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![Page 1: A D D E N D U M # [Insert Number]...15 CBC (DIFF/PLT) 85025 1,300 $ - 16 HEP B SURF AG W/CONF 87340 1,300 $ - 17 VIT D 25OH LC/MS/MS 82306 1,300 $ - 18 BASIC METAB PNL 80048 1,000](https://reader033.dokumen.tips/reader033/viewer/2022050501/5f93a9244db57d560d439f51/html5/thumbnails/1.jpg)
A D D E N D U M # 1
M U L T N O M A H C O U N T Y O R E G O N
June 19, 2013
Address all questions to: Catherine Kwong, CPPB
Multnomah County Purchasing 501 SE Hawthorne Boulevard, Suite 400
Portland, OR 97214 503-988-5111, Extension 24151 [email protected]
RFP NO: 4000001576
TITLE: Medical Laboratory Services
NEW CLOSING DATE:
July 1, 2013 / NOT LATER THAN 4:00 P.M.
This Addendum is issued to the above referenced RFP to make the following changes, additions, deletions, and/or clarifications:
1. Change Closing date has been changed from June 24, 2013 to July 1, 2013.
2. Delete and Replace
Attachment 4, Cost Worksheet: Delete Attachment 4 in its entirety and replace with the Revised Attachment 4 as attached to this addendum. Notes:
A. A new column “Performed by Another Lab” has been added. Please check if the answer is “yes” for each item.
B. Item 82 has been replaced by Item 250 Transport Fee in the 82 Item Total.
3. Add Revised Attachment 4, Cost Worksheet: Clarifications on some test items on the Cost Worksheet are attached to this addendum as Addendum 1 – Attachment 1.
4. Delete and Replace
Multnomah County Services Contract, Exhibit 2, Insurance Requirements: Delete Exhibit 2 and replace with the Revised Exhibit 2 as attached to this addendum as Addendum 1 - Attachment 2.
5. Clarification Section 2.15, Insurance Requirements: Question: Please clarify insurance types required. Answer: Revised Exhibit 2 in the Multnomah County Services Contract
4000001576 Page 1 of 26
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(Attachment 2) reflects the minimum insurance required of a Contractor to provide this service. Proof of self insurance programs will be considered. Additional insurance may be required. Final insurance requirements will be subject to negotiation between, and mutual agreement of, the parties prior to contract execution.
6. Clarification Section 2.7.9, Client Services Support: Question: Please clarify “referral procedures”. Answer: These are procedures for difficult blood draws and /or specialized blood draws that require special handling.
7. Clarification Section 2.7.10.2, Billing Services: Question: Clarify “Payments received from Medicaid and Medicare constitute payment in full”. Answer: Contractor will accept as payment in full the Medicare/aid reimbursement rates as published by CMS
8. Clarification Section 3.1, Proposal Questions Instructions: Question: Clarify how the point system works. Answer: Points will start from zero and increase. Total number of points available for each proposal is 100 and is scored per section as described in the table in Section 3.1. Proposers must answer all questions in 3.2, with the exception of question 3.2.6.2, Social Equity (see item 11 below), in which Proposers should answer questions in either Section A (if you have employees) or section B (if you do not have employees).
9. Clarification Question 3.2.1.4, Company Profile: Question: Please clarify “key staff personnel”. Answer: Submit credentials of your lab director, supervisors and lead technicians in your primary location.
10. Add Question 3.2.3, Patient Care and Service Delivery:
Add the following question after item 7: “8. How many patient services centers do you have in Multnomah County?” Add the following sentence to the end of evaluation criteria: “Proposer has a good number of patient services centers in Multnomah County.”
4000001576 Page 2 of 26
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6/10/10 snt 4000001576
3
11. Change Question 3.6.1.2, Page 20 and Page 23: Change the question number on top of Section A (Page 20) and Section B (Page 23) from 3.6.1.2 to 3.2.6.2.
