 CUSTOMER: Department of Veterans Affairs Alaska VA Healthcare System and Regional Office 1201 North Muldoon Road Anchorage, AK 99504 USA 1001 – 0134 (as specified) 01/01/2013-12/31/2013 CUSTOMER: Department of Veterans Affairs Alaska VA Healthcare System and Regional Office 1201 North Muldoon Road Anchorage, AK 99504 USA 2001 - 2134 (as specified) 01/01/2014-12/31/2014 CUSTOMER: Department of Veterans Affairs Alaska VA Healthcare System and Regional Office 1201 North Muldoon Road Anchorage, AK 99504 USA 3001 - 3134 (as specified) 01/01/2015-12/31/2015 CUSTOMER: Department of Veterans Affairs Alaska VA Healthcare System and Regional Office 1201 North Muldoon Road Anchorage, AK 99504 USA 4001 - 4134 (as specified) 01/01/2016-12/31/2016 CUSTOMER: Department of Veterans Affairs Alaska VA Healthcare System and Regional Office 1201 North Muldoon Road Anchorage, AK 99504 USA SECTION C - CONTRACT CLAUSES C.1 52.212-4 CONTRACT TERMS AND CONDITIONS--COMMERCIAL ITEMS (JUN 2010) (a) Inspection/Acceptance. The Contractor shall only tender for acceptance those items that conform to the requirements of this contract. The Government reserves the right to inspect or test any supplies or services that have been tendered for acceptance. The Government may require repair or replacement of nonconforming supplies or reperformance of nonconforming services at no increase in contract price. If repair/replacement or reperformance will not correct the defects or is not possible, the Government may seek an equitable price reduction or adequate consideration for acceptance of nonconforming supplies or services. The Government must exercise its post-acceptance rights- (1) Within a reasonable time after the defect was discovered or should have been discovered; and (2) Before any substantial change occurs in the condition of the item, unless the change is due to the defect in the item. (b) Assignment. The Contractor or its assignee may assign its rights to receive payment due as a result of performance of this contract to a bank, trust company, or other financing institution, including any Federal lending agency in accordance with the Assignment of Claims Act (31 U.S.C. 3727). However, when a third party makes payment (e.g., use of the Governmentwide commercial purchase card), the Contractor may not assign its rights to receive payment under this contract. (c) Changes. Changes in the terms and conditions of this contract may be made only by written agreement of the parties. (d) Disputes. This contract is subject to the Contract Disputes Act of 1978, as amended (41 U.S.C. 601-613). Failure of the parties to this contract to reach agreement on any request for equitable adjustment, claim, appeal or action arising under or relating to this contract shall be a dispute to be resolved in accordance with the clause at FAR 52.233-1, Disputes, which is incorporated herein by reference. The Contractor shall proceed diligently with performance of this contract, pending final resolution of any dispute arising under the contract. (e) Definitions. The clause at FAR 52.202-1, Definitions, is incorporated herein by reference. (f) Excusable delays. The Contractor shall be liable for default unless nonperformance is caused by an occurrence beyond the reasonable control of the Contractor and without its fault or negligence such as, acts of God or the public enemy, acts of the Government in either its sovereign or contractual capacity, fires, floods, epidemics, quarantine restrictions, strikes, unusually severe weather, and delays of common carriers. The Contractor shall notify the Contracting Officer in writing as soon as it is reasonably possible after the commencement of any excusable delay, setting forth the full particulars in connection therewith, shall remedy such occurrence with all reasonable dispatch, and shall promptly give written notice to the Contracting Officer of the cessation of such occurrence. (g) Invoice. (1) The Contractor shall submit an original invoice and three copies(or electronic invoice, if authorized) to the address designated in the contract to receive invoices. An invoice must include- (i) Name and address of the Contractor; (ii) Invoice date and number; (iii) Contract number, contract line item number and, if applicable, the order number; (iv) Description, quantity, unit of measure, unit price and extended price of the items delivered; (v) Shipping number and date of shipment, including the bill of lading number and weight of shipment if shipped on Government bill of lading; (vi) Terms of any discount for prompt payment offered; (vii) Name and address of official to whom payment is to be sent; (viii) Name, title, and phone number of person to notify in event of defective invoice; and (ix) Taxpayer Identification Number (TIN). The Contractor shall include its TIN on the invoice only if required elsewhere in this contract. (x) Electronic funds transfer (EFT) banking information. (A) The Contractor shall include EFT banking information on the invoice only if required elsewhere in this contract. (B) If EFT banking information is not required to be on the invoice, in order for the invoice to be a proper invoice, the Contractor shall have submitted correct EFT banking information in accordance with the applicable solicitation provision, contract clause (e.g., 52.232-33, Payment by Electronic Funds Transfer-- Central Contractor Registration, or 52.232-34, Payment by Electronic Funds Transfer--Other Than Central Contractor Registration), or applicable agency procedures. (C) EFT banking information is not required if the Government waived the requirement to pay by EFT. (2) Invoices will be handled in accordance with the Prompt Payment Act (31 U.S.C. 3903) and Office of Management and Budget (OMB) prompt payment regulations at 5 CFR part 1315. (h) Patent indemnity. The Contractor shall indemnify the Government and its officers, employees and agents against liability, including costs, for actual or alleged direct or contributory infringement of, or inducement to infringe, any United States or foreign patent, trademark or copyright, arising out of the performance of this contract, provided the Contractor is reasonably notified of such claims and proceedings. (i) Payment.- (1) Items accepted. Payment shall be made for items accepted by the Government that have been delivered to the delivery destinations set forth in this contract. (2) Prompt payment. The Government will make payment in accordance with the Prompt Payment Act (31 U.S.C. 3903) and prompt payment regulations at 5 CFR part 1315. (3) Electronic Funds Transfer (EFT). If the Government makes payment by EFT, see 52.212-5(b) for the appropriate EFT clause. (4) Discount. In connection with any discount offered for early payment, time shall be computed from the date of the invoice. For the purpose of computing the discount earned, payment shall be considered to have been made on the date which appears on the payment check or the specified payment date if an electronic funds transfer payment is made. (5) Overpayments. If the Contractor becomes aware of a duplicate contract financing or invoice payment or that the Government has otherwise overpaid on a contract financing or invoice payment, the Contractor shall-- (i) Remit the overpayment amount to the payment office cited in the contract along with a description of the overpayment including the-- (A) Circumstances of the overpayment (e.g., duplicate payment, erroneous payment, liquidation errors, date(s) of overpayment); (B) Affected contract number and delivery order number, if applicable; (C) Affected contract line item or subline item, if applicable; and (D) Contractor point of contact. (ii) Provide a copy of the remittance and supporting documentation to the Contracting Officer. (6) Interest. (i) All amounts that become payable by the Contractor to the Government under this contract shall bear simple interest from the date due until paid unless paid within 30 days of becoming due. The interest rate shall be the interest rate established by the Secretary of the Treasury as provided in Section 611 of the Contract Disputes Act of 1978 (Public Law 95-563), which is applicable to the period in which the amount becomes due, as provided in (i)(6)(v) of this clause, and then at the rate applicable for each six-month period as fixed by the Secretary until the amount is paid. (ii) The Government may issue a demand for payment to the Contractor upon finding a debt is due under the contract. (iii) Final decisions. The Contracting Officer will issue a final decision as required by 33.211 if-- (A) The Contracting Officer and the Contractor are unable to reach agreement on the existence or amount of a debt within 30 days; (B) The Contractor fails to liquidate a debt previously demanded by the Contracting Officer within the timeline specified in the demand for payment unless the amounts were not repaid because the Contractor has requested an installment payment agreement; or (C) The Contractor requests a deferment of collection on a debt previously demanded by the Contracting Officer (see 32.607-2). (iv) If a demand for payment was previously issued for the debt, the demand for payment included in the final decision shall identify the same due date as the original demand for payment. (v) Amounts shall be due at the earliest of the following dates: (A) The date fixed under this contract. (B) The date of the first written demand for payment, including any demand for payment resulting from a default termination. (vi) The interest charge shall be computed for the actual number of calendar days involved beginning on the due date and ending on-- (A) The date on which the designated office receives payment from the Contractor; (B) The date of issuance of a Government check to the Contractor from which an amount otherwise payable has been withheld as a credit against the contract debt; or (C) The date on which an amount withheld and applied to the contract debt would otherwise have become payable to the Contractor. (vii) The interest charge made under this clause may be reduced under the procedures prescribed in 32.608-2 of the Federal Acquisition Regulation in effect on the date of this contract. (j) Risk of loss. Unless the contract specifically provides otherwise, risk of loss or damage to the supplies provided under this contract shall remain with the Contractor until, and shall pass to the Government upon: (1) Delivery of the supplies to a carrier, if transportation is f.o.b. origin; or (2) Delivery of the supplies to the Government at the destination specified in the contract, if transportation is f.o.b. destination. (k) Taxes. The contract price includes all applicable Federal, State, and local taxes and duties. (l) Termination for the Government's convenience. The Government reserves the right to terminate this contract, or any part hereof, for its sole convenience. In the event of such termination, the Contractor shall immediately stop all work hereunder and shall immediately cause any and all of its suppliers and subcontractors to cease work. Subject to the terms of this contract, the Contractor shall be paid a percentage of the contract price reflecting the percentage of the work performed prior to the notice of termination, plus reasonable charges the Contractor can demonstrate to the satisfaction of the Government using its standard record keeping system, have resulted from the termination. The Contractor shall not be required to comply with the cost accounting standards or contract cost principles for this purpose. This paragraph does not give the Government any right to audit the Contractor's records. The Contractor shall not be paid for any work performed or costs incurred which reasonably could have been avoided. (m) Termination for cause. The Government may terminate this contract, or any part hereof, for cause in the event of any default by the Contractor, or if the Contractor fails to comply with any contract terms and conditions, or fails to provide the Government, upon request, with adequate assurances of future performance. In the event of termination for cause, the Government shall not be liable to the Contractor for any amount for supplies or services not accepted, and the Contractor shall be liable to the Government for any and all rights and remedies provided by law. If it is determined that the Government improperly terminated this contract for default, such termination shall be deemed a termination for convenience. (n) Title. Unless specified elsewhere in this contract, title to items furnished under this contract shall pass to the Government upon acceptance, regardless of when or where the Government takes physical possession. (o) Warranty. The Contractor warrants and implies that the items delivered hereunder are merchantable and fit for use for the particular purpose described in this contract. (p) Limitation of liability. Except as otherwise provided by an express warranty, the Contractor will not be liable to the Government for consequential damages resulting from any defect or deficiencies in accepted items. (q) Other compliances. The Contractor shall comply with all applicable Federal, State and local laws, executive orders, rules and regulations applicable to its performance under this contract. (r) Compliance with laws unique to Government contracts. The Contractor agrees to comply with 31 U.S.C. 1352 relating to limitations on the use of appropriated funds to influence certain Federal contracts; 18 U.S.C. 431 relating to officials not to benefit; 40 U.S.C. 3701, et seq., Contract Work Hours and Safety Standards Act; 41 U.S.C. 51-58, Anti-Kickback Act of 1986; 41 U.S.C. 265 and 10 U.S.C. 2409 relating to whistleblower protections; 49 U.S.C. 40118, Fly American; and 41 U.S.C. 423 relating to procurement integrity. (s) Order of precedence. Any inconsistencies in this solicitation or contract shall be resolved by giving precedence in the following order: (1) The schedule of supplies/services. (2) The Assignments, Disputes, Payments, Invoice, Other Compliances, and Compliance with Laws Unique to Government Contracts paragraphs of this clause. (3) The clause at 52.212-5. (4) Addenda to this solicitation or contract, including any license agreements for computer software. (5) Solicitation provisions if this is a solicitation. (6) Other paragraphs of this clause. (7) The Standard Form 1449. (8) Other documents, exhibits, and attachments (9) The specification. (t) Central Contractor Registration (CCR). (1) Unless exempted by an addendum to this contract, the Contractor is responsible during performance and through final payment of any contract for the accuracy and completeness of the data within the CCR database, and for any liability resulting from the Government's reliance on inaccurate or incomplete data. To remain registered in the CCR database after the initial registration, the Contractor is required to review and update on an annual basis from the date of initial registration or subsequent updates its information in the CCR database to ensure it is current, accurate and complete. Updating information in the CCR does not alter the terms and conditions of this contract and is not a substitute for a properly executed contractual document. (2)(i) If a Contractor has legally changed its business name, "doing business as" name, or division name (whichever is shown on the contract), or has transferred the assets used in performing the contract, but has not completed the necessary requirements regarding novation and change-of-name agreements in FAR subpart 42.12, the Contractor shall provide the responsible Contracting Officer a minimum of one business day's written notification of its intention to (A) change the name in the CCR database; (B) comply with the requirements of subpart 42.12; and (C) agree in writing to the timeline and procedures specified by the responsible Contracting Officer. The Contractor must provide with the notification sufficient documentation to support the legally changed name. (ii) If the Contractor fails to comply with the requirements of paragraph (t)(2)(i) of this clause, or fails to perform the agreement at paragraph (t)(2)(i)(C) of this clause, and, in the absence of a properly executed novation or change-of-name agreement, the CCR information that shows the Contractor to be other than the Contractor indicated in the contract will be considered to be incorrect information within the meaning of the "Suspension of Payment" paragraph of the electronic funds transfer (EFT) clause of this contract. (3) The Contractor shall not change the name or address for EFT payments or manual payments, as appropriate, in the CCR record to reflect an assignee for the purpose of assignment of claims (see Subpart 32.8, Assignment of Claims). Assignees shall be separately registered in the CCR database. Information provided to the Contractor's CCR record that indicates payments, including those made by EFT, to an ultimate recipient other than that Contractor will be considered to be incorrect information within the meaning of the "Suspension of payment" paragraph of the EFT clause of this contract. (4) Offerors and Contractors may obtain information on registration and annual confirmation requirements via the internet at or by calling 1-888-227-2423 or 269-961-5757. (End of Clause) C.2 52.212-5 CONTRACT TERMS AND CONDITIONS REQUIRED TO IMPLEMENT STATUTES OR EXECUTIVE ORDERS--COMMERCIAL ITEMS (AUG 2011) (a) The Contractor shall comply with the following Federal Acquisition Regulation (FAR) clauses, which are incorporated in this contract by reference, to implement provisions of law or Executive orders applicable to acquisitions of commercial items: (1) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104 (g)). (2) 52.233-3, Protest After Award (Aug 1996) (31 U.S.C. 3553). (3) 52.233-4, Applicable