12. Change Question 3.2.6.2.3 Employee Healthcare and Other Benefits:
A. Employee Healthcare Change: (2% of total points) to (2 Points) Change: (0% of total points) to (0 Points) B. Other Benefits Sick Leave Change: (1% of total points) to (1 Points) Change: (0% of total points) to (0 Points) Vacation Benefits Change: (1% of total points) to (1 Points) Change: (0% of total points) to (0 Points) Retirement Benefits Change: (1% of total points) to (1 Points) Change: (0% of total points) to (0 Points)
c: H. Liebrandt/K. Raisler C. Kwong K. Braeme-Burr File
4000001576 Page 3 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
1 COMP METAB PNL 80053 10,400 -$
2 HEMOGLOBIN A1C 83036 5,800 -$
3 HDL-CHOLESTEROL 83718 5,200 -$
4 TSH (REFL) 84443 3,700 -$
5 CHOL TOTAL,(REFL) 82465 3,200 -$
6 TRIGLYCERIDES(REFL) 84478 3,200 -$
7 AUTOMATED PAP & RVW 88175 2,400 -$
8 CREATININE RAND (U) 82570 2,100 -$
9 CHOLESTEROL, TOTAL 82465 2,100 -$
10 TRIGLYCERIDES 84478 2,100 -$
11 DIRECT LDL 83721 2,100 -$
12HIV1/2 AB SCR W/RFLS to Western Blot 86703 2,000 -$
13
*MALB, RAND UR W/CR Random Microalbumin and Creatinine Ratio MACR 82043, 82570 1,700 -$
14 HIV-1 RNA,QN,RT PCR 87536 1,400 -$
15 CBC (DIFF/PLT) 85025 1,300 -$
16 HEP B SURF AG W/CONF 87340 1,300 -$
17 VIT D 25OH LC/MS/MS 82306 1,300 -$
18 BASIC METAB PNL 80048 1,000 -$
19 PM Profile 1 (urine 10 drug screen) 80101 (11) 1,000 -$
20 HEP C AB 86803 960 -$
21 TSH 84443 920 -$
22 T-4, FREE 84439 820 -$
23 RUBELLA IMMUNE 86762 690 -$
24 AB SCR RFX ID/TITER 86850 640 -$
25 ABO GRP AND RH TYPE 86900, 86901 630 -$
Page 1 of 204000001576 Page 4 of 26
![Page 5: A D D E N D U M # [Insert Number]...15 CBC (DIFF/PLT) 85025 1,300 $ - 16 HEP B SURF AG W/CONF 87340 1,300 $ - 17 VIT D 25OH LC/MS/MS 82306 1,300 $ - 18 BASIC METAB PNL 80048 1,000](https://reader033.dokumen.tips/reader033/viewer/2022050501/5f93a9244db57d560d439f51/html5/thumbnails/5.jpg)
4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
26 RPR(DX)REFL FTA 86592 620 -$
27 IRON, TOTAL, & IBC 83540, 83550 570 -$
28 FERRITIN 82728 550 -$
29 GLUC, GEST SCRN Cut off Range 140 82950 500 -$
30 MICROALBUMIN RAND UR 82043 460 -$
31 VITAMIN B12 82607 450 -$
32 FOLATE,SERUM 82746 420 -$
33 METHYLMALONIC ACID 83921 330 -$
34 LIPASE 83690 290 -$
35HEPATIC FUNC PNL CMS Approved Panel 80076 290 -$
36 URIC ACID 84550 280 -$
37 HCG, TOTAL, QN 84702 280 -$
38 TESTOSTERONE, FR&TOT 84402, 84403 260 -$
39 HEP B SURFACE AB QN 86317 260 -$
40 HOMOCYSTEINE,NU/CON 83090 260 -$
41 PATH REVIEW, LIQ PAP 88141 250 -$
42 IV-PATH, G&M, 1SP 88174, 88175 240 -$
43 OXYCODONE (U) 80101 240 -$
44 PSA, TOTAL 84153 230 -$
45CHLAMYDIA/GC RNA,Transcription-Mediated Amplification 87491, 87591 230 -$
46 MATERNAL SERUM SCR 582105, 82397, 82677, 84702, 86336 230 -$
47 PRO TIME WITH INR 85610 220 -$
48 BNP 83880 220 -$
49 BILI, FRAC, PEDIATR. 82247, 82248 220 -$
Page 2 of 204000001576 Page 5 of 26
![Page 6: A D D E N D U M # [Insert Number]...15 CBC (DIFF/PLT) 85025 1,300 $ - 16 HEP B SURF AG W/CONF 87340 1,300 $ - 17 VIT D 25OH LC/MS/MS 82306 1,300 $ - 18 BASIC METAB PNL 80048 1,000](https://reader033.dokumen.tips/reader033/viewer/2022050501/5f93a9244db57d560d439f51/html5/thumbnails/6.jpg)
4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
50 VALPROIC ACID 80164 200 -$
51 LITHIUM 80178 200 -$
52 HEP A IGM AB 86709 200 -$
53 CULT, HSV+TYPING 87255 200 -$
54 HCV RNA BY PCR,QT 87522 200 -$
55 VZV IGG AB 86787 190 -$
56 HPV HR 87621 190 -$
57 ANA SCREEN 86038 190 -$
58 HEP B CORE AB, TOTAL 86704 180 -$
59 MAGNESIUM 83735 170 -$
60 CK, TOTAL 82550 160 -$
61 N. GONORRHOEAE RNA, TMA, 87591 150 -$
62 AMYLASE 82150 150 -$
63 HEP B SURF AB QL 86706 150 -$
64 PROLACTIN 84146 150 -$
65 HBC TOTAL W/REFL IGM 86704 140 -$
66 CRP 86140 130 -$
67 PHENYTOIN 80185 120 -$
68 H.PYLORI AG STOOL 87338 120 -$
69 ALT 84460 120 -$
70 FSH 83001 120 -$
71 HCV GENOTYPE LIPA 87902 120 -$
72 PTT, ACTIVATED 85730 120 -$
73 CCP AB IGG 86200 120 -$
74 CYTO, NON-GYN FLUID(rectal) 88104 110 -$
75 CARBAMAZEPINE, TOTAL 80156 110 -$
Page 3 of 204000001576 Page 6 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
76 RHEUMATOID FACTOR 86431 110 -$
77 PROTEIN ELECTRO. 84155, 84165 110 -$
78 HEPATITIS A AB,TOTAL 86708 110 -$
79 RETICULOCYTE COUNT 85045 100 -$
80 HEP A AB,W/REFL IGM 86708 100 -$
81 PTH,INTACT & CALCIUM 82310, 83970 100 -$
250 TRANSPORT FEE 10 99001 288 -$
-$
82 HEP B CORE IGM AB 86705 100
83 BILIRUBIN, TOTAL 82247 90
84 *HEMOGLOBINOPATHY83021, 85014, 85018, 85041 90
85 IMMUNOGLOBULIN A 82784 90
86 TTG IGA 83516 80
87 HIV-1 GENOTYPE 87901 80
88 T-4 (THYROXINE) 84436 80
89 GTT, GESTATIONAL, 4 82951, 82952 80
90 SED RATE MANUAL WEST 85651 80
91 MUMPS VIRUS IGG, EIA 86735 80
92 GLIADIN IGA 83516 80
93 MEASLES AB IGG,EIA 86765 80
94 CALCIUM, IONIZED 82330 70
95 HSV TYPE 2 87140 70
96 RENAL FUNC PNL 80069 70
97 HGB INDICES 85014, 85018, 85041 70
98 HIV-1 AB BY WBA 86689 70
99 GGT 82977 70
82-Item Total
Page 4 of 204000001576 Page 7 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
100 TOXO IGG AB 86777 70
101 AFP,TUMOR (CHIRON) 82105 70
102 T-3, FREE 84481 70
103 HSV 1/2 HERPESELECT 86695, 86696 60
104 PHOSPHATE (AS PHOS) 84100 60
105 T-3 UPTAKE 84479 60
106 TROPONIN-I 84484 50
107 HEP B C AB, TOT (REFL) 86704 50
108 HBV DNA QUANT 87517 50
109 TESTOSTERONE, TOTAL 84403 50
110 TP RAND (U) W/ CREAT 82570, 84156 50
111 C DIFF TOXIN A&B 87324 50
112 DIGOXIN 80162 50
113 HPV HIGH RISK AR 87621 50
114 GLUCOSE, PLASMA 82947 50
115 AMMONIA (P) 82140 40
116 TTG IGG,IGA 83516 (2) 40
117 RNP ANTIBODY 86235 40
118 HEP A AB, TOTAL 86708 40
119 LDH, TOTAL 83615 40
120 T-3, TOTAL 84480 40
121 **HCV RNA QUALITATIVE PCR 87521 30
122 LH 83002 30
123 HLA-B*5701 TYPING83891, 83896 (30), 83900, 83912 30
124 ANA W/RFX 86038 30
125 ANTI-DSDNA AB, EIA 86225 30
Page 5 of 204000001576 Page 8 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
126 LEAD, (B) 83655 30
127 POTASSIUM 84132 30
128 CHLAMYDIA/N. GON RNA, TMA 87491, 87591 30
129 GLUCOSE, SERUM 82947 30