Law for Breach of Contract Claim (Oct 2004) (Pub. L. 108-77, 108-78) (b) The Contractor shall comply with the FAR clauses in this paragraph (b) that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.203-6, Restrictions on Subcontractor Sales to the Government (Sept 2006), with Alternate I (Oct 1995) (41 U.S.C. 253g and 10 U.S.C. 2402). [X] (2) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010)(Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). [] (3) 52.203-15, Whistleblower Protections under the American Recovery and Reinvestment Act of 2009 (JUN 2010) (Section 1553 of Pub. L. 111-5). (Applies to contracts funded by the American Recovery and Reinvestment Act of 2009.) [X] (4) 52.204-10, Reporting Executive Compensation and First-Tier Subcontract Awards (JUL 2010) (Pub. L. 109-282) (31 U.S.C. 6101 note). [] (5) 52.204-11, American Recovery and Reinvestment Act-Reporting Requirements (JUL 2010) (Pub. L. 111-5). [X] (6) 52.209-6, Protecting the Government's Interest When Subcontracting with Contractors Debarred, Suspended, or Proposed for Debarment. (Dec 2010) (31 U.S.C. 6101 note). [] (7) 52.209-10, Prohibition on Contracting with Inverted Domestic Corporations (section 740 of Division C of Public Law 111-117, section 743 of Division D of Public Law 111-8, and section 745 of Division D of Public Law 110-161) [] (8) 52.219-3, Notice of Total HUBZone Set-Aside or Sole-Source Award (JAN 2011) (15 U.S.C. 657a). [] (9) 52.219-4, Notice of Price Evaluation Preference for HUBZone Small Business Concerns (JAN 2011) (if the offeror elects to waive the preference, it shall so indicate in its offer) (15 U.S.C. 657a). [] (10) [Reserved] [] (11)(i) 52.219-6, Notice of Total Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-6. [] (iii) Alternate II (Mar 2004) of 52.219-6. [] (12)(i) 52.219-7, Notice of Partial Small Business Set-Aside (June 2003) (15 U.S.C. 644). [] (ii) Alternate I (Oct 1995) of 52.219-7. [] (iii) Alternate II (Mar 2004) of 52.219-7. [X] (13) 52.219-8, Utilization of Small Business Concerns (JAN 2011) (15 U.S.C. 637(d)(2) and (3)). [X] (14)(i) 52.219-9, Small Business Subcontracting Plan (JAN 2011) (15 U.S.C. 637(d)(4)). [] (ii) Alternate I (Oct 2001) of 52.219-9. [] (iii) Alternate II (Oct 2001) of 52.219-9. [] (iv) Alternate III (JUL 2010) of 52.219-9. [] (15) 52.219-14, Limitations on Subcontracting (Dec 1996) (15 U.S.C. 637(a)(14)). [X] (16) 52.219-16, Liquidated Damages--Subcontracting Plan (Jan 1999) (15 U.S.C. 637(d)(4)(F)(i)). [] (17)(i) 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns (OCT 2008) (10 U.S.C. 2323) (if the offeror elects to waive the adjustment, it shall so indicate in its offer.) [] (ii) Alternate I (June 2003) of 52.219-23. [X] (18) 52.219-25, Small Disadvantaged Business Participation Program--Disadvantaged Status and Reporting (DEC 2010) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [] (19) 52.219-26, Small Disadvantaged Business Participation Program--Incentive Subcontracting (Oct 2000) (Pub. L. 103-355, section 7102, and 10 U.S.C. 2323). [] (20) 52.219-27, Notice of Total Service-Disabled Veteran-Owned Small Business Set-Aside (May 2004) (15 U.S.C. 657 f). [X] (21) 52.219-28, Post Award Small Business Program Rerepresentation (APR 2009) (15 U.S.C 632(a)(2)). [] (22) 52.219-29 Notice of Total Set-Aside for Economically Disadvantaged Women-Owned Small Business (EDWOSB) Concerns (APR 2011). [] (23) 52.219-30 Notice of Total Set-Aside for Women-Owned Small Business (WOSB) Concerns Eligible Under the WOSB Program (APR 2011). [X] (24) 52.222-3, Convict Labor (June 2003) (E.O. 11755). [] (25) 52.222-19, Child Labor--Cooperation with Authorities and Remedies (JUL 2010) (E.O. 13126). [X] (26) 52.222-21, Prohibition of Segregated Facilities (Feb 1999). [X] (27) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). [X] (28) 52.222-35, Equal Opportunity for Veterans (SEP 2010) (38 U.S.C. 4212). [X] (29) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793). [X] (30) 52.222-37, Employment Reports on Veterans (SEP 2010) (38 U.S.C. 4212). [X] (31) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). [X] (32) 52.222-54, Employment Eligibility Verification (Jan 2009). (Executive Order 12989). (Not applicable to the acquisition of commercially available off-the-shelf items or certain other types of commercial items as prescribed in 22.1803.) [] (33)(i) 52.223-9, Estimate of Percentage of Recovered Material Content for EPA-Designated Items (May 2008) (42 U.S.C.6962(c)(3)(A)(ii)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (ii) Alternate I (MAY 2008) of 52.223-9 (42 U.S.C. 6962(i)(2)(C)). (Not applicable to the acquisition of commercially available off-the-shelf items.) [] (34) 52.223-15, Energy Efficiency in Energy-Consuming Products (DEC 2007)(42 U.S.C. 8259b). [] (35)(i) 52.223-16, IEEE 1680 Standard for the Environmental Assessment of Personal Computer Products (DEC 2007) (E.O. 13423). [] (ii) Alternate I (DEC 2007) of 52.223-16. [X] (36) 52.223-18, Encouraging Contractor Policies to Ban Text Messaging While Driving (AUG 2011) [] (37) 52.225-1, Buy American Act--Supplies (FEB 2009) (41 U.S.C. 10a-10d). [] (38)(i) 52.225-3, Buy American Act--Free Trade Agreements-- Israeli Trade Act (JUN 2009) (41 U.S.C. 10a-10d, 19 U.S.C. 3301 note, 19 U.S.C. 2112 note, 19 U.S.C 3805 note, Pub. L. 108-77, 108-78, 108-286, 108-302, 109-53 and 109-169, 109-283, and 110-138). [] (ii) Alternate I (Jan 2004) of 52.225-3. [] (iii) Alternate II (Jan 2004) of 52.225-3. [X] (39) 52.225-5, Trade Agreements (AUG 2009) (19 U.S.C. 2501, et seq., 19 U.S.C. 3301 note). [X] (40) 52.225-13, Restrictions on Certain Foreign Purchases (JUN 2008) (E.O.'s, proclamations, and statutes administered by the Office of Foreign Assets Control of the Department of the Treasury). [] (41) 52.226-4, Notice of Disaster or Emergency Area Set-Aside (Nov 2007) (42 U.S.C. 5150). [] (42) 52.226-5, Restrictions on Subcontracting Outside Disaster or Emergency Area (Nov 2007) (42 U.S.C. 5150). [] (43) 52.232-29, Terms for Financing of Purchases of Commercial Items (Feb 2002) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (44) 52.232-30, Installment Payments for Commercial Items (Oct 1995) (41 U.S.C. 255(f), 10 U.S.C. 2307(f)). [] (45) 52.232-33, Payment by Electronic Funds Transfer--Central Contractor Registration (Oct 2003) (31 U.S.C. 3332). [X] (46) 52.232-34, Payment by Electronic Funds Transfer--Other than Central Contractor Registration (May 1999) (31 U.S.C. 3332). [] (47) 52.232-36, Payment by Third Party (FEB 2010) (31 U.S.C. 3332). [] (48) 52.239-1, Privacy or Security Safeguards (Aug 1996) (5 U.S.C. 552a). [] (49)(i) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). [] (ii) Alternate I (Apr 2003) of 52.247-64. (c) The Contractor shall comply with the FAR clauses in this paragraph (c), applicable to commercial services, that the Contracting Officer has indicated as being incorporated in this contract by reference to implement provisions of law or Executive orders applicable to acquisitions of commercial items: [X] (1) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). [X] (2) 52.222-42, Statement of Equivalent Rates for Federal Hires (May 1989) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). Employee Class Monetary Wage-Fringe Benefits (Multiple Healthcare Positions) Registered Nurse GS-10 $22.97/hr Licensed Practical Nurse GS-06 $15.34/hr [X] (3) 52.222-43, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Multiple Year and Option Contracts) (Sep 2009) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (4) 52.222-44, Fair Labor Standards Act and Service Contract Act--Price Adjustment (Sep 2009) (29 U.S.C. 206 and 41 U.S.C. 351, et seq.). [] (5) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements (Nov 2007) (41 U.S.C. 351, et seq.). [] (6) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services--Requirements (FEB 2009) (41 U.S.C. 351, et seq.). [] (7) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247) [] (8) 52.237-11, Accepting and Dispensing of $1 Coin (SEP 2008) (31 U.S.C. 5112(p)(1)). (d) Comptroller General Examination of Record. The Contractor shall comply with the provisions of this paragraph (d) if this contract was awarded using other than sealed bid, is in excess of the simplified acquisition threshold, and does not contain the clause at 52.215-2, Audit and Records--Negotiation. (1) The Comptroller General of the United States, or an authorized representative of the Comptroller General, shall have access to and right to examine any of the Contractor's directly pertinent records involving transactions related to this contract. (2) The Contractor shall make available at its offices at all reasonable times the records, materials, and other evidence for examination, audit, or reproduction, until 3 years after final payment under this contract or for any shorter period specified in FAR Subpart 4.7, Contractor Records Retention, of the other clauses of this contract. If this contract is completely or partially terminated, the records relating to the work terminated shall be made available for 3 years after any resulting final termination settlement. Records relating to appeals under the disputes clause or to litigation or the settlement of claims arising under or relating to this contract shall be made available until such appeals, litigation, or claims are finally resolved. (3) As used in this clause, records include books, documents, accounting procedures and practices, and other data, regardless of type and regardless of form. This does not require the Contractor to create or maintain any record that the Contractor does not maintain in the ordinary course of business or pursuant to a provision of law. (e)(1) Notwithstanding the requirements of the clauses in paragraphs (a), (b), (c), and (d) of this clause, the Contractor is not required to flow down any FAR clause, other than those in this paragraph (e)(1) in a subcontract for commercial items. Unless otherwise indicated below, the extent of the flow down shall be as required by the clause-- (i) 52.203-13, Contractor Code of Business Ethics and Conduct (APR 2010) (Pub. L. 110-252, Title VI, Chapter 1 (41 U.S.C. 251 note)). (ii) 52.219-8, Utilization of Small Business Concerns (DEC 2010) (15 U.S.C. 637(d)(2) and (3)), in all subcontracts that offer further subcontracting opportunities. If the subcontract (except subcontracts to small business concerns) exceeds $650,000 ($1.5 million for construction of any public facility), the subcontractor must include 52.219-8 in lower tier subcontracts that offer subcontracting opportunities. (iii) [Reserved] (iv) 52.222-26, Equal Opportunity (Mar 2007) (E.O. 11246). (v) 52.222-35, Equal Opportunity for Veterans (SEP 2010) (38 U.S.C. 4212). (vi) 52.222-36, Affirmative Action for Workers with Disabilities (Oct 2010) (29 U.S.C. 793). (vii) 52.222-40, Notification of Employee Rights Under the National Labor Relations Act (DEC 2010) (E.O. 13496). Flow down required in accordance with paragraph (f) of FAR clause 52.222-40. (viii) 52.222-41, Service Contract Act of 1965 (Nov 2007) (41 U.S.C. 351, et seq.). (ix) 52.222-50, Combating Trafficking in Persons (FEB 2009) (22 U.S.C. 7104(g)). Alternate I (AUG 2007) of 52.222-50 (22 U.S.C. 7104(g)). (x) 52.222-51, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment--Requirements "(Nov 2007)" (41 U.S.C. 351, et seq.). (xi) 52.222-53, Exemption from Application of the Service Contract Act to Contracts for Certain Services-Requirements (FEB 2009)(41 U.S.C. 351, et seq.). (xii) 52.222-54, Employee Eligibility Verification (JAN 2009) (xiii) 52.226-6, Promoting Excess Food Donation to Nonprofit Organizations. (MAR 2009)(Pub. L. 110-247). Flow down required in accordance with paragraph (e) of FAR clause 52.226-6. (xiv) 52.247-64, Preference for Privately Owned U.S.-Flag Commercial Vessels (Feb 2006) (46 U.S.C. Appx. 1241(b) and 10 U.S.C. 2631). Flow down required in accordance with paragraph (d) of FAR clause 52.247-64. (2) While not required, the contractor may include in its subcontracts for commercial items a minimal number of additional clauses necessary to satisfy its contractual obligations. (End of Clause) C.3 52.216-18 ORDERING (OCT 1995) (a) Any supplies and services to be furnished under this contract shall be ordered by issuance of delivery orders or task orders by the individuals or activities designated in the Schedule. Such orders may be issued from 01 January 2012 through 31 December 2012*. (b) All delivery orders or task orders are subject to the terms and conditions of this contract. In the event of conflict between a delivery order or task order and this contract, the contract shall control. (c) If mailed, a delivery order or task order is considered "issued" when the Government deposits the order in the mail. Orders may be issued orally, by facsimile, or by electronic commerce methods only if authorized in the Schedule.*1st Option year: 01 January 2012 through 31 December 2012 2nd Option year: 01 January 2013 through 31 December 2013 3rd Option year: 01 January 2014 through 31 December 2014 4th Option year: 01 January 2015 through 31 December 2015 (End of Clause) C.4 52.216-19 ORDER LIMITATIONS (OCT 1995) (a) Minimum order. When the Government requires supplies or services covered by this contract in an amount of less than $6,000,000.00, the Government is not obligated to purchase, nor is the Contractor obligated to furnish, those supplies or services under the contract. (b) Maximum order. The Contractor is not obligated to honor-- (1) Any order for a single item in excess of $1,000,000.00; (2) Any order for a combination of items in excess of $60,000,000.000; or (3) A series of orders from the same ordering office within seven (7) days that together call for quantities exceeding the limitation in paragraph (b)(1) or (2) of this section. (c) If this is a requirements contract (i.e., includes the Requirements clause at subsection 52.216-21 of the Federal Acquisition Regulation (FAR)), the Government is not required to order a part of any one requirement from the Contractor if that requirement exceeds the maximum-order limitations in paragraph (b) of this section. (d) Notwithstanding paragraphs (b) and (c) of this section, the Contractor shall honor any order exceeding the maximum order limitations in paragraph (b), unless that order (or orders) is returned to the ordering office within seven (7) days after issuance, with written notice stating the Contractor's intent not to ship the item (or items) called for and the reasons. Upon receiving this notice, the Government may acquire the supplies or services from another source. (End of Clause) C.5 52.217-8 OPTION TO EXTEND SERVICES (NOV 1999) The Government may require continued performance of any services within the limits and at the rates specified in the contract. These rates may be adjusted only as a result of revisions to prevailing labor rates provided by the Secretary of Labor. The option provision may be exercised more than once, but the total extension of performance hereunder shall not exceed 6 months. The Contracting Officer may exercise the option by written notice to the Contractor within 30 calendar days prior to contract expiry. (End of Clause) C.6 52.217-9 OPTION TO EXTEND THE TERM OF THE CONTRACT (MAR 2000) (a) The Government may extend the term of this contract by written notice to the Contractor within 30 calendar days prior to contract expiry; provided that the Government gives the Contractor a preliminary written notice of its intent to extend at least 60 calendar days before the contract expires. The preliminary notice does not commit the Government to an extension. (b) If the Government exercises this option, the extended contract shall be considered to include this option clause. (c) The total duration of this contract, including the exercise of any options under this clause, shall not exceed five (5) years and six (6) months. (End of Clause) C.7 52.232-18 AVAILABILITY OF FUNDS (APR 1984) Funds are not presently available for this contract. The Government's obligation under this contract is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise until funds are made available to the Contracting Officer for this contract and until the Contractor receives notice of such availability, to be confirmed in writing by the Contracting Officer. (End of Clause) C.8 52.232-19 AVAILABILITY OF FUNDS FOR THE NEXT FISCAL YEAR (APR 1984) Funds are not presently available for performance under this contract beyond 30 September 2012*. The Government's obligation for performance of this contract beyond that date is contingent upon the availability of appropriated funds from which payment for contract purposes can be made. No legal liability on the part of the Government for any payment may arise for performance under this contract beyond 30 September 2012*, until funds are made available to the Contracting Officer for performance and until the Contractor receives notice of availability, to be confirmed in writing by the Contracting Officer.