130 HEP C AB (REFL) 86803 30
131 LYMPH SUBSET PNL 3 86359, 86360 30
132 HSV TYPE 1 87140 30
133 CREATININE 82565 30
134 TP 24HR (U) W/CREAT 82570, 84156 30
135 Plasma Renin Assay LC/MS/MS 84244 30
136 ALDOSTERONE,LC/MS/MS 82088 30
137 CHROMATIN AUTO AB 86235 30
138 SM ANTIBODY 86235 30
139 SM/RNP ABS 86235 30
140 BILE ACIDS, TOTAL 82239 30
141 D-DIMER QN 85379 20
142 CHILDHOOD ALLERGY PROFILE 82785, 86003 (15) 20
143 CULTURE FUNGUS S/H/N 87101 20
144 HISTO SP STAIN GP I 88314 20
145 GTT, 2 SPEC 82950 20
146 LEVETIRACETAM 80299 20
147 HEP BE AG 87350 20
148 AST 84450 20
149 CORTISOL, A.M. 82533 20
150 MATERNAL SERUM AFP 82105 20
151 TESTOSTERONE,T,LC/MS 84403 20
Page 6 of 204000001576 Page 9 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
152 III-PATH, G&M, 1 88302 20
153 HCV W/REFL HCV RIBA 86803 20
154 JO-1 ANTIBODY 86235 20
155 CBC(DIFF/PLT)W/SMEAR 85007, 85027 20
156 ANA TITER&PATTERN 86039 20
157 HEP BE AB 86707 20
158 **BENZODIAZEOINE; U 80101 20
159 IMMUNOFIXATION, SERUM 86334 10
160 PROTEIN ELECTRO. 82570, 84156, 84166 10
161 LAMOTRIGINE 80299 10
162 MITOCHONDRIAL W/REFL 86255, 86256 10
163 CULTURE, BLOOD 87040 10
164 INSULIN 83525 10
165 THYROID PEROXID AB 86376 10
166 LUPUS ANTICOAG W/RFL 85613, 85730 10
167 BUPRENORPHINE QN 83925 10
168 C. TRACHOMATIS RNA, TMA, 87491 10
169 **HCV RNA BDNA 87522 10
170 CK ISOENZYMES 82552 10
171 PHENOBARBITAL 80184 10
172 THYROGLOBULIN AB 86800 10
173 SCL-70 86235 10
174 METANPH.24 HR URINE 83835 10
175 TSH W/REFL FT4 84443 10
176 MUMPS V AB(IGM) 86735 10
177 A-1-ANTITRYPSIN QN 82103 10
Page 7 of 204000001576 Page 10 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
178 CERULOPLASMIN 82390 10
179 PATH REVIEW OF SMEAR 85060 10
180 VZV AB IGM 86787 10
181 GLUCOSE, RAND (P) 82947 10
182 IGF I, ECL 84305 10
183 SS A RO AB(IGG)EIA 86235 10
184 SJOGRENS AB (SS-B) 86235 10
185 ERYTHROPOIETIN 82668 10
186 CORTISOL, FREE 24HR 82530 10
187 CATECHOLAMINES, FRAC 82384 10
188 CREATININE (U) 82570 10
189 CULT, (U) ROUTINE 87086, 87088 10
190 G-6-PD (B) 82955 10
191 SICKLE CELL SCREEN 85660 10
192 HSV IGM AB SCREEN 86694 (2) 10
193 CREATININE CLEARANCE 82575 10
194 SODIUM, RAND (U) 82570, 84300 10
195 METANEPHRINES,FRACT 83835 10
196 LH,3RD GENERATION 83002 10
197 OXCARBAZEPINE 83789 10
198 ANCA 86021 (2) 10
199 HAPTOGLOBIN 83010
200 BILIRUBIN,DIRECT 82248
201 DHEA-SULFATE 82627
202 VALPROIC ACID, F & T 80164 (2)
203 HIV1 INTEGRASE 87906
Page 8 of 204000001576 Page 11 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
204 FSH,3RD GENERATION 83001
205 HIV-2 AB,EIA 86689, 86702
206 PREALBUMIN 84134
207 KAPPA/LAMBDA W/RATIO 83883 (2)
208 SP, MANUAL SCREEN 88142
209 ESTROGEN, TOTAL (S) 82672
210 THEOPHYLLINE 80198
211 PROTEIN S, ACTIVITY 85306
212 SJOGREN'S ANTIBODIES 86235 (2)
213 **HEPATITIS C SUPPLEMENT 86804
214 MEASLES AB IGG,IGM 86765 (2)
215 CLONAZEPAM URINE 80154
216 CA125 86304
217 ANTITHROMBIN III ACT 85300
218 FACTOR VIII ACTIVITY 85240
219 AMITRIPTYLINE 80152
220 OSMOLALITY 83930
221 PROTEIN ELECTRO, (U) 82570, 84156, 84166
222 RSV AG (IA) 87807
223 GLUCOSE, GEST. SCR. 82950
224 PROTEIN C, ACT & AG 85302, 85303
225 H.PYLORI IGG AB 86677
226 ANTIBODY PANEL X1 86870
227 CORTISOL, TOTAL 82533
228 OSMOLALITY (U) 83935
229 CEA 82378
Page 9 of 204000001576 Page 12 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
230 CA 24HR W/ CREAT 82340, 82570
231 EOSINOPHIL COUNT (U) 81015
232 SODIUM W/O CREAT RAND UR 84300
233 CRYP.AG EIA W/TITER 86406, 87327
234 Mircobiology organismis ID 1 87181
235 ALCOHOL, ETHYL (B) 82055
236 ESTRADIOL 82670
237 ANTITHROMBIN III AG 85301
238 EBV AB PANEL 86664, 86665 (2)
239 CARDIO CRP 86141
240 FACTOR V (LEIDEN)83891, 83898, 83909, 83912, 83914
241 HBV DNA PCR, QUAL 87516
242 SHARED ASSAY COMP 83891 Delete Delete Delete
243 ALK PHOS ISOENZYMES 84075, 84080
244 ZINC (P) 84630
245 CHROMOSOME, BLOOD 88230, 88262, 88291
246 DAP 10 80101 (10) Delete Delete Delete
247 HSV IGM TITER 86694
248 ACTIN ANTIBODY (IGG) 83516
249 IGFBP-3 83519250 Item Moved Item Moved Item Moved Item Moved Item Moved
251 ALDOLASE 82085
252 CALCIUM 82310
253 COPPER 82525
254 C-PEPTIDE 84681
Page 10 of 204000001576 Page 13 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
255 IRON, TOTAL 83540
256 CARDIOLIPIN IGG AB 86147
257 CARDIOLP AB G/M/A 86147 (3)
258 PROTEIN,TOT,W/O CREAT 84156
259 PHOSPHOLIPID NEUT 85597
260 MALB, RAND UR W/O CR 82043
261 TPMT ACTIVITY 83789
262 TROFILE DNA 87906
263 HCG W/GEST TABLE 84702
264 PM Profile 1 + ALC(urine drug) 80101 (9)
265 DRVVT 1:1 MIX 85613
266 HEREDITARY HEMO.83891, 83892 (2), 83900, 83909, 83912
267 *B.HENSELAE W/REFL 86611 (4)
268 OLANZAPINE 80299
269 SUSC-1 micro suspectiblity 87181, 87184, 87186
270 RISTOCETIN COFACTOR 85245
271 FRAGILE X PCR83898, 83900, 83909 (2), 83912
272 HEPARIN ANTI-XA LMWH 85520
273 PSA FREE & TOTAL 84153, 84154
274 ASO 86060
275 TOPIRAMATE 80201
276CARDIOLP SC/RF (igA, igM, igG Combined) 86147 (4)
276a CARDIOLP SC/RF (igA Only) 86147 (4)276b CARDIOLP SC/RF (igM Only) 86147 (4)276c CARDIOLP SC/RF (igG Only) 86147 (4)
Page 11 of 204000001576 Page 14 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
277 STAT ASSAY 1 99199
278 VANCOMYCIN, TROUGH 80202
279 IMMUNOGLOBULIN E 82785
280 INTRINSIC FACTOR AB 86340
281 UA 24HR (U) 82570, 84560
282 RISPERIDONE / METAB, SP 83789
283 DRAW FEE, PSC SPEC. 36415
284 CORTISOL, P.M. 82533
285 CARDIOLIPIN IGM AB 86147
286 COMP C3C4 86160 (2)
287 FRUCTOSAMINE 82985
288 CYCLOSP TR FPIA 80158
289 CALCIUM W/O CREAT 24 H UR 82340
290 ENDOMYSIAL IGA AB 86255
291 FENTANYL / METABOLITE, U 83925
292 STONE ANALYSIS 82365
293 HOMOCYSTEINE,CARDIO 83090
294 TOXO IGM EIA 86778
295 IMIPRAMINE 80174
296 VON WILLEBRAND AG 85246
297 HEP DELTA VIRUS AB 86692
298 SYNOVIAL FL ANALYSIS 83872, 89051, 89060
299 SUSCEPT AER MIC 87186
300 HIV-1 CORECEPTOR TROPISM 87906
301 HEAVY METALS, 24HR (U) 82175, 83655, 83825
302 PROGESTERONE 84144
Page 12 of 204000001576 Page 15 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
303 IMCAP, PEANUT (F13) 86003