*1st Option year: 30 September 2013 2nd Option year: 30 September 2014 3rd Option year: 30 September 2015 4th Option year: 30 September 2016 (End of Clause) C.9 VAAR 852.203-70 COMMERCIAL ADVERTISING (JAN 2008) The bidder or offeror agrees that if a contract is awarded to him/her, as a result of this solicitation, he/she will not advertise the award of the contract in his/her commercial advertising in such a manner as to state or imply that the Department of Veterans Affairs endorses a product, project or commercial line of endeavor. (End of Clause) C.10 VAAR 852.203-71 DISPLAY OF DEPARTMENT OF VETERAN AFFAIRS HOTLINE POSTER (DEC 1992) (a) Except as provided in paragraph (c) below, the Contractor shall display prominently, in common work areas within business segments performing work under VA contracts, Department of Veterans Affairs Hotline posters prepared by the VA Office of Inspector General. (b) Department of Veterans Affairs Hotline posters may be obtained from the VA Office of Inspector General (53E), P.O. Box 34647, Washington, DC 20043-4647. (c) The Contractor need not comply with paragraph (a) above if the Contractor has established a mechanism, such as a hotline, by which employees may report suspected instances of improper conduct, and instructions that encourage employees to make such reports. (End of Clause) C.11 VAAR 852.215-70 SERVICE-DISABLED VETERAN-OWNED AND VETERAN-OWNED SMALL BUSINESS EVALUATION FACTORS (DEC 2009) (a) In an effort to achieve socioeconomic small business goals, depending on the evaluation factors included in the solicitation, VA shall evaluate offerors based on their service-disabled veteran-owned or veteran-owned small business status and their proposed use of eligible service-disabled veteran-owned small businesses and veteran-owned small businesses as subcontractors. (b) Eligible service-disabled veteran-owned offerors will receive full credit, and offerors qualifying as veteran-owned small businesses will receive partial credit for the Service-Disabled Veteran-Owned and Veteran-owned Small Business Status evaluation factor. To receive credit, an offeror must be registered and verified in Vendor Information Pages (VIP) database. (). (c) Non-veteran offerors proposing to use service-disabled veteran-owned small businesses or veteran-owned small businesses as subcontractors will receive some consideration under this evaluation factor. Offerors must state in their proposals the names of the SDVOSBs and VOSBs with whom they intend to subcontract and provide a brief description of the proposed subcontracts and the approximate dollar values of the proposed subcontracts. In addition, the proposed subcontractors must be registered and verified in the VIP database (). (End of Clause) C.12 VAAR 852.216-70 ESTIMATED QUANTITIES (APR 1984) As it is impossible to determine the exact quantities that will be required during the contract term, each bidder whose bid is accepted wholly or in part will be required to deliver all articles or services that may be ordered during the contract term, except as he/she otherwise indicates in his/her bid and except as otherwise provided herein. Bids will be considered if made with the proviso that the total quantities delivered shall not exceed a certain specified quantity. Bids offering less than 75 percent of the estimated requirement or which provide that the Government shall guarantee any definite quantity, will not be considered. The fact that quantities are estimated shall not relieve the contractor from filling all orders placed under this contract to the extent of his/ her obligation. Also, the Department of Veterans Affairs shall not be relieved of its obligation to order from the contractor all articles or services that may, in the judgment of the ordering officer, be needed except that in the public exigency procurement may be made without regard to this contract. (End of Clause) C.13 VAAR 852.219-71 VA MENTOR-PROT?G? PROGRAM (DEC 2009) (a) Large businesses are encouraged to participate in the VA Mentor-Protégé Program for the purpose of providing developmental assistance to eligible service-disabled veteran-owned small businesses and veteran-owned small businesses to enhance the small businesses' capabilities and increase their participation as VA prime contractors and as subcontractors. (b) The program consists of: (1) Mentor firms, which are contractors capable of providing developmental assistance; (2) Protégé firms, which are service-disabled veteran-owned small business concerns or veteran-owned small business concerns; and (3) Mentor-Protégé Agreements approved by the VA Office of Small and Disadvantaged Business Utilization. (c) Mentor participation in the program means providing business developmental assistance to aid protégés in developing the requisite expertise to effectively compete for and successfully perform VA prime contracts and subcontracts. (d) Large business prime contractors serving as mentors in the VA Mentor-Protégé Program are eligible for an incentive for subcontracting plan credit. VA will recognize the costs incurred by a mentor firm in providing assistance to a protégé firm and apply those costs for purposes of determining whether the mentor firm attains its subcontracting plan participation goals under a VA contract. The amount of credit given to a mentor firm for these protégé developmental assistance costs shall be calculated on a dollar-for-dollar basis and reported by the large business prime contractor via the Electronic Subcontracting Reporting System (eSRS). (e) Contractors interested in participating in the program are encouraged to contact the VA Office of Small and Disadvantaged Business Utilization for more information. (End of Clause) C.14 MANDATORY WRITTEN DISCLOSURES Mandatory written disclosures required by FAR clause 52.203-13 to the Department of Veterans Affairs, Office of Inspector General (OIG) must be made electronically through the VA OIG Hotline at and clicking on "FAR clause 52.203-13 Reporting." If you experience difficulty accessing the website, call the Hotline at 1-800-488-8244 for further instructions. C.15 52.252-2 CLAUSES INCORPORATED BY REFERENCE (FEB 1998) This contract incorporates one or more clauses by reference, with the same force and effect as if they were given in full text. Upon request, the Contracting Officer will make their full text available. Also, the full text of a clause may be accessed electronically at this/these address(es): (End of Clause) 52.222-24PREAWARD ON-SITE EQUAL OPPORTUNITYFEB 1999 COMPLIANCE EVALUATION52.222-38COMPLIANCE WITH VETERANS' EMPLOYMENTSEP 2010 REPORTING REQUIREMENTS52.227-17RIGHTS IN DATA--SPECIAL WORKSDEC 200752.246-4INSPECTION OF SERVICES--FIXED-PRICEAUG 1996 852.211-74 LIQUIDATED DAMAGES JAN 2008 SECTION D - CONTRACT DOCUMENTS, EXHIBITS, OR ATTACHMENTS ATTACHMENT 1 - QUALITY ASSURANCE SURVEILLANCE PLAN (QASP)Contract Number: (To Be Determined)Oncology Chemotherapy/Infusion ServicesFor the Alaska VA Healthcare System (AVAHS), Anchorage, AK.1.0. INTRODUCTION: 1.1. The VACO Medical Sharing Office is requiring that all new contracts have a QASP. The purpose of the QASP is to provide the Government and contractor with evaluation criteria that determines whether or not the performance standards for a specific contract have been met.1.2. Contract Description: Provide comprehensive medical oncology professional and infusion services and direct patient care responsibilities for Alaska VA Healthcare System inpatient and outpatients.1.3. Contractor’s name: (To Be Determined)2.0. PURPOSE: 2.1. The QASP provides a systematic method to evaluate performance for the stated contract. The QASP explains the following: a. What will be monitored? b. How will monitoring take place? c. Who will conduct the monitoring? d. How will monitoring efforts and results will be documented?2.2. This QASP does not detail how the contractor accomplishes the work. Rather, the QASP is created with the premise that the contractor is responsible for management and quality control actions to meet the terms of the contract. It is the Government’s responsibility to be objective, fair, and consistent in evaluating performance. 2.3. The QASP is a living document and the Government may review and revise it on a regular basis. However, the Government shall coordinate changes with the contractor. Copies of the original QASP and revisions shall be provided to the contractor and Government officials implementing surveillance activities.3.0. GOVERNMENT ROLES AND RESPONSIBILITIES:3.1. The following personnel shall oversee and coordinate surveillance activities:3.1.1. Contracting Officer (CO) – Mark Erickson - The CO shall ensure performance of all necessary actions for effective contracting, ensure compliance with the contract terms, and shall safeguard the interests of the United States in the contractual relationship. The CO shall also assure that the contractor receive impartial, fair, and equitable treatment under this contract. The CO is ultimately responsible for the final determination of the adequacy of the contractor’s performance.3.1.2. Contracting Officer’s Technical Representative (COTR) - (To Be Determined). The COTR confers with the clinical expert (Dr. Cynthia Joe or designee) of the contract and together shall ensure proper: 3.1.2.1. Government surveillance of the contractor’s performance. The designated COTR will review and document Contractor performance quarterly.3.1.2.2. The COTR shall keep a quality assurance file. The designated COTR will give quarterly updates of Contractor performance to Clinical Medical Oncology Expert. The COTR is not empowered to make any contractual commitments or to authorize any contractual changes on the Government’s behalf.4.0. CONTRACTOR REPRESENTATIVES: The following employees of the contractor serve as the contractor’s program manager for this contract.Program Manager - (To Be Determined)5.0. PERFORMANCE STANDARDS:5.1. Performance standards define desired services. The Government performs surveillance to determine if the contractor exceeds, meets or does not meet these standards.5.2. The Performance Requirements Summary Matrix, in the Performance Work Statement (PWS), includes performance standards. The Government shall use these standards to determine contractor performance and shall compare contractor performance to the Acceptable Quality Level (AQL).5.3. Evaluation Factors:TASKIDPERFORMANCEINDICATORSPERFORMANCE STANDARDSACCEPT-ABLEQUALITY LEVELMETHOD OFSURVEILANCEINCENTIVEQuality1Stage recorded prior to treatment for NSCLC Will exceed established threshold>80%Random chart reviewExercise of option renewal/Past performance/Payment refusal2No adjuvant chemotherapy for Stage IA NSCLCWill be below established acceptable level>90%Random chart reviewExercise of option renewal/Past performance/Payment refusal3Adjuvant chemotherapy for resected stage II-IIIA NSCLCWill exceed established threshold>70%Random chart reviewExercise of option renewal/Past performance/Payment refusal4Combined chemotherapy-radiation therapy for stage III NSCLCWill exceed established threshold>70%Random chart reviewExercise of option renewal/Past performance/Payment refusal5Platinum-based doublet chemotherapy for stage IV NSCLCWill exceed established threshold>70%Random chart reviewExercise of option renewal/Past performance/Payment refusal6Platinum-based doublet chemotherapy for SCLCWill exceed established threshold>70%Random chart reviewExercise of option renewal/Past performance/Payment refusal7Spine MRI or myelography for suspected spinal cord compression with advanced cancerWill exceed established threshold>80%Chart reviewExercise of option renewal/Past performance/Payment refusal8Outpatient screening for pain for patients with advanced cancerWill exceed established threshold>90%Random chart reviewExercise of option renewal/Past performance/Payment refusalEnd of Life Care9Outpatient screening for pain in the month prior to death or hospice enrollmentWill exceed established threshold>90%Random chart reviewExercise of option renewal/Past performance/Payment refusal10Re-assessment after change in opioid treatment in the month prior to death or hospice enrollmentWill exceed established threshold>90%Random chart reviewExercise of option renewal/Past performance/Payment refusal11Administration of Chemotherapy within one month Prior to DeathWill be below established acceptable level>30%Random chart reviewExercise of option renewal/Past performance/Payment refusal6.0. INCENTIVES: The Government will use exercise of the option period, past performance, and payment refusal as incentives. Incentives shall be based on exceeding, meeting, or not meeting performance standards. 7.0. METHODS OF QA SURVEILLANCE: Various methods exist to monitor performance. The COTR shall use the surveillance methods listed below in the administration of this QASP. 7.1. Periodic Inspection: Evaluates outcomes on a periodic basis. Inspections may be scheduled daily, weekly, monthly, quarterly, or annually, or unscheduled, as required. Used for Performance Indicators 1 -12.7.2. Periodic Sampling: Variations of random sampling. However, sample is only taken when a problem/deficiency is suspected. Sample results are applicable only for the specific work inspected. Since sample is not entirely random, it cannot be applied to total activity performance. Used for Performance Indicators 1 – 13.8.0. Ratings: Metrics and methods are designed to determine if performance exceeds, meets, or does not meet a given standard and acceptable quality level. A rating scale shall be used to determine a positive, neutral, or negative outcome. The following ratings shall be used:9.0. DOCUMENTING PERFORMANCE:9.1. Acceptable Performance: The Government shall document positive performance. Any report may become a part of the supporting documentation for any contractual action. 9.2. Unacceptable Performance: 9.2.1. When unacceptable performance occurs, the COTR shall inform the contractor. This will normally be in writing unless circumstances necessitate verbal communication. In any case the COTR shall document the discussion and place it in the COTR file. 9.2.2. When the COTR determines formal written communication is required, the COTR shall prepare a Contract Discrepancy Report (CDR), and present it to the contractor's program manager. 9.2.3. The contractor shall acknowledge receipt of the CDR in writing. The CDR will specify if the contractor is required to prepare a corrective action plan to document how the contractor shall correct the unacceptable performance and avoid a recurrence. The CDR will also state how long after receipt the contractor has to present this corrective action plan to the COTR. The Government shall review the contractor's corrective action plan to determine acceptability. 9.2.4. Any CDRs may become a part of the supporting documentation for any contractual action deemed necessary by the CO. 10.0. Frequency of Measurement:10.1. Frequency of Measurement: During contract performance, the COTR will periodically analyze whether the negotiated frequency of surveillance is appropriate for the work being performed. 10.2. Frequency of Performance Assessment Meetings: The COTR shall meet with the contractor quarterly to assess performance and shall provide a written assessment. 11.0. SIGNATURES OF KEY PERSONNEL:11.1 _________________________________ _____________________________ Signature – Contractor Program Manager Printed Name11.2. ________________________________ ______________________________ Signature – Contracting Officer’s Printed Name Technical RepresentativeATTACHMENT 2 – WAGE DETERMINATIONWD 05-2017 (Rev.-13) was first posted on on 06/22/2010************************************************************************REGISTER OF WAGE DETERMINATIONS UNDER | U.S. DEPARTMENT OF LABOR THE SERVICE CONTRACT ACT | EMPLOYMENT STANDARDS ADMINISTRATIONBy direction of the Secretary of Labor | WAGE AND HOUR DIVISION | WASHINGTON D.C. 20210 | | | | Wage Determination No.: 2005-2017Shirley F. Ebbesen Division of | Revision No.: 13Director Wage Determinations| Date Of Revision: 06/15/2010_______________________________________|____________________________________________State: AlaskaArea: Alaska Statewide____________________________________________________________________________________ **Fringe Benefits Required Follow the Occupational Listing**OCCUPATION CODE - TITLE FOOTNOTE RATE01000 - Administrative Support And Clerical Occupations 01011 - Accounting Clerk I 15.33 01012 - Accounting Clerk II 18.76 01013 - Accounting Clerk III 20.98 01020 - Administrative Assistant 23.34 01040 - Court Reporter 18.84 01051 - Data Entry Operator I 14.86 01052 - Data Entry Operator II 17.86 01060 - Dispatcher, Motor Vehicle 20.25 01070 - Document Preparation Clerk 15.39 01090 - Duplicating Machine Operator 14.72 01111 - General Clerk I 15.59 01112 - General Clerk II 17.01 01113 - General Clerk III 19.09 01120 - Housing Referral Assistant 21.01 01141 - Messenger Courier 15.60 01191 - Order Clerk I 15.45 01192 - Order Clerk II 16.86 01261 - Personnel Assistant (Employment) I 19.07 01262 - Personnel Assistant (Employment) II 21.33 01263 - Personnel Assistant (Employment) III 23.79 01270 - Production Control Clerk 22.59 01280 - Receptionist 14.09 01290 - Rental Clerk 16.84 01300 - Scheduler, Maintenance 16.84 01311 - Secretary I 16.84 01312 - Secretary II 18.84 01313 - Secretary III 21.01 01320 - Service Order Dispatcher 16.48 01410 - Supply Technician 23.34 01420 - Survey Worker 18.78 01531 - Travel Clerk I 15.21 01532 - Travel Clerk II 16.80 01533 - Travel Clerk III 18.57 01611 - Word Processor I 16.18 01612 - Word Processor II 18.16 01613 - Word Processor III 20.3105000 - Automotive Service Occupations 05005 - Automobile Body Repairer, Fiberglass 27.64 05010 - Automotive Electrician 23.64 05040 - Automotive Glass Installer 21.87 05070 - Automotive Worker 21.87 05110 - Mobile Equipment Servicer 19.62 05130 - Motor Equipment Metal Mechanic 23.96 05160 - Motor Equipment Metal Worker 21.87 05190 - Motor Vehicle Mechanic 23.96 05220 - Motor Vehicle Mechanic Helper 18.53 05250 - Motor Vehicle Upholstery Worker 21.87 05280 - Motor Vehicle Wrecker 21.87 05310 - Painter, Automotive 22.86 05340 - Radiator Repair Specialist 21.87 05370 - Tire Repairer 17.78 05400 - Transmission Repair Specialist 23.9607000 - Food Preparation And Service Occupations 07010 - Baker 16.67 07041 - Cook I 15.17 07042 - Cook II 17.46 07070 - Dishwasher 10.99 07130 - Food Service Worker 13.46 07210 - Meat Cutter 18.87 07260 - Waiter/Waitress 11.9109000 - Furniture Maintenance And Repair Occupations 09010 - Electrostatic Spray Painter 25.94 09040 - Furniture Handler 17.36 09080 - Furniture Refinisher 25.94 09090 - Furniture Refinisher Helper 19.58 09110 - Furniture Repairer, Minor 22.74 09130 - Upholsterer 25.9411000 - General Services And Support Occupations 11030 - Cleaner, Vehicles 11.68 11060 - Elevator Operator 11.68 11090 - Gardener 17.52 11122 - Housekeeping Aide 14.15 11150 - Janitor 14.15 11210 - Laborer, Grounds Maintenance 14.59 11240 - Maid or Houseman 10.96 11260 - Pruner 13.18 11270 - Tractor Operator 16.53 11330 - Trail Maintenance Worker 14.59 11360 - Window Cleaner 15.6712000 - Health Occupations 12010 - Ambulance Driver 22.66 12011 - Breath Alcohol Technician 20.48 12012 - Certified Occupational Therapist Assistant 22.50 12015 - Certified Physical Therapist Assistant 21.90 12020 - Dental Assistant 20.32 12025 - Dental Hygienist 44.92 12030 - EKG Technician 29.90 12035 - Electroneurodiagnostic Technologist 29.90 12040 - Emergency Medical Technician 22.66 12071 - Licensed Practical Nurse I 18.31 12072 - Licensed Practical Nurse II 20.48 12073 - Licensed Practical Nurse III 22.84 12100 - Medical Assistant 17.49 12130 - Medical Laboratory Technician 21.01 12160 - Medical Record Clerk 16.04 12190 - Medical Record Technician 17.94 12195 - Medical Transcriptionist 20.41 12210 - Nuclear Medicine Technologist 43.70 12221 - Nursing Assistant I 13.27 12222 - Nursing Assistant II 14.92 12223 - Nursing Assistant III 16.28 12224 - Nursing Assistant IV 18.27 12235 - Optical Dispenser 20.20 12236 - Optical Technician 18.31 12250 - Pharmacy Technician 17.55 12280 - Phlebotomist 18.27 12305 - Radiologic Technologist 29.67 12311 - Registered Nurse I 28.98 12312 - Registered Nurse II 35.45 12313 - Registered Nurse II, Specialist 35.45 12314 - Registered Nurse III 42.88 12315 - Registered Nurse III, Anesthetist 42.88 12316 - Registered Nurse IV 51.40 12317 - Scheduler (Drug and Alcohol Testing) 25.3813000 - Information And Arts Occupations 13011 - Exhibits Specialist I 21.09 13012 - Exhibits Specialist II 25.29 13013 - Exhibits Specialist III 30.90 13041 - Illustrator I 21.09 13042 - Illustrator II 25.29 13043 - Illustrator III 30.90 13047 - Librarian 25.66 13050 - Library Aide/Clerk 15.59 13054 - Library Information Technology Systems 23.84 Administrator 13058 - Library Technician 19.63 13061 - Media Specialist I 16.71 13062 - Media Specialist II 18.70 13063 - Media Specialist III 20.85 13071 - Photographer I 19.50 13072 - Photographer II 23.82 13073 - Photographer III 27.01 13074 - Photographer IV 33.05 13075 - Photographer V 35.10 13110 - Video Teleconference Technician 18.4314000 - Information Technology Occupations 14041 - Computer Operator I 17.09 14042 - Computer Operator II 19.12 14043 - Computer Operator III 24.42 14044 - Computer Operator IV 25.98 14045 - Computer Operator V 14071 - Computer Programmer I (see 1) 14072 - Computer Programmer II (see 1) 14073 - Computer Programmer III (see 1) 14074 - Computer Programmer IV (see 1) 14101 - Computer Systems Analyst I (see 1) 14102 - Computer Systems Analyst II (see 1) 14103 - Computer Systems Analyst III (see 1) 14150 - Peripheral Equipment Operator 18.34 14160 - Personal Computer Support Technician 27.6215000 - Instructional Occupations 15010 - Aircrew Training Devices Instructor (Non-Rated) 34.09 15020 - Aircrew Training Devices Instructor (Rated) 41.24 15030 - Air Crew Training Devices Instructor (Pilot) 49.42 15050 - Computer Based Training Specialist / Instructor 34.09 15060 - Educational Technologist 25.26 15070 - Flight Instructor (Pilot) 44.47 15080 - Graphic Artist 25.25 15090 - Technical Instructor 23.55 15095 - Technical Instructor/Course Developer 28.83 15110 - Test Proctor 19.12 15120 - Tutor 19.1216000 - Laundry, Dry-Cleaning, Pressing And Related Occupations 16010 - Assembler 11.14 16030 - Counter Attendant 11.14 16040 - Dry Cleaner 14.19 16070 - Finisher, Flatwork, Machine 11.14 16090 - Presser, Hand 11.14 16110 - Presser, Machine, Drycleaning 11.14 16130 - Presser, Machine, Shirts 11.14 16160 - Presser, Machine, Wearing Apparel, Laundry 11.14 16190 - Sewing Machine Operator 15.20 16220 - Tailor 16.24 16250 - Washer, Machine 12.1619000 - Machine Tool Operation And Repair Occupations 19010 - Machine-Tool Operator (Tool Room) 26.22 19040 - Tool And Die Maker 32.6621000 - Materials Handling And Packing Occupations 21020 - Forklift Operator 19.56 21030 - Material Coordinator 22.59 21040 - Material Expediter 22.59 21050 - Material Handling Laborer 17.01 21071 - Order Filler 15.49 21080 - Production Line Worker (Food Processing) 19.56 21110 - Shipping Packer 17.80 21130 - Shipping/Receiving Clerk 17.80 21140 - Store Worker I 14.56 21150 - Stock Clerk 19.82 21210 - Tools And Parts Attendant 19.56 21410 - Warehouse Specialist 19.5623000 - Mechanics And Maintenance And Repair Occupations 23010 - Aerospace Structural Welder 29.25 23021 - Aircraft Mechanic I 27.66 23022 - Aircraft Mechanic II 29.25 23023 - Aircraft Mechanic III 30.86 23040 - Aircraft Mechanic Helper 21.69 23050 - Aircraft, Painter 27.45 23060 - Aircraft Servicer 24.23 23080 - Aircraft Worker 25.48 23110 - Appliance Mechanic 24.68 23120 - Bicycle Repairer 19.56 23125 - Cable Splicer 32.26 23130 - Carpenter, Maintenance 27.35 23140 - Carpet Layer 24.62 23160 - Electrician, Maintenance 33.25 23181 - Electronics Technician Maintenance I 28.23 23182 - Electronics Technician Maintenance II 33.62 23183 - Electronics Technician Maintenance III 35.69 23260 - Fabric Worker 23.00 23290 - Fire Alarm System Mechanic 25.71 23310 - Fire Extinguisher Repairer 21.40 23311 - Fuel Distribution System Mechanic 28.42 23312 - Fuel Distribution System Operator 24.75 23370 - General Maintenance Worker 21.71 23380 - Ground Support Equipment Mechanic 27.66 23381 - Ground Support Equipment Servicer 24.23 23382 - Ground Support Equipment Worker 25.48 23391 - Gunsmith I 21.40 23392 - Gunsmith II 24.62 23393 - Gunsmith III 27.84 23410 - Heating, Ventilation And Air-Conditioning 26.32 Mechanic 23411 - Heating, Ventilation And Air Contditioning 28.62 Mechanic (Research Facility) 23430 - Heavy Equipment Mechanic 30.13 23440 - Heavy Equipment Operator 29.79 23460 - Instrument Mechanic 27.68 23465 - Laboratory/Shelter Mechanic 26.22 23470 - Laborer 17.01 23510 - Locksmith 25.45 23530 - Machinery Maintenance Mechanic 27.44 23550 - Machinist, Maintenance 27.84 23580 - Maintenance Trades Helper 19.42 23591 - Metrology Technician I 27.68 23592 - Metrology Technician II 29.27 23593 - Metrology Technician III 30.88 23640 - Millwright 27.84 23710 - Office Appliance Repairer 23.24 23760 - Painter, Maintenance 24.94 23790 - Pipefitter, Maintenance 32.26 23810 - Plumber, Maintenance 30.80 23820 - Pneudraulic Systems Mechanic 27.84 23850 - Rigger 27.84 23870 - Scale Mechanic 24.62 23890 - Sheet-Metal Worker, Maintenance 27.48 23910 - Small Engine Mechanic 24.62 23931 - Telecommunications Mechanic I 26.79 23932 - Telecommunications Mechanic II 30.61 23950 - Telephone Lineman 28.61 23960 - Welder, Combination, Maintenance 25.93 23965 - Well Driller 27.05 23970 - Woodcraft Worker 27.84 23980 - Woodworker 21.4024000 - Personal Needs Occupations 24570 - Child Care Attendant 12.47 24580 - Child Care Center Clerk 15.54 24610 - Chore Aide 14.06 24620 - Family Readiness And Support Services 16.21 Coordinator 24630 - Homemaker 18.9425000 - Plant And System Operations Occupations 25010 - Boiler Tender 29.26 25040 - Sewage Plant Operator 28.70 25070 - Stationary Engineer 29.26 25190 - Ventilation Equipment Tender 21.66 25210 - Water Treatment Plant Operator 28.7027000 - Protective Service Occupations 27004 - Alarm Monitor 19.71 27007 - Baggage Inspector 15.91 27008 - Corrections Officer 27.17 27010 - Court Security Officer 26.28 27030 - Detection Dog Handler 18.14 27040 - Detention Officer 27.17 27070 - Firefighter 22.46 27101 - Guard I 15.91 27102 - Guard II 18.14 27131 - Police Officer I 31.05 27132 - Police Officer II 34.5028000 - Recreation Occupations 28041 - Carnival Equipment Operator 14.59 28042 - Carnival Equipment Repairer 15.47 28043 - Carnival Equpment Worker 11.99 28210 - Gate Attendant/Gate Tender 14.96 28310 - Lifeguard 12.47 28350 - Park Attendant (Aide) 17.23 28510 - Recreation Aide/Health Facility Attendant 12.21 28515 - Recreation Specialist 26.20 28630 - Sports Official 13.72 28690 - Swimming Pool Operator 21.9029000 - Stevedoring/Longshoremen Occupational Services 29010 - Blocker And Bracer 24.62 29020 - Hatch Tender 24.62 29030 - Line Handler 24.62 29041 - Stevedore I 27.49 29042 - Stevedore II 30.4330000 - Technical Occupations 30010 - Air Traffic Control Specialist, Center (HFO) (see 2) 35.77 30011 - Air Traffic Control Specialist, Station (HFO) (see 2) 24.66 30012 - Air Traffic Control Specialist, Terminal (HFO) (see 2) 27.16 30021 - Archeological Technician I 21.46 30022 - Archeological Technician II 24.90 30023 - Archeological Technician III 29.46 30030 - Cartographic Technician 31.78 30040 - Civil Engineering Technician 29.63 30061 - Drafter/CAD Operator I 23.41 30062 - Drafter/CAD Operator II 27.28 30063 - Drafter/CAD Operator III 29.19 30064 - Drafter/CAD Operator IV 34.79 30081 - Engineering Technician I 22.72 30082 - Engineering Technician II 26.56 30083 - Engineering Technician III 29.74 30084 - Engineering Technician IV 33.02 30085 - Engineering Technician V 38.08 30086 - Engineering Technician VI 45.77 30090 - Environmental Technician 22.13 30210 - Laboratory Technician 26.61 30240 - Mathematical Technician 32.95 30361 - Paralegal/Legal Assistant I 21.93 30362 - Paralegal/Legal Assistant II 27.15 30363 - Paralegal/Legal Assistant III 33.22 30364 - Paralegal/Legal Assistant IV 40.20 30390 - Photo-Optics Technician 32.95 30461 - Technical Writer I 20.22 30462 - Technical Writer II 24.72 30463 - Technical Writer III 33.98 30491 - Unexploded Ordnance (UXO) Technician I 22.74 30492 - Unexploded Ordnance (UXO) Technician II 27.51 30493 - Unexploded Ordnance (UXO) Technician III 32.97 30494 - Unexploded (UXO) Safety Escort 22.74 30495 - Unexploded (UXO) Sweep Personnel 22.74 30620 - Weather Observer, Combined Upper Air Or (see 2) 29.19 Surface Programs 30621 - Weather Observer, Senior (see 2) 32.4231000 - Transportation/Mobile Equipment Operation Occupations 31020 - Bus Aide 12.71 31030 - Bus Driver 19.13 31043 - Driver Courier 17.79 31260 - Parking and Lot Attendant 13.19 31290 - Shuttle Bus Driver 17.89 31310 - Taxi Driver 15.74 31361 - Truckdriver, Light 17.89 31362 - Truckdriver, Medium 19.85 31363 - Truckdriver, Heavy 22.18 31364 - Truckdriver, Tractor-Trailer 22.1899000 - Miscellaneous Occupations 99030 - Cashier 12.27 99050 - Desk Clerk 14.09 99095 - Embalmer 22.74 99251 - Laboratory Animal Caretaker I 12.34 99252 - Laboratory Animal Caretaker II 20.92 99310 - Mortician 22.74 99410 - Pest Controller 22.53 99510 - Photofinishing Worker 11.95 99710 - Recycling Laborer 25.38 99711 - Recycling Specialist 30.29 99730 - Refuse Collector 22.92 99810 - Sales Clerk 13.82 99820 - School Crossing Guard 16.32 99830 - Survey Party Chief 26.44 99831 - Surveying Aide 17.60 99832 - Surveying Technician 24.04 99840 - Vending Machine Attendant 17.01 99841 - Vending Machine Repairer 19.91 99842 - Vending Machine Repairer Helper 17.01________________________________________________________________________ALL OCCUPATIONS LISTED ABOVE RECEIVE THE FOLLOWING BENEFITS:HEALTH & WELFARE: $3.50 per hour or $140.00 per week or $606.67 per monthVACATION: 2 weeks paid vacation after 1 year of service with a contractor orsuccessor; 3 weeks after 5 years, and 4 weeks after 15 years. Length of serviceincludes the whole span of continuous service with the present contractor orsuccessor, wherever employed, and with the predecessor contractors in theperformance of similar work at the same Federal facility. (Reg. 29 CFR 4.173)HOLIDAYS: A minimum of eleven paid holidays per year: New Year's Day, MartinLuther King Jr's Birthday, Washington's Birthday, Good Friday, Memorial Day,Independence Day, Labor Day, Columbus Day, Veterans' Day, Thanksgiving Day, andChristmas Day. A contractor may substitute for any of the named holidays anotherday off with pay in accordance with a plan communicated to the employees involved.)(See 29 CFR 4.174)THE OCCUPATIONS WHICH HAVE NUMBERED FOOTNOTES IN PARENTHESES RECEIVE THE FOLLOWING:1) COMPUTER EMPLOYEES: Under the SCA at section 8(b), this wage determination does not apply to any employee who individually qualifies as a bona fide executive,administrative, or professional employee as defined in 29 C.F.R. Part 541. Becausemost Computer System Analysts and Computer Programmers who are compensated at a ratenot less than $27.63 (or on a salary or fee basis at a rate not less than $455 perweek) an hour would likely qualify as exempt computer professionals, (29 C.F.R. 541.400) wage rates may not be listed on this wage determination for all occupationswithin those job families. In addition, because this wage determination may notlist a wage rate for some or all occupations within those job families if the surveydata indicates that the prevailing wage rate for the occupation equals or exceeds$27.63 per hour conformances may be necessary for certain nonexempt employees. Forexample, if an individual employee is nonexempt but nevertheless performs dutieswithin the scope of one of the Computer Systems Analyst or Computer Programmeroccupations for which this wage determination does not specify an SCA wage rate,then the wage rate for that employee must be conformed in accordance with theconformance procedures described in the conformance note included on this wagedetermination.Additionally, because job titles vary widely and change quickly in the computerindustry, job titles are not determinative of the application of the computerprofessional exemption. Therefore, the exemption applies only to computer employeeswho satisfy the compensation requirements and whose primary duty consists of: (1) The application of systems analysis techniques and procedures, includingconsulting with users, to determine hardware, software or system functionalspecifications; (2) The design, development, documentation, analysis, creation, testing ormodification of computer systems or programs, including prototypes, based on andrelated to user or system design specifications; (3) The design, documentation, testing, creation or modification of computerprograms related to machine operating systems; or (4) A combination of the aforementioned duties, the performance of whichrequires the same level of skills. (29 C.F.R. 541.400).2) AIR TRAFFIC CONTROLLERS AND WEATHER OBSERVERS - NIGHT PAY & SUNDAY PAY: If youwork at night as part of a regular tour of duty, you will earn a night differentialand receive an additional 10% of basic pay for any hours worked between 6pm and 6am. If you are a full-time employed (40 hours a week) and Sunday is part of yourregularly scheduled workweek, you are paid at your rate of basic pay plus a Sundaypremium of 25% of your basic rate for each hour of Sunday work which is not overtime(i.e. occasional work on Sunday outside the normal tour of duty is consideredovertime work).HAZARDOUS PAY DIFFERENTIAL: An 8 percent differential is applicable to employees employed in a position that represents a high degree of hazard when working with or in close proximity to ordinance, explosives, and incendiary materials. Thisincludes work such as screening, blending, dying, mixing, and pressing of sensitiveordance, explosives, and pyrotechnic compositions such as lead azide, black powderand photoflash powder. All dry-house activities involving propellants or explosives. Demilitarization, modification, renovation, demolition, and maintenance operationson sensitive ordnance, explosives and incendiary materials. All operationsinvolving regrading and cleaning of artillery ranges.A 4 percent differential is applicable to employees employed in a position thatrepresents a low degree of hazard when working with, or in close proximity toordance, (or employees possibly adjacent to) explosives and incendiary materialswhich involves potential injury such as laceration of hands, face, or arms of theemployee engaged in the operation, irritation of the skin, minor burns and thelike; minimal damage to immediate or adjacent work area or equipment being used.All operations involving, unloading, storage, and hauling of ordance, explosive, andincendiary ordnance material other than small arms ammunition. These differentialsare only applicable to work that has been specifically designated by the agency forordance, explosives, and incendiary material differential pay.