304 HBV GENOTYPE83891, 83894, 83900, 83904 (4), 83912
305 TTG IGG 83516
306 IMMUNOGLOBULIN G 82784
307 IMMUNOGLOBULIN M 82784
308 BENZODIAZEPINES, QUANT,UR 80154
309 NORTRIPTYLINE 80182
310 CHLORIDE (U) 82436, 82570
311 POTASSIUM RAND (U) 82570, 84133
312 PROTHROMBIN GENE 83891, 83898, 83912, 83914
313 OPIATES, GC/MS (U) 83925
314 COOMBS, DIRECT 86880
315 PRIMIDONE 80184, 80188
316 HCG TOTAL QL 84703
317 MIXING STUDY85610, 85611, 85730, 85732 (2)
318 CRYP.AG L.A. W/TITER 86403
319 17-OHPROGEST.LC/MSMS 83498
320SB: TSI Thyroid Stimulating Immuoglobulin 84445
321 LUPUS ANTICOAG HEX 85598
322 METHYLPHENIDATE 80299
323 ANTIBODY TITER X1 86886
324 ACETAMINOPHEN 82003
325 COPPER (U) 82525
326 CLOZAPINE (CLOZARIL) 83789
Page 13 of 204000001576 Page 16 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
327 PROTEIN C, ACTIVITY 85303
328 CARDIOLIPIN IGA AB 86147
329 VON WILLEBRAND, MULT 85247
330 AMYLASE, RAND UR 82150, 82570
331 GLIADIN AB IGG/IGA 83516 (2)
332 TRANSPORT FEE 25 99001
333 ANTIPHOSPHATIDYLSER 86148 (3)
334 VITAMIN D,1,25 82652
335 TRAMADOL SCN ;U 80101
336 METHYLPHENIDATE&MET;U 83789
337 HIV-1 RNA QN BDNA 87536
338 MATERNAL SERUM 482105, 82677, 84702, 86336
339 B2-GLYCO I(IGA) 86146
340 B2-GLYCO I(IGM) 86146
341 B2-GLYCO I(IGG) 86146
342 TRAMADOL&MET CFM;U 83789
343 BUN/CREAT RATIO 82565, 84520
344 DOXEPIN 80166
345 VITAMIN A 84590
346 IMCAP, EGG WHITE (F1) 86003
347 IMCAP, CODFISH (F3) 86003
348 IMCAP, TUNA (F40) 86003
349 IMCAP, SALMON (F41) 86003
350 CORTISOL, 2 SPEC 82533, 8253391
351 H. PYLORI AB (IGG), WB 86677
352 ZONISAMIDE 80299
Page 14 of 204000001576 Page 17 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
353 LACTIC ACID, (P) 83605
354 REDUCING SUB, FECES 84376
355 SM & SM/RNP ABS 86235 (2)
356 TACROLIMUS, LC/MS/MS 80197
357 ACTH 82024
358 HGH 83003
359 THC METAB., GC/MS U 82542
360 CHROM HIGHRESOLUTION88230, 88262, 88289, 88291
361 COCCI TOTAL AB,W/RFX 86635
362 IV-PATH,G&M,1SP,TC 88305TC
363 T PALLIDUM AB BY PA 86780
364 METHADONE 83840
365 ETHOSUXIMIDE 80168
366 CMV IGG AB 86644
367 ABO GROUP 86900
368 RH TYPE 86901
369 VITAMIN B6 84207
370 ALCOHOL, ETHANOL (U) 80101
371 IMCAP, MILK (F2) 86003
372 C DIFF TOXIN B QL 87230
373 CMV IGM AB 86645
374 GIARDIA AG DETECTION 87329
375 CHLORIDE W/O CREAT RAND 82436
376 AAT MUTATION ANALY83891, 83892 (2), 83900, 83909, 83912
377 ANTI-MULLERIAN 83520
Page 15 of 204000001576 Page 18 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
378 H. PYLORI IGG, QN 86317
379 DENGUE FEVER AB PNL 86790 (2)
380 STRONGYLOIDES IGG AB 86682
381 ANGIOTENSIN II 82163
382 CHSV RAPID METHOD 87255
383 TPMT GENOTYPE
83890, 83892 (2), 83896 (4), 83900, 83912
384 ANTIGEN TYPE X1 86905
385 COAG FACTOR X ACT 85260
386 HIAA, 5-, URINE 83497
387 HLA-B27 ANTIGEN 86812
388 HETEROPHILE, MONO 86308
389 HANDLING CHARGE 99001
390 CULTURE, AEROBIC BAC 87070
391 CT,DIFF SYNOVIAL FL 89051
392 CULT,FUNGUS,SKIN87101, 87106, 87107, 87143, 87149, 87220
393 VITAMIN B1,THIAMINE 84425
394 PARVO B19 IGG/IGM 86747 (2)