** UNIFORM ALLOWANCE **If employees are required to wear uniforms in the performance of this contract(either by the terms of the Government contract, by the employer, by the state orlocal law, etc.), the cost of furnishing such uniforms and maintaining (bylaundering or dry cleaning) such uniforms is an expense that may not be borne by anemployee where such cost reduces the hourly rate below that required by the wagedetermination. The Department of Labor will accept payment in accordance with thefollowing standards as compliance:The contractor or subcontractor is required to furnish all employees with anadequate number of uniforms without cost or to reimburse employees for the actualcost of the uniforms. In addition, where uniform cleaning and maintenance is madethe responsibility of the employee, all contractors and subcontractors subject tothis wage determination shall (in the absence of a bona fide collective bargainingagreement providing for a different amount, or the furnishing of contraryaffirmative proof as to the actual cost), reimburse all employees for such cleaningand maintenance at a rate of $3.35 per week (or $.67 cents per day). However, inthose instances where the uniforms furnished are made of "wash and wear"materials, may be routinely washed and dried with other personal garments, and donot require any special treatment such as dry cleaning, daily washing, or commerciallaundering in order to meet the cleanliness or appearance standards set by the termsof the Government contract, by the contractor, by law, or by the nature of the work,there is no requirement that employees be reimbursed for uniform maintenance costs.The duties of employees under job titles listed are those described in the"Service Contract Act Directory of Occupations", Fifth Edition, April 2006,unless otherwise indicated. Copies of the Directory are available on the Internet. Alinks to the Directory may be found on the WHD home page at or through the Wage Determinations On-Line (WDOL) Web site at FOR AUTHORIZATION OF ADDITIONAL CLASSIFICATION AND WAGE RATE {Standard Form 1444 (SF 1444)}Conformance Process:The contracting officer shall require that any class of service employee which isnot listed herein and which is to be employed under the contract (i.e., the work tobe performed is not performed by any classification listed in the wagedetermination), be classified by the contractor so as to provide a reasonablerelationship (i.e., appropriate level of skill comparison) between such unlistedclassifications and the classifications listed in the wage determination. Suchconformed classes of employees shall be paid the monetary wages and furnished thefringe benefits as are determined. Such conforming process shall be initiated bythe contractor prior to the performance of contract work by such unlisted class(es)of employees. The conformed classification, wage rate, and/or fringe benefits shallbe retroactive to the commencement date of the contract. {See Section 4.6 (C)(vi)}When multiple wage determinations are included in a contract, a separate SF 1444should be prepared for each wage determination to which a class(es) is to beconformed.The process for preparing a conformance request is as follows:1) When preparing the bid, the contractor identifies the need for a conformedoccupation(s) and computes a proposed rate(s).2) After contract award, the contractor prepares a written report listing in orderproposed classification title(s), a Federal grade equivalency (FGE) for eachproposed classification(s), job description(s), and rationale for proposed wagerate(s), including information regarding the agreement or disagreement of theauthorized representative of the employees involved, or where there is no authorizedrepresentative, the employees themselves. This report should be submitted to thecontracting officer no later than 30 days after such unlisted class(es) of employeesperforms any contract work.3) The contracting officer reviews the proposed action and promptly submits a reportof the action, together with the agency's recommendations and pertinentinformation including the position of the contractor and the employees, to the Wageand Hour Division, Employment Standards Administration, U.S. Department of Labor,for review. (See section 4.6(b)(2) of Regulations 29 CFR Part 4).4) Within 30 days of receipt, the Wage and Hour Division approves, modifies, ordisapproves the action via transmittal to the agency contracting officer, ornotifies the contracting officer that additional time will be required to processthe request.5) The contracting officer transmits the Wage and Hour decision to the contractor.6) The contractor informs the affected rmation required by the Regulations must be submitted on SF 1444 or bond paper.When preparing a conformance request, the "Service Contract Act Directory ofOccupations" (the Directory) should be used to compare job definitions to insurethat duties requested are not performed by a classification already listed in thewage determination. Remember, it is not the job title, but the required tasks thatdetermine whether a class is included in an established wage determination.Conformances may not be used to artificially split, combine, or subdivideclassifications listed in the wage determination. SECTION E - SOLICITATION PROVISIONS E.1 52.212-2 EVALUATION--COMMERCIAL ITEMS (JAN 1999) (a) The Government will award a contract resulting from this solicitation to the responsible offeror whose offer conforming to the solicitation will be most advantageous to the Government, price and other factors considered. The following factors shall be used to evaluate offers: 1. Technical Capability (Services Management Plan, Quality Control Plan, SD/VOSB Subcontractor Plan); 2. Past Performance; 3. Price. Technical and past performance, when combined, are substantially more important than Price.. (b) Options. The Government will evaluate offers for award purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s). (c) A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the offer, shall result in a binding contract without further action by either party. Before the offer's specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award. (End of Provision)E.2 ADDENDUM TO 52.212-2 BASIS OF SELECTIONOncology Chemotherapy/Infusion Servicesfor theVA Alaska Healthcare System (AVAHS), Anchorage, AK.PROPOSALS ARE DUE INTO THIS OFFICENO LATER THAN 16 DECEMBER 2011.Evaluation -Commercial Items - Basis Of Selection1. Contract Type: The agreement will be firm fixed price. The Government intends to select one contractor for award of an Indefinite Delivery, Indefinite Quantity (IDIQ) type contract. However, the Government retains the right to award multiple contracts should this be determined to be in the best interest of the Government. If awarded, multiple contracts would be awarded in separate geographic locations throughout Alaska. 2. Responsive and Responsible: This is a best value negotiated acquisition based on trade-offs of evaluation factors. A single offeror will be selected who is deemed responsive and responsible in accordance with the Federal Acquisition Regulation (FAR) 9.104-1, whose offer conforms to the RFP’s requirements and who has acceptable or neutral past performance.3. Options: The Government will evaluate the submitted offer for selection purposes by adding the total price for all options to the total price for the basic requirement. The Government may determine that an offer is unacceptable if the option prices are significantly unbalanced. Evaluation of options shall not obligate the Government to exercise the option(s).4. IDIQ Contract: A written notice of award or acceptance of an offer, mailed or otherwise furnished to the successful offeror within the time for acceptance specified in the solicitation, shall result in a contract without further action by either party. Before the offer’s specified expiration time, the Government may accept an offer (or part of an offer), whether or not there are negotiations after its receipt, unless a written notice of withdrawal is received before award.5. CCR Registration: Offeror must be registered in the Central Contractor Registration (CCR) system. No contract will be entered into with an unregistered contractor. Internet access allows you to register by completing an electronic on-line registration application at . On-line Representations and Certifications (ORCA) may also be filled out at this website. 6. Proposal Preparation Instructions:7.1 Specific Instructions: All proposals shall be legible and prepared in the following general format to be properly evaluated. A cover sheet with the company’s name, address and telephone number, Request for Proposal (RFP) number, title of the RFP and the original date of submittal. The original date shall be located in the upper right hand corner of the cover sheet. Return proposals no later than 16 December 2011, at 12:00:00 PM (PST), to the address shown in Block 9 (page 1) of the form SF 1449. Please send to the attention of the Contracting Officer, Mark Erickson. Offer shall be complete, self-sufficient, and respond directly to the requirements of this solicitation.NOTE: Return proposals no later than 16 December 2011, at 12:00:00 PM (PST), to the address shown in Block 9. Include the solicitation number, closing date and closing time on the outside of your sealed envelope containing your proposal.7.1.1 Format. Part I: Executed Request for ProposalsPart II: Price 1Part III: Technical Capability (Quality) Part IV: Past Performance 7.1.2 Part I - Executed Request for Proposals: Requires the offeror to complete blocks 17a, 17b,30a, 30b and 30c. Complete all necessary fill-ins and certifications concerning – Offeror Representations and Certifications at FAR Clause 52.212-3 and acknowledgement of amendments issued (may be done online-see paragraph 5 above). The form, Contractor Employees Legal Status (Appendix C of the PWS)) shall also be signed and submitted with the offeror’s proposal.7.1.3 Part II - Price: Insert proposed pricing in the table located on pages 32 through 86. Note that quantity amounts are estimated based on historical records, but do not guarantee the Contractor that services in these amounts will be ordered. Note: Annual pricing is for comparison purposes when evaluating offerors’ price proposals. Estimated quantities listed in Appendix A do not commit the Government to those amounts. Actual Medicare pricing may adjust over the life of the contract; thus, annual pricing may also adjust. 7.1.4 Part III - Technical Quality: Technical Quality will be determined by evaluation of the following submitted documents, which represent technical subfactors:7.1.4.1. Subfactor 1 - Services Management Plan: This is the Contractor’s plan that explains in detail how the Contractor is organized to provide the required services in a timely and cost-effective manner to the Government and VA client patients. Plan shall address the offeror’s 1) ability to meet timeliness and quality care requirements; 2) ability to provide qualified physicians and nurses in required medical specialties; 3) ability to coordinate care with the VA and its patients; 4) ability to meet the requirements specified in the Statement of Work; and 5) ability of contractor personnel to be credentialed and privileged to provide services as the inpatient service provider.7.1.4.2. Subfactor 2 - Quality Control Plan: This is the Contractor’s plan that outlines the Contractor’s process in ensuring the quality of the services they will provide under this agreement.7.1.4.3. Subfactor 3 - VOSB/SDVOSB Subcontracting Plan: The Offeror shall state whether or not they are Service Disabled Veteran Owned Small Business (SDVOSB) or a Veteran Owned Small Business (VOSB) as applicable, and submit a Subcontracting Plan outlining their plan to utilize SDVOSB and/or VOSB in fulfillment of socioeconomic small business goals in the performance of this agreement.7.1.5. Part IV - Past Performance: Offeror shall submit the name of the company, telephone number and point of contact for a minimum of three (3) recent and relevant contracts that show past performance information on the same type of contract as is proposed here. If the offeror has no past performance information on this type of contract, the offeror shall specifically state that it has no such past performance. The Government reserves the right to obtain past performance information from other sources. The past performance information shall include the following:7.1.5.1. Name of contracting activity(ies);7.1.5.2. Contract number(s);7.1.5.3. Contract type(s);7.1.5.4. Total contract value(s);7.1.5.5. Brief statement of contract work performed with contract performance period(s); 7.1.5.6. Name, telephone and fax numbers, and email addresses of the subject contract(s) Contracting Officer(s), Contracting Officer’s Representatives(s), and Program Manager(s). E.3 52.212-3 OFFEROR REPRESENTATIONS AND CERTIFICATIONS-- COMMERCIAL ITEMS (MAY 2011) An offeror shall complete only paragraph (b) of this provision if the offeror has completed the annual representations and certifications electronically at . If an offeror has not completed the annual representations and certifications electronically at the ORCA website, the offeror shall complete only paragraphs (c) through (o) of this provision. (a) Definitions. As used in this provision-- "Economically disadvantaged women-owned small business (EDWOSB) concern" means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States and who are economically disadvantaged in accordance with 13 CFR part 127. It automatically qualifies as a women-owned small business eligible under the WOSB Program. "Forced or indentured child labor" means all work or service-- (1) Exacted from any person under the age of 18 under the menace of any penalty for its nonperformance and for which the worker does not offer himself voluntarily; or (2) Performed by any person under the age of 18 pursuant to a contract the enforcement of which can be accomplished by process or penalties. "Inverted domestic corporation", as used in this section, means a foreign incorporated entity which is treated as an inverted domestic corporation under 6 U.S.C. 395(b), i.e., a corporation that used to be incorporated in the United States, or used to be a partnership in the United States, but now is incorporated in a foreign country, or is a subsidiary whose parent corporation is incorporated in a foreign country, that meets the criteria specified in 6 U.S.C. 395(b), applied in accordance with the rules and definitions of 6 U.S.C. 395(c). An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code at 26 U.S.C. 7874. "Manufactured end product" means any end product in Federal Supply Classes (FSC) 1000-9999, except-- (1) FSC 5510, Lumber and Related Basic Wood Materials; (2) Federal Supply Group (FSG) 87, Agricultural Supplies; (3) FSG 88, Live Animals; (4) FSG 89, Food and Related Consumables; (5) FSC 9410, Crude Grades of Plant Materials; (6) FSC 9430, Miscellaneous Crude Animal Products, Inedible; (7) FSC 9440, Miscellaneous Crude Agricultural and Forestry Products; (8) FSC 9610, Ores; (9) FSC 9620, Minerals, Natural and Synthetic; and (10) FSC 9630, Additive Metal Materials. "Place of manufacture" means the place where an end product is assembled out of components, or otherwise made or processed from raw materials into the finished product that is to be provided to the Government. If a product is disassembled and reassembled, the place of reassembly is not the place of manufacture. "Restricted business operations" means business operations in Sudan that include power production activities, mineral extraction activities, oil-related activities, or the production of military equipment, as those terms are defined in the Sudan Accountability and Divestment Act of 2007 (Pub. L. 110-174). Restricted business operations do not include business operations that the person (as that term is defined in Section 2 of the Sudan Accountability and Divestment Act of 2007) conducting the business can demonstrate- (1) Are conducted under contract directly and exclusively with the regional government of southern Sudan; (2) Are conducted pursuant to specific authorization from the Office of Foreign Assets Control in the Department of the Treasury, or are expressly exempted under Federal law from the requirement to be conducted under such authorization; (3) Consist of providing goods or services to marginalized populations of Sudan; (4) Consist of providing goods or services to an internationally recognized peacekeeping force or humanitarian organization; (5) Consist of providing goods or services that are used only to promote health or education; or (6) Have been voluntarily suspended. "Service-disabled veteran-owned small business concern"-- (1) Means a small business concern-- (i) Not less than 51 percent of which is owned by one or more service-disabled veterans or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more service-disabled veterans; and (ii) The management and daily business operations of which are controlled by one or more service-disabled veterans or, in the case of a service-disabled veteran with permanent and severe disability, the spouse or permanent caregiver of such veteran. (2) Service-disabled veteran means a veteran, as defined in 38 U.S.C. 101(2), with a disability that is service-connected, as defined in 38 U.S.C. 101(16). "Small business concern" means a concern, including its affiliates, that is independently owned and operated, not dominant in the field of operation in which it is bidding on Government contracts, and qualified as a small business under the criteria in 13 CFR Part 121 and size standards in this solicitation. "Subsidiary" means an entity in which more than 50 percent of the entity is owned-- (1) Directly by a parent corporation; or (2) Through another subsidiary of a parent corporation. "Veteran-owned small business concern" means a small business concern-- (1) Not less than 51 percent of which is owned by one or more veterans (as defined at 38 U.S.C. 101(2)) or, in the case of any publicly owned business, not less than 51 percent of the stock of which is owned by one or more veterans; and (2) The management and daily business operations of which are controlled by one or more veterans. "Women-owned business concern" means a concern which is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women. "Women-owned small business concern" means a small business concern-- (1) That is at least 51 percent owned by one or more women; or, in the case of any publicly owned business, at least 51 percent of the stock of which is owned by one or more women; and (2) Whose management and daily business operations are controlled by one or more women. "Women-owned small business (WOSB) concern eligible under the WOSB Program" (in accordance with 13 CFR part 127), means a small business concern that is at least 51 percent directly and unconditionally owned by, and the management and daily business operations of which are controlled by, one or more women who are citizens of the United States. (b)(1) Annual Representations and Certifications. Any changes provided by the offeror in paragraph (b)(2) of this provision do not automatically change the representations and certifications posted on the Online Representations and Certifications Application (ORCA) website. (2) The offeror has completed the annual representations and certifications electronically via the ORCA website at . After reviewing the ORCA database information, the offeror verifies by submission of this offer that the representations and certifications currently posted electronically at FAR 52.212-3, Offeror Representations and Certifications--Commercial Items, have been entered or updated in the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201), except for paragraphs N/A. (c) Offerors must complete the following representations when the resulting contract will be performed in the United States or its outlying areas. Check all that apply. (1) Small business concern. The offeror represents as part of its offer that it [ ] is, [ ] is not a small business concern. (2) Veteran-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a veteran-owned small business concern. (3) Service-disabled veteran-owned small business concern. [Complete only if the offeror represented itself as a veteran-owned small business concern in paragraph (c)(2) of this provision.] The offeror represents as part of its offer that it [ ] is, [ ] is not a service-disabled veteran-owned small business concern. (4) Small disadvantaged business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, for general statistical purposes, that it [ ] is, [ ] is not a small disadvantaged business concern as defined in 13 CFR 124.1002. (5) Women-owned small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is, [ ] is not a women-owned small business concern. Note: Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold. (6) WOSB concern eligible under the WOSB Program. [Complete only if the offeror represented itself as a women-owned small business concern in paragraph (c)(5) of this provision.] The offeror represents that-- (i) It [ ] is, [ ] is not a WOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(6)(i) of this provision is accurate in reference to the WOSB concern or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the WOSB concern or concerns that are participating in the joint venture:______________.] Each WOSB concern participating in the joint venture shall submit a separate signed copy of the WOSB representation. (7) Economically disadvantaged women-owned small business (EDWOSB) concern. [Complete only if the offeror represented itself as a WOSB concern eligible under the WOSB Program in (c)(6) of this provision.] The offeror represents that-- (i) It [ ] is, [ ] is not an EDWOSB concern eligible under the WOSB Program, has provided all the required documents to the WOSB Repository, and no change in circumstances or adverse decisions have been issued that affects its eligibility; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR part 127, and the representation in paragraph (c)(7)(i) of this provision is accurate in reference to the EDWOSB concern or concerns that are participating in the joint venture. The offeror shall enter the name or names of the EDWOSB concern or concerns that are participating in the joint venture:_______________. Each EDWOSB concern participating in the joint venture shall submit a separate signed copy of the EDWOSB representation. Note to paragraphs (c)(8) and (9): Complete paragraphs (c)(8) and (c)(9) only if this solicitation is expected to exceed the simplified acquisition threshold. (8) Women-owned business concern (other than small business concern). [Complete only if the offeror is a women-owned business concern and did not represent itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents that it [ ] is a women-owned business concern. (9) Tie bid priority for labor surplus area concerns. If this is an invitation for bid, small business offerors may identify the labor surplus areas in which costs to be incurred on account of manufacturing or production (by offeror or first-tier subcontractors) amount to more than 50 percent of the contract price: ___________________________________________ (10) [Complete only if the solicitation contains the clause at FAR 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns, or FAR 52.219-25, Small Disadvantaged Business Participation Program--Disadvantaged Status and Reporting, and the offeror desires a benefit based on its disadvantaged status.] (i) General. The offeror represents that either-- (A) It [ ] is, [ ] is not certified by the Small Business Administration as a small disadvantaged business concern and identified, on the date of this representation, as a certified small disadvantaged business concern in the CCR Dynamic Small Business Search database maintained by the Small Business Administration, and that no material change in disadvantaged ownership and control has occurred since its certification, and, where the concern is owned by one or more individuals claiming disadvantaged status, the net worth of each individual upon whom the certification is based does not exceed $750,000 after taking into account the applicable exclusions set forth at 13 CFR 124.104(c)(2); or (B) It [ ] has, [ ] has not submitted a completed application to the Small Business Administration or a Private Certifier to be certified as a small disadvantaged business concern in accordance with 13 CFR 124, Subpart B, and a decision on that application is pending, and that no material change in disadvantaged ownership and control has occurred since its application was submitted. (ii) [ ] Joint Ventures under the Price Evaluation Adjustment for Small Disadvantaged Business Concerns. The offeror represents, as part of its offer, that it is a joint venture that complies with the requirements in 13 CFR 124.1002(f) and that the representation in paragraph (c)(10)(i) of this provision is accurate for the small disadvantaged business concern that is participating in the joint venture. [The offeror shall enter the name of the small disadvantaged business concern that is participating in the joint venture: ___________________.] (11) HUBZone small business concern. [Complete only if the offeror represented itself as a small business concern in paragraph (c)(1) of this provision.] The offeror represents, as part of its offer, that-- (i) It [ ] is, [ ] is not a HUBZone small business concern listed, on the date of this representation, on the List of Qualified HUBZone Small Business Concerns maintained by the Small Business Administration, and no material change in ownership and control, principal office, or HUBZone employee percentage has occurred since it was certified by the Small Business Administration in accordance with 13 CFR Part 126; and (ii) It [ ] is, [ ] is not a joint venture that complies with the requirements of 13 CFR Part 126, and the representation in paragraph (c)(11)(i) of this provision is accurate for the HUBZone small business concern or concerns that are participating in the joint venture. [The offeror shall enter the name or names of the HUBZone small business concern or concerns that are participating in the joint venture:____________.] Each HUBZone small business concern participating in the joint venture shall submit a separate signed copy of the HUBZone representation. (d) Representations required to implement provisions of Executive Order 11246-- (1) Previous contracts and compliance. The offeror represents that-- (i) It [ ] has, [ ] has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; and (ii) It [ ] has, [ ] has not filed all required compliance reports. (2) Affirmative Action Compliance. The offeror represents that-- (i) It [ ] has developed and has on file, [ ] has not developed and does not have on file, at each establishment, affirmative action programs required by rules and regulations of the Secretary of Labor (41 CFR parts 60-1 and 60-2), or (ii) It [ ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (e) Certification Regarding Payments to Influence Federal Transactions (31 U.S.C. 1352). (Applies only if the contract is expected to exceed $150,000.) By submission of its offer, the offeror certifies to the best of its knowledge and belief that no Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress or an employee of a Member of Congress on his or her behalf in connection with the award of any resultant contract. If any registrants under the Lobbying Disclosure Act of 1995 have made a lobbying contact on behalf of the offeror with respect to this contract, the offeror shall complete and submit, with its offer, OMB Standard Form LLL, Disclosure of Lobbying Activities, to provide the name of the registrants. The offeror need not report regularly employed officers or employees of the offeror to whom payments of reasonable compensation were made. (f) Buy American Act Certificate. (Applies only if the clause at Federal Acquisition Regulation (FAR) 52.225-1, Buy American Act--Supplies, is included in this solicitation.) (1) The offeror certifies that each end product, except those listed in paragraph (f)(2) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The offeror shall list as foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of "domestic end product." The terms "commercially available off-the-shelf (COTS) item," "component," "domestic end product," "end product," "foreign end product," and "United States" are defined in the clause of this solicitation entitled "Buy American Act--Supplies." (2) Foreign End Products: Line Item No Country of Origin ______________ _________________ ______________ _________________ ______________ _________________ [List as necessary] (3) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (g)(1) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate. (Applies only if the clause at FAR 52.225-3, Buy American Act--Free Trade Agreements--Israeli Trade Act, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(1)(ii) or (g)(1)(iii) of this provision, is a domestic end product and that for other than COTS items, the offeror has considered components of unknown origin to have been mined, produced, or manufactured outside the United States. The terms "Bahrainian, Moroccan, Omani, or Peruvian end product," "commercially available off-the-shelf (COTS) item," "component," "domestic end product," "end product," "foreign end product," "Free Trade Agreement country," "Free Trade Agreement country end product," "Israeli end product," and "United States" are defined in the clause of this solicitation entitled "Buy American Act-Free Trade Agreements-Israeli Trade Act." (ii) The offeror certifies that the following supplies are Free Trade Agreement country end products (other than Bahrainian, Moroccan, Omani, or Peruvian end products) or Israeli end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Free Trade Agreement Country End Products (Other than Bahrainian, Moroccan, Omani, or Peruvian End Products) or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________ [List as necessary] (iii) The offeror shall list those supplies that are foreign end products (other than those listed in paragraph (g)(1)(ii) of this provision) as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act." The offeror shall list as other foreign end products those end products manufactured in the United States that do not qualify as domestic end products, i.e., an end product that is not a COTS item and does not meet the component test in paragraph (2) of the definition of "domestic end product." Other Foreign End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________ [List as necessary] (iv) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. (2) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate I. If Alternate I to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Canadian End Products: Line Item No. __________________________________________ __________________________________________ __________________________________________ [List as necessary] (3) Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate, Alternate II. If Alternate II to the clause at FAR 52.225-3 is included in this solicitation, substitute the following paragraph (g)(1)(ii) for paragraph (g)(1)(ii) of the basic provision: (g)(1)(ii) The offeror certifies that the following supplies are Canadian end products or Israeli end products as defined in the clause of this solicitation entitled "Buy American Act--Free Trade Agreements--Israeli Trade Act": Canadian or Israeli End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________ [List as necessary] (4) Trade Agreements Certificate. (Applies only if the clause at FAR 52.225-5, Trade Agreements, is included in this solicitation.) (i) The offeror certifies that each end product, except those listed in paragraph (g)(4)(ii) of this provision, is a U.S.-made, designated country end product, as defined in the clause of this solicitation entitled "Trade Agreements." (ii) The offeror shall list as other end products those end products that are not U.S.-made or designated country, end products. Other End Products: Line Item No. Country of Origin ______________ _________________ ______________ _________________ ______________ _________________ [List as necessary] (iii) The Government will evaluate offers in accordance with the policies and procedures of FAR Part 25. For line items covered by the WTO GPA, the Government will evaluate offers of U.S.-made or designated country end products without regard to the restrictions of the Buy American Act. The Government will consider for award only offers of U.S.-made or designated country end products unless the Contracting Officer determines that there are no offers for such products or that the offers for such products are insufficient to fulfill the requirements of the solicitation. (h) Certification Regarding Responsibility Matters (Executive Order 12689). (Applies only if the contract value is expected to exceed the simplified acquisition threshold.) The offeror certifies, to the best of its knowledge and belief, that the offeror and/or any of its principals-- (1) [ ] Are, [ ] are not presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (2) [ ] Have, [ ] have not, within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a Federal, state or local government contract or subcontract; violation of Federal or state antitrust statutes relating to the submission of offers; or Commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property; (3) [ ] Are, [ ] are not presently indicted for, or otherwise criminally or civilly charged by a Government entity with, commission of any of these offenses enumerated in paragraph (h)(2) of this clause; and (4) [ ] Have, [ ] have not, within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied. (i) Taxes are considered delinquent if both of the following criteria apply: (A) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. (B) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded. (ii) Examples. (A) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (B) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. Sec. 