395 ALLERGY PNL REG 17 82785, 86003 (23)
396 URORISK DIAG PROF
82340, 82507, 82570, 83735, 83945, 83986, 84105, 84133, 84300, 84392, 84560
397 LEU & LYM 24 MARKERS88184, 88185 (23), 88189
Page 16 of 204000001576 Page 19 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
398 HSV 1/2 IGM AB, IFA 86695, 86696
399 DHEA, LC/MS/MS 82626
400 PRO PREDICTRX META 82492
401 ETG W/CONFIRM, U *ERROR*
402 C1 INHIBITOR, PROTEIN 86160
403 MERCURY (B) 83825
404 IMCAP, CRAB (F23) 86003
405 IMCAP, LOBSTER (F80) 86003
406ALLERGY 13,PCS,Allergy testing for insects allergy 86003 (5)
407 ELASTASE EL1, STOOL 82656
408 CENTROMERE AB, EIA 86038
409 CBC(DIFF/PLT)W/PATH 85025, 85060
410 SHBG 84270
411 PLT AB EXPANDED 86022 (3), 86023 (3)
412 GAD-65 AB 83519
413 PTH, INTACT 83970
414 ISLET CELL AB 512 86341
415 INSULIN ABS, HIGHLY 86337
416 HBSAG CONFIRMATION 87341
417 AMIODARONE 82492
418 ISLET CELL RFX TITER 86341 (2)
419 ACHR BINDING AB 83519
420 ANTI-DNASE B TITER 86215
421 GBM ANTIBODY 83520
422 CELL CT AND DIFF,CSF 89051
423 FIBRINOGEN QN 85384
Page 17 of 204000001576 Page 20 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
424 GLUCOSE, CSF 82945
425 PROTEIN, TOTAL, CSF 84157
426 VISCOSITY 85810
427 CULT,CMV RAPID/CONV 87252, 87254
428 CULT, VZV, RAPID 87254
429 VDRL, CSF 86592
430 PLASMINOGEN ACTIVITY 85420
431 CRYSTALS, SYN FLD 89060
432 LYME AB-WB CONFIRM 86617 (2), 86618
433 CF CARRIER SCREEN
83891, 83900, 83901 (13), 83909, 83912, 83914 (32)
434 CK-MB WITH RATIO 82550, 82553
435 CK-MB (CK-2) 82553
436 MTHFR, DNA MUTATION83891, 83900, 83909, 83912, 83914 (2)
437 ACHR MODULATING AB 83519
438 PROTHROMBIN GENE83891, 83892, 83896 (2), 83908, 83912
439 ACHR BLOCKING 83519
440 CRYOGLOB EVAL 82595
441 CMV IGG AB W/REFL 86644, 86645
442 SHARED ASSAY COMP 83891
443 CYCLOSPORINE (B) 80158
444 T.VAGINALIS RNA,MALE 87798
445 AMPHETAMINES (U) 82145
Page 18 of 204000001576 Page 21 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
446 STONE RISK DIAG PROF
82140, 82340, 82507, 82570, 83735, 83945, 83986, 84105, 84133, 84300, 84392, 84560
447 CULT, NEISSERIA 87081, 87184
448 LD ISOENZYMES 83625
449 CULT, CHLAMYDIA 87110, 87140
450 METALS/METALLO PAN 1;SP 82175, 83655, 83825
451 CULTURE,AEROB/ANAER 87070, 87075, 87205
452 CULT,FUNGUS,OTHER 87102, 87206
453 INFLUENZA A&B AB, CF 86710 (2)
454 LACTOFERRIN DET. 83630
455 THROMBIN-ANTITH.TAT 83520
456 VONWILLEBRAND FACTOR 83520
457 HSV/VZV RAPID CULT 87254 (2)
458 HISTOPLASMA AG UR 87385
459 BILI, TOTAL PEDIATR. 82247
460 SCHISTOSOMIASIS IGG 86682
461 ENTAMOEBA HIST 87337
462 CULTURE,RAPID FLU A&B 87254 (2)
463 RPR TITER 86593
464 PORPH FRAC RAND (U) 84120
465 OXYCODONE CONF (U) 83925
466 KAPPA/LAMBDA L CHAIN 83883 (2)
467 APC RESISTANCE 85307
468 ALKALINE PHOSPHATASE 84075
Page 19 of 204000001576 Page 22 of 26
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4000001576 Medical Laboratory ServicesCost Worksheet (Revised)
Revised Attachment 4
List of most requested lab tests CPT Code
Performed by Another Lab?