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (C) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment. (D) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code). (i) Certification Regarding Knowledge of Child Labor for Listed End Products (Executive Order 13126). (1) Listed end products. Listed End ProductListed Countries of Origin (2) Certification. [If the Contracting Officer has identified end products and countries of origin in paragraph (i)(1) of this provision, then the offeror must certify to either (i)(2)(i) or (i)(2)(ii) by checking the appropriate block.] [ ] (i) The offeror will not supply any end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. [ ] (ii) The offeror may supply an end product listed in paragraph (i)(1) of this provision that was mined, produced, or manufactured in the corresponding country as listed for that product. The offeror certifies that it has made a good faith effort to determine whether forced or indentured child labor was used to mine, produce, or manufacture any such end product furnished under this contract. On the basis of those efforts, the offeror certifies that it is not aware of any such use of child labor. (j) Place of manufacture. (Does not apply unless the solicitation is predominantly for the acquisition of manufactured end products.) For statistical purposes only, the offeror shall indicate whether the place of manufacture of the end products it expects to provide in response to this solicitation is predominantly-- (1) __ In the United States (Check this box if the total anticipated price of offered end products manufactured in the United States exceeds the total anticipated price of offered end products manufactured outside the United States); or (2) __ Outside the United States. (k) Certificates regarding exemptions from the application of the Service Contract Act. (Certification by the offeror as to its compliance with respect to the contract also constitutes its certification as to compliance by its subcontractor if it subcontracts out the exempt services.) [ ] (1) Maintenance, calibration, or repair of certain equipment as described in FAR 22.1003-4(c)(1). The offeror [ ] does [ ] does not certify that-- (i) The items of equipment to be serviced under this contract are used regularly for other than Governmental purposes and are sold or traded by the offeror (or subcontractor in the case of an exempt subcontract) in substantial quantities to the general public in the course of normal business operations; (ii) The services will be furnished at prices which are, or are based on, established catalog or market prices (see FAR 22.1003- 4(c)(2)(ii)) for the maintenance, calibration, or repair of such equipment; and (iii) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract will be the same as that used for these employees and equivalent employees servicing the same equipment of commercial customers. [ ] (2) Certain services as described in FAR 22.1003- 4(d)(1). The offeror [ ] does [ ] does not certify that-- (i) The services under the contract are offered and sold regularly to non-Governmental customers, and are provided by the offeror (or subcontractor in the case of an exempt subcontract) to the general public in substantial quantities in the course of normal business operations; (ii) The contract services will be furnished at prices that are, or are based on, established catalog or market prices (see FAR 22.1003-4(d)(2)(iii)); (iii) Each service employee who will perform the services under the contract will spend only a small portion of his or her time (a monthly average of less than 20 percent of the available hours on an annualized basis, or less than 20 percent of available hours during the contract period if the contract period is less than a month) servicing the Government contract; and (iv) The compensation (wage and fringe benefits) plan for all service employees performing work under the contract is the same as that used for these employees and equivalent employees servicing commercial customers. (3) If paragraph (k)(1) or (k)(2) of this clause applies-- (i) If the offeror does not certify to the conditions in paragraph (k)(1) or (k)(2) and the Contracting Officer did not attach a Service Contract Act wage determination to the solicitation, the offeror shall notify the Contracting Officer as soon as possible; and (ii) The Contracting Officer may not make an award to the offeror if the offeror fails to execute the certification in paragraph (k)(1) or (k)(2) of this clause or to contact the Contracting Officer as required in paragraph (k)(3)(i) of this clause. (l) Taxpayer Identification Number (TIN) (26 U.S.C. 6109, 31 U.S.C. 7701). (Not applicable if the offeror is required to provide this information to a central contractor registration database to be eligible for award.) (1) All offerors must submit the information required in paragraphs (l)(3) through (l)(5) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the Internal Revenue Service (IRS). (2) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resulting contract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN. (3) Taxpayer Identification Number (TIN). [ ] TIN: _____________________. [ ] TIN has been applied for. [ ] TIN is not required because: [ ] Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; [ ] Offeror is an agency or instrumentality of a foreign government; [ ] Offeror is an agency or instrumentality of the Federal Government. (4) Type of organization. [ ] Sole proprietorship; [ ] Partnership; [ ] Corporate entity (not tax-exempt); [ ] Corporate entity (tax-exempt); [ ] Government entity (Federal, State, or local); [ ] Foreign government; [ ] International organization per 26 CFR 1.6049-4; [ ] Other _________________________. (5) Common parent. [ ] Offeror is not owned or controlled by a common parent; [ ] Name and TIN of common parent: Name _____________________. TIN _____________________. (m) Restricted business operations in Sudan. By submission of its offer, the offeror certifies that the offeror does not conduct any restricted business operations in Sudan. (n) Prohibition on Contracting with Inverted Domestic Corporations--(1) Relation to Internal Revenue Code. An inverted domestic corporation as herein defined does not meet the definition of an inverted domestic corporation as defined by the Internal Revenue Code 25 U.S.C. 7874. (2) Representation. By submission of its offer, the offeror represents that-- (i) It is not an inverted domestic corporation; and (ii) It is not a subsidiary of an inverted domestic corporation. (o) Sanctioned activities relating to Iran. (1) Unless a waiver is granted or an exception applies as provided in paragraph (o)(2) of this provision, by submission of its offer, the offeror certifies that the offeror, or any person owned or controlled by the offeror, does not engage in any activities for which sanctions may be imposed under section 5 of the Iran Sanctions Act of 1996. (2) The certification requirement of paragraph (o)(1) of this provision does not apply if-- (i) This solicitation includes a trade agreements certification (e.g., 52.212-3(g) or a comparable agency provision); and (ii) The offeror has certified that all the offered products to be supplied are designated country end products. (End of Provision) E.4 52.203-2 CERTIFICATE OF INDEPENDENT PRICE DETERMINATION (APR 1985) (a) The offeror certifies that-- (1) The prices in this offer have been arrived at independently, without, for the purpose of restricting competition, any consultation, communication, or agreement with any other offeror or competitor relating to-- (i) those prices; (ii) the intention to submit an offer;, or (iii) the methods or factors used to calculate the prices offered; (2) The prices in this offer have not been and will not be knowingly disclosed by the offeror, directly or indirectly, to any other offeror or competitor before bid opening (in the case of a sealed bid solicitation) or contract award (in the case of a negotiated solicitation) unless otherwise required by law; and (3) No attempt has been made or will be made by the offeror to induce any other concern to submit or not to submit an offer for the purpose of restricting competition. (b) Each signature on the offer is considered to be a certification by the signatory that the signatory-- (1) Is the person in the offeror's organization responsible for determining the prices being offered in this bid or proposal, and that the signatory has not participated and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) above; or (2) (i) Has been authorized, in writing, to act as agent for the following principals in certifying that those principals have not participated, and will not participate in any action contrary to subparagraphs (a)(1) through (a)(3) above ____________________________________________ ____________________________________________ ____________________________________________ [Insert full name of person(s) in the offeror's organization responsible for determining the prices offered in the bid or proposal, and the title of his or her position in the offeror's organization]; (ii) As an authorized agent, does certify that the principals named in subdivision (b)(2)(i) above have not participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) above; and (iii) As an agent, has not personally participated, and will not participate, in any action contrary to subparagraphs (a)(1) through (a)(3) above. (c) If the offeror deletes or modifies subparagraph (a)(2) of this provision, the offeror must furnish with its offer a signed statement setting forth in detail the circumstances of the disclosure. (End of Provision) E.5 52.204-3 TAXPAYER IDENTIFICATION (OCT 1998) (a) Definitions. "Common parent," as used in this provision, means that corporate entity that owns or controls an affiliated group of corporations that files its Federal income tax returns on a consolidated basis, and of which the offeror is a member. "Taxpayer Identification Number (TIN)," as used in this provision, means the number required by the Internal Revenue Service (IRS) to be used by the offeror in reporting income tax and other returns. The TIN may be either a Social Security Number or an Employer Identification Number. (b) All offerors must submit the information required in paragraphs (d) through (f) of this provision to comply with debt collection requirements of 31 U.S.C. 7701(c) and 3325(d), reporting requirements of 26 U.S.C. 6041, 6041A, and 6050M, and implementing regulations issued by the IRS. If the resulting contract is subject to the payment reporting requirements described in Federal Acquisition Regulation (FAR) 4.904, the failure or refusal by the offeror to furnish the information may result in a 31 percent reduction of payments otherwise due under the contract. (c) The TIN may be used by the Government to collect and report on any delinquent amounts arising out of the offeror's relationship with the Government (31 U.S.C. 7701(c)(3)). If the resultingcontract is subject to the payment reporting requirements described in FAR 4.904, the TIN provided hereunder may be matched with IRS records to verify the accuracy of the offeror's TIN. (d) Taxpayer Identification Number (TIN). [ ] TIN:. ____________________________ [ ] TIN has been applied for. [ ] TIN is not required because: [ ] Offeror is a nonresident alien, foreign corporation, or foreign partnership that does not have income effectively connected with the conduct of a trade or business in the United States and does not have an office or place of business or a fiscal paying agent in the United States; [ ] Offeror is an agency or instrumentality of a foreign government; [ ] Offeror is an agency or instrumentality of the Federal Government. (e) Type of organization. [ ] Sole proprietorship; [ ] Partnership; [ ] Corporate entity (not tax-exempt); [ ] Corporate entity (tax-exempt); [ ] Government entity (Federal, State, or local); [ ] Foreign government; [ ] International organization per 26 CFR 1.6049-4; [ ] Other ___________________________________________ (f) Common parent. [ ] Offeror is not owned or controlled by a common parent as defined in paragraph (a) of this provision. [ ] Name and TIN of common parent: Name ____________________________________________________ TIN ____________________________________________________ (End of Provision) E.6 52.204-5 WOMEN-OWNED BUSINESS (OTHER THAN SMALL BUSINESS) (MAY 1999) (a) Definition. Women-owned business concern, as used in this provision, means a concern that is at least 51 percent owned by one or more women; or in the case of any publicly owned business, at least 51 percent of its stock is owned by one or more women; and whose management and daily business operations are controlled by one or more women. (b) Representation. [Complete only if the offeror is a women-owned business concern and has not represented itself as a small business concern in paragraph (b)(1) of FAR 52.219-1, Small Business Program Representations, of this solicitation.] The offeror represents that it [ ] is a women-owned business concern. (End of Provision) E.7 52.204-6 DATA UNIVERSAL NUMBERING SYSTEM (DUNS) NUMBER (APR 2008) (a) The offeror shall enter, in the block with its name and address on the cover page of its offer, the annotation "DUNS" or "DUNS+4" followed by the DUNS number or "DUNS+4" that identifies the offeror's name and address exactly as stated in the offer. The DUNS number is a nine-digit number assigned by Dun and Bradstreet, Inc. The DUNS+4 is the DUNS number plus a 4-character suffix that may be assigned at the discretion of the offeror to establish additional CCR records for identifying alternative Electronic Funds Transfer (EFT) accounts (see Subpart 32.11) for the same concern. (b) If the offeror does not have a DUNS number, it should contact Dun and Bradstreet directly to obtain one. (1) An offeror may obtain a DUNS number-- (i) Via the Internet at or if the offeror does not have internet access, it may call Dun and Bradstreet at 1-866-705-5711 if located within the United States; or (ii) If located outside the United States, by contacting the local Dun and Bradstreet office. The offeror should indicate that it is an offeror for a U.S. Government contract when contacting the local Dun and Bradstreet office. (2) The offeror should be prepared to provide the following information: (i) Company legal business name. (ii) Tradestyle, doing business, or other name by which your entity is commonly recognized. (iii) Company physical street address, city, state and Zip Code. (iv) Company mailing address, city, state and Zip Code (if separate from physical). (v) Company telephone number. (vi) Date the company was started. (vii) Number of employees at your location. (viii) Chief executive officer/key manager. (ix) Line of business (industry). (x) Company Headquarters name and address (reporting relationship within your entity). (End of Provision) E.8 52.204-8 ANNUAL REPRESENTATIONS AND CERTIFICATIONS (MAY 2011) (a)(1) The North American Industry Classification System (NAICS) code for this acquisition is 622110. (2) The small business size standard is $34.5 Million. (3) The small business size standard for a concern which submits an offer in its own name, other than on a construction or service contract, but which proposes to furnish a product which it did not itself manufacture, is 500 employees. (b)(1) If the clause at 52.204-7, Central Contractor Registration, is included in this solicitation, paragraph (d) of this provision applies. (2) If the clause at 52.204-7 is not included in this solicitation, and the offeror is currently registered in CCR, and has completed the ORCA electronically, the offeror may choose to use paragraph (d) of this provision instead of completing the corresponding individual representations and certifications in the solicitation. The offeror shall indicate which option applies by checking one of the following boxes: [ ] (i) Paragraph (d) applies. [ ] (ii) Paragraph (d) does not apply and the offeror has completed the individual representations and certifications in the solicitation. (c)(1) The following representations or certifications in ORCA are applicable to this solicitation as indicated: (i) 52.203-2, Certificate of Independent Price Determination. This provision applies to solicitations when a firm-fixed-price contract or fixed-price contract with economic price adjustment is contemplated, unless-- (A) The acquisition is to be made under the simplified acquisition procedures in Part 13; (B) The solicitation is a request for technical proposals under two-step sealed bidding procedures; or (C) The solicitation is for utility services for which rates are set by law or regulation. (ii) 52.203-11, Certification and Disclosure Regarding Payments to Influence Certain Federal Transactions. This provision applies to solicitations expected to exceed $150,000. (iii) 52.204-3, Taxpayer Identification. This provision applies to solicitations that do not include the clause at 52.204-7, Central Contractor Registration. (iv) 52.204-5, Women-Owned Business (Other Than Small Business). This provision applies to solicitations that-- (A) Are not set aside for small business concerns; (B) Exceed the simplified acquisition threshold; and (C) Are for contracts that will be performed in the United States or its outlying areas. (v) 52.209-2, Prohibition on Contracting with Inverted Domestic Corporations--Representation. This provision applies to solicitations using funds appropriated in fiscal years 2008, 2009, or 2010. (vi) 52.209-5, Certification Regarding Responsibility Matters. This provision applies to solicitations where the contract value is expected to exceed the simplified acquisition threshold. (vii) 52.214-14, Place of Performance--Sealed Bidding. This provision applies to invitations for bids except those in which the place of performance is specified by the Government. (viii) 52.215-6, Place of Performance. This provision applies to solicitations unless the place of performance is specified by the Government. (ix) 52.219-1, Small Business Program Representations (Basic & Alternate I). This provision applies to solicitations when the contract will be performed in the United States or its outlying areas. (A) The basic provision applies when the solicitations are issued by other than DoD, NASA, and the Coast Guard. (B) The provision with its Alternate I applies to solicitations issued by DoD, NASA, or the Coast Guard. (x) 52.219-2, Equal Low Bids. This provision applies to solicitations when contracting by sealed bidding and the contract will be performed in the United States or its outlying areas. (xi) 52.222-22, Previous Contracts and Compliance Reports. This provision applies to solicitations that include the clause at 52.222-26, Equal Opportunity. (xii) 52.222-25, Affirmative Action Compliance. This provision applies to solicitations, other than those for construction, when the solicitation includes the clause at 52.222-26, Equal Opportunity. (xiii) 52.222-38, Compliance with Veterans' Employment Reporting Requirements. This provision applies to solicitations when it is anticipated the contract award will exceed the simplified acquisition threshold and the contract is not for acquisition of commercial items. (xiv) 52.223-1, Biobased Product Certification. This provision applies to solicitations that require the delivery or specify the use of USDA-designated items; or include the clause at 52.223-2, Affirmative Procurement of Biobased Products Under Service and Construction Contracts. (xv) 52.223-4, Recovered Material Certification. This provision applies to solicitations that are for, or specify the use of, EPA-designated items. (xvi) 52.225-2, Buy American Act Certificate. This provision applies to solicitations containing the clause at 52.225-1. (xvii) 52.225-4, Buy American Act--Free Trade Agreements--Israeli Trade Act Certificate. (Basic, Alternate I, and Alternate II) This provision applies to solicitations containing the clause at 52.225-3. (A) If the acquisition value is less than $25,000, the basic provision applies. (B) If the acquisition value is $25,000 or more but is less than $50,000, the provision with its Alternate I applies. (C) If the acquisition value is $50,000 or more but is less than $67,826, the provision with its Alternate II applies. (xviii) 52.225-6, Trade Agreements Certificate. This provision applies to solicitations containing the clause at 52.225-5. (xix) 52.225-20, Prohibition on Conducting Restricted Business Operations in Sudan--Certification. This provision applies to all solicitations. (xx) 52.225-25, Prohibition on Engaging in Sanctioned Activities Relating to Iran--Certification. This provision applies to all solicitations. (xxi) 52.226-2, Historically Black College or University and Minority Institution Representation. This provision applies to-- (A) Solicitations for research, studies, supplies, or services of the type normally acquired from higher educational institutions; and (B) For DoD, NASA, and Coast Guard acquisitions, solicitations that contain the clause at 52.219-23, Notice of Price Evaluation Adjustment for Small Disadvantaged Business Concerns. (2) The following certifications are applicable as indicated by the Contracting Officer: [](i) 52.219-22, Small Disadvantaged Business Status. [](A) Basic. [](B) Alternate I. [](ii) 52.222-18, Certification Regarding Knowledge of Child Labor for Listed End Products. [](iii) 52.222-48, Exemption from Application of the Service Contract Act to Contracts for Maintenance, Calibration, or Repair of Certain Equipment Certification. [](iv) 52.222-52 Exemption from Application of the Service Contract Act to Contracts for Certain Services--Certification. [](v) 52.223-9, with its Alternate I, Estimate of Percentage of Recovered Material Content for EPA-Designated Products (Alternate I only). [](vi) 52.227-6, Royalty Information. [](A) Basic. [](B) Alternate I. [](vii) 52.227-15, Representation of Limited Rights Data and Restricted Computer Software. (d) The offeror has completed the annual representations and certifications electronically via the Online Representations and Certifications Application (ORCA) website at . After reviewing the ORCA database information, the offeror verifies by submission of the offer that the representations and certifications currently posted electronically that apply to this solicitation as indicated in paragraph (c) of this provision have been entered or updated within the last 12 months, are current, accurate, complete, and applicable to this solicitation (including the business size standard applicable to the NAICS code referenced for this solicitation), as of the date of this offer and are incorporated in this offer by reference (see FAR 4.1201); except for the changes identified below [offeror to insert changes, identifying change by clause number, title, date]. These amended representation(s) and/or certification(s) are also incorporated in this offer and are current, accurate, and complete as of the date of this offer. ------------------------------------------------------------------------FAR Clause #TitleDateChange ---------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ Any changes provided by the offeror are applicable to this solicitation only, and do not result in an update to the representations and certifications posted on ORCA. (End of Provision) E.9 52.209-5 CERTIFICATION REGARDING RESPONSIBILITY MATTERS (APR 2010) (a)(1) The Offeror certifies, to the best of its knowledge and belief, that - (i) The Offeror and/or any of its Principals - (A) Are [ ] are not [ ] presently debarred, suspended, proposed for debarment, or declared ineligible for the award of contracts by any Federal agency; (B) Have [ ] have not [ ], within a three-year period preceding this offer, been convicted of or had a civil judgment rendered against them for: commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (Federal, State, or local) contract or subcontract; violation of Federal or State antitrust statutes relating to the submission of offers; or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, tax evasion, violating Federal criminal tax laws, or receiving stolen property (if offeror checks "have," the offeror shall also see 52.209-7, if included in this solicitation); (C) Are [ ] are not [ ] presently indicted for, or otherwise criminally or civilly charged by a governmental entity with, commission of any of the offenses enumerated in subdivision (a)(1)(i)(B) of this provision; and (D) Have [ ], have not [ ], within a three-year period preceding this offer, been notified of any delinquent Federal taxes in an amount that exceeds $3,000 for which the liability remains unsatisfied. (1) Federal taxes are considered delinquent if both of the following criteria apply: (i) The tax liability is finally determined. The liability is finally determined if it has been assessed. A liability is not finally determined if there is a pending administrative or judicial challenge. In the case of a judicial challenge to the liability, the liability is not finally determined until all judicial appeal rights have been exhausted. (ii) The taxpayer is delinquent in making payment. A taxpayer is delinquent if the taxpayer has failed to pay the tax liability when full payment was due and required. A taxpayer is not delinquent in cases where enforced collection action is precluded. (2) Examples. (i) The taxpayer has received a statutory notice of deficiency, under I.R.C. Sec. 6212, which entitles the taxpayer to seek Tax Court review of a proposed tax deficiency. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek Tax Court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (ii) The IRS has filed a notice of Federal tax lien with respect to an assessed tax liability, and the taxpayer has been issued a notice under I.R.C. Sec. 6320 entitling the taxpayer to request a hearing with the IRS Office of Appeals contesting the lien filing, and to further appeal to the Tax Court if the IRS determines to sustain the lien filing. In the course of the hearing, the taxpayer is entitled to contest the underlying tax liability because the taxpayer has had no prior opportunity to contest the liability. This is not a delinquent tax because it is not a final tax liability. Should the taxpayer seek tax court review, this will not be a final tax liability until the taxpayer has exercised all judicial appeal rights. (iii) The taxpayer has entered into an installment agreement pursuant to I.R.C. Sec. 6159. The taxpayer is making timely payments and is in full compliance with the agreement terms. The taxpayer is not delinquent because the taxpayer is not currently required to make full payment. (iv) The taxpayer has filed for bankruptcy protection. The taxpayer is not delinquent because enforced collection action is stayed under 11 U.S.C. 362 (the Bankruptcy Code). (ii) The Offeror has [ ] has not [ ], within a 3-year period preceding this offer, had one or more contracts terminated for default by any Federal agency. (2) Principal, for the purposes of this certification, means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). THIS CERTIFICATION CONCERNS A MATTER WITHIN THE JURISDICTION OF AN AGENCY OF THE UNITED STATES AND THE MAKING OF A FALSE, FICTITIOUS, OR FRAUDULENT CERTIFICATION MAY RENDER THE MAKER SUBJECT TO PROSECUTION UNDER SECTION 1001, TITLE 18, UNITED STATES CODE. (b) The Offeror shall provide immediate written notice to the Contracting Officer if, at any time prior to contract award, the Offeror learns that its certification was erroneous when submitted or has become erroneous by reason of changed circumstances. (c) A certification that any of the items in paragraph (a) of this provision exists will not necessarily result in withholding of an award under this solicitation. However, the certification will be considered in connection with a determination of the Offeror's responsibility. Failure of the Offeror to furnish a certification or provide such additional information as requested by the Contracting Officer may render the Offeror nonresponsible. (d) Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render, in good faith, the certification required by paragraph (a) of this provision. The knowledge and information of an Offeror is not required to exceed that which is normally possessed by a prudent person in the ordinary course of business dealings. (e) The certification in paragraph (a) of this provision is a material representation of fact upon which reliance was placed when making award. If it is later determined that the Offeror knowingly rendered an erroneous certification, in addition to other remedies available to the Government, the Contracting Officer may terminate the contract resulting from this solicitation for default. (End of Provision) E.10 52.209-7 INFORMATION REGARDING RESPONSIBILITY MATTERS (JAN 2011) (a) Definitions. As used in this provision-- "Administrative proceeding" means a non-judicial process that is adjudicatory in nature in order to make a determination of fault or liability (e.g., Securities and Exchange Commission Administrative Proceedings, Civilian Board of Contract Appeals Proceedings, and Armed Services Board of Contract Appeals Proceedings). This includes administrative proceedings at the Federal and State level but only in connection with performance of a Federal contract or grant. It does not include agency actions such as contract audits, site visits, corrective plans, or inspection of deliverables. "Federal contracts and grants with total value greater than $10,000,000" means-- (1) The total value of all current, active contracts and grants, including all priced options; and (2) The total value of all current, active orders including all priced options under indefinite-delivery, indefinite-quantity, 8(a), or requirements contracts (including task and delivery and multiple-award Schedules). "Principal" means an officer, director, owner, partner, or a person having primary management or supervisory responsibilities within a business entity (e.g., general manager; plant manager; head of a division or business segment; and similar positions). (b) The offeror [ ] has [ ] does not have current active Federal contracts and grants with total value greater than $10,000,000. (c) If the offeror checked "has" in paragraph (b) of this provision, the offeror represents, by submission of this offer, that the information it has entered in the Federal Awardee Performance and Integrity Information System (FAPIIS) is current, accurate, and complete as of the date of submission of this offer with regard to the following information: (1) Whether the offeror, and/or any of its principals, has or has not, within the last five years, in connection with the award to or performance by the offeror of a Federal contract or grant, been the subject of a proceeding, at the Federal or State level that resulted in any of the following dispositions: (i) In a criminal proceeding, a conviction. (ii) In a civil proceeding, a finding of fault and liability that results in the payment of a monetary fine, penalty, reimbursement, restitution, or damages of $5,000 or more. (iii) In an administrative proceeding, a finding of fault and liability that results in-- (A) The payment of a monetary fine or penalty of $5,000 or more; or (B) The payment of a reimbursement, restitution, or damages in excess of $100,000. (iv) In a criminal, civil, or administrative proceeding, a disposition of the matter by consent or compromise with an acknowledgment of fault by the Contractor if the proceeding could have led to any of the outcomes specified in paragraphs (c)(1)(i), (c)(1)(ii), or (c)(1)(iii) of this provision. (2) If the offeror has been involved in the last five years in any of the occurrences listed in (c)(1) of this provision, whether the offeror has provided the requested information with regard to each occurrence. (d) The offeror shall post the information in paragraphs (c)(1)(i) through (c)(1)(iv) of this provision in FAPIIS as required through maintaining an active registration in the Central Contractor Registration database at (see 52.204-7). (End of Provision) E.11 52.216-1 TYPE OF CONTRACT (APR 1984) The Government contemplates award of a Firm Fixed Price, Indefinite Delivery Indefinite Quantity (IDIQ) contract resulting from this solicitation. (End of Provision)E.12 52.216-27 SINGLE OR MULTIPLE AWARDS (OCT 1995) The Government may elect to award a single delivery order contract or task order contract or to award multiple delivery order contracts or task order contracts for the same or similar supplies or services to two or more sources under this solicitation. (End of Provision)C.13 52.222-22 PREVIOUS CONTRACTS AND COMPLIANCE REPORTS (FEB 1999) The offeror represents that-- (a) It [ ] has, [ ] has not participated in a previous contract or subcontract subject to the Equal Opportunity clause of this solicitation; the clause originally contained in Section 310 of Executive Order No. 10925, or the clause contained in Section 201 of Executive Order No. 11114; (b) It [ ] has, [ ] has not filed all required compliance reports; and (c) Representations indicating submission of required compliance reports, signed by proposed subcontractors, will be obtained before subcontract awards. (End of Provision) C.14 52.222-25 AFFIRMATIVE ACTION COMPLIANCE (APR 1984) The offeror represents that-- (a) It [ ] has developed and has on file, [ ] has not developed and does not have on file, at each establishment, affirmative action programs required by the rules and regulations of the Secretary of Labor (41 CFR 60-1 and 60-2), or (b) It [ ] has not previously had contracts subject to the written affirmative action programs requirement of the rules and regulations of the Secretary of Labor. (End of Provision)E.15 VAAR 852.233-70 PROTEST CONTENT/ALTERNATIVE DISPUTE RESOLUTION (JAN 2008) (a) Any protest filed by an interested party shall: (1) Include the name, address, fax number, and telephone number of the protester; (2) Identify the solicitation and/or contract number; (3) Include an original signed by the protester or the protester's representative and at least one copy; (4) Set forth a detailed statement of the legal and factual grounds of the protest, including a description of resulting prejudice to the protester, and provide copies of relevant documents; (5) Specifically request a ruling of the individual upon whom the protest is served; (6) State the form of relief requested; and (7) Provide all information establishing the timeliness of the protest. (b) Failure to comply with the above may result in dismissal of the protest without further consideration. (c) Bidders/offerors and contracting officers are encouraged to use alternative dispute resolution (ADR) procedures to resolve protests at any stage in the protest process. If ADR is used, the Department of Veterans Affairs will not furnish any documentation in an ADR proceeding beyond what is allowed by the Federal Acquisition Regulation. (End of Provision) E.16 VAAR 852.233-71 ALTERNATE PROTEST PROCEDURE (JAN 1998) As an alternative to filing a protest with the contracting officer, an interested party may file a protest with the Deputy Assistant Secretary for Acquisition and Materiel Management, Acquisition Administration Team, Department of Veterans Affairs, 810 Vermont Avenue, NW., Washington, DC 20420, or for solicitations issued by the Office of Construction and Facilities Management, the Director, Office of Construction and Facilities Management, 810 Vermont Avenue, NW., Washington, DC 20420. The protest will not be considered if the interested party has a protest on the same or similar issues pending with the contracting officer. (End of Provision) E.17 VAAR 852.252-70 SOLICITATION PROVISIONS OR CLAUSES INCORPORATED BY REFERENCE (JAN 2008) The following provisions or clauses incorporated by reference in this solicitation must be completed by the offeror or prospective contractor and submitted with the quotation or offer. Copies of these provisions or clauses are available on the Internet at the Web sites provided in the provision at FAR 52.252-1, Solicitation Provisions Incorporated by Reference, or the clause at FAR 52.252-2, Clauses Incorporated by Reference. Copies may also be obtained from the contracting officer. (End of Provision) E.18 VAAR 852.270-1 REPRESENTATIVES OF CONTRACTING OFFICERS (JAN 2008) The contracting officer reserves the right to designate representatives to act for him/her in furnishing technical guidance and advice or generally monitor the work to be performed under this contract. Such designation will be in writing and will define the scope and limitation of the designee's authority. A copy of the designation shall be furnished to the contractor. (End of Provision) E.19 VAAR 852.271-70 NONDISCRIMINATION IN SERVICES PROVIDED TO BENEFICIARIES (JAN 2008) The contractor agrees to provide all services specified in this contract for any person determined eligible by the Department of Veterans Affairs, regardless of the race, color, religion, sex, or national origin of the person for whom such services are ordered. The contractor further warrants that he/she will not resort to subcontracting as a means of circumventing this provision. (End of Provision) E.20 VAAR 852.273-70 LATE OFFERS (JAN 2003) This provision replaces paragraph (f) of FAR provision 52.212-1. Offers or modifications of offers received after the time set forth in a request for quotations or request for proposals may be considered, at the discretion of the contracting officer, if determined to be in the best interest of the Government. Late bids submitted in response to an invitation for bid (IFB) will not be considered. (End of Provision) E.21 VAAR 852.273-74 AWARD WITHOUT EXCHANGES (JAN 2003) The Government intends to evaluate proposals and award a contract without exchanges with offerors. Therefore, each initial offer should contain the offeror's best terms from a cost or price and technical standpoint. However, the Government reserves the right to conduct exchanges if later determined by the contracting officer to be necessary. (End of Provision) ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download