6 Month Estimated No. of
Units Unit Price Extended Price
469 COAG FACTOR XI ACT 85270
470 MYOGLOBIN, (U) 83874
471 RPR MONITOR W/REFL 86592
472 BETA-2-MICROGLOBULIN 82232
473 TRANSFERRIN 84466
474 VITAMIN C 82180
475 GABAPENTIN, PLASMA 80299
476 PORPHYRINS, FRAC (P) 82492
477 PORPHOBILINOGEN, RAND (U) 84110
478 PROTEIN, TOTAL 84156
479 LKM-1 ANTIBODY(IGG) 86376
480 HLA CLASSI A,B,C DNA83891, 83896 (90), 83900 (3), 83912 (3)
481 LEU & LYM 22 MARKERS 88184, 88185 (21), 88189
482 KAPPA/LAMBDA 24 HR U 83883 (2)
483 TRICHOMONAS VAG RNA, QL 87798
484 LGV DFF AB PNL MIF 86631 (8), 86632 (4)
485 MARIJUANA CONF GC/MS 82542
486 PTH-RELATED PROTEIN 83519
487 COPPER;B 82525
Page 20 of 204000001576 Page 23 of 26
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4000001576 Medical Laboratory ServicesWorksheet Questions and Responses
Addendum 1, Attachment 1
Question CPT Code Response
4 TSH (REFL) Please clarify reflex. 84443
We would like to set-up a test that runs the TSH and if abnormal it would automatically reflexed to a free T4.
7
AUTOMATED PAP & RVW Thin Prep Image Guided or Sure Path methodology? With or without HPV? 88175 SurePath with the option to choose a reflex to HPV
12HIV1/2 AB SCR W/RFLS to Western Blot 86703 Yes reflex to a WesternBlot if screen positive
13*MALB, RAND UR W/CR Microalbumin? Random... 82043, 82570 Yes a random Microalbumin and Creatinine Ratio MACR
16
HEP B SURF AG W/CONF With reflex to confirmation by nutralization with Hep BSAB? 87340 Yes that is correct
19
PM Profile 1 (urine 10 drug screen) Which components are included in this panel? 80101 (11)
The following drugs should be included: Amphetamines, Barbiturates, Benzodiazepines, Marijuana metabolites, Methadone, Opiates, Oxycodone, Phencyclidine, Propoxyphene
29GLUC, GEST SCRN 140 what is the 140? 82950 Cut-off range
35HEPATIC FUNC PNL The CMS approved panel? 80076 Yes that is correct
42 IV-PATH, G&M, 1SP Please clarify 88174, 88175 Cost of additonal tests done on a positive tissue sample
43OXYCODONE (U) We are not familiar with S and C. We test for oxycodone 80101 Disreagard the S & C
45CHLAMYDIA/GC RNA,TMA please define TMA 87491, 87591 Transcription-Mediated Amplification (TMA)
46MATERNAL SERUM SCR 5 would you please list the components?
82105, 82397, 82677, 84702, 86336
AFP, unconjugated Estriol, hCG, Dimeric Inhibin A, ITA (hyperglycoslated hCG), and Marternal Risk Intrepretation
47 PRO TIME WITH INR 85610 Assess prenatal risk for NTD's, Down syndrome, and trisomy 18
131 LYMPH SUBSET PNL 3 please clarify 86359, 86360 Test for Abs Lymphs % CD3, Abs CD3, % CD4, Abs CD4, %CD8, Abs CD8, CD4/CD8 ratio135 PRA LC/MS/MS Please clarify 84244 Plasma Renin Assay
162MITOCHONDRIAL W/REFL please clarify 86255, 86256 AB with reflex to a titre
234 ORG ID 1 Please clarify 87181 Mircobiology organismis ID
242 SHARED ASSAY COMP please clarify 83891 Item to be deleted
246 DAP 10 please clarify components 80101 (10) Item to be deleted
Page 1 of 24000001576 Page 24 of 26
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4000001576 Medical Laboratory ServicesWorksheet Questions and Responses
Addendum 1, Attachment 1
Question CPT Code Response
250 TRANSPORT FEE 10 Please clarify 99001
(NEW LOCATION - item has been moved and is now located after Item 81) STAT pickups that fall outside the normal pickup schedule and could be done at either the clinic sites or from our main laboratory.
264PM Profile 1 + ALC(urine drug) Please include components 80101 (9) See item 19 + Alcohol
269 SUSC-1 please clarify 87181, 87184, 87186 micro suspectiblity
276 CARDIOLIPID (igA, IgM, IgG) 86147 (4) Cost for all three plus breakout of each separtely (added 276a-c to revised worksheet)
277 STAT ASSAY 1 - Which assay? 99199 Do you charge for doing a test STAT?
299 SUSCEPT AER MIC Please clarify 87186 Aerobic organism MIC cost.
320 TSI Please clarify 84445 SB: TSI Thyroid Stimulating Immuoglobulin
362 IV-PATH,G&M,1SP,TC please clarify 88305TC Cost of a tissue evaluation that is positive. Additional slide preparation
406 ALLERGY 13,PCS,INSCT Please clarify 86003 (5) Allergy testing for insects allergy
450METALS/METALLO PAN 1;SP please clarify 82175, 83655, 83825 Heavy metals assay: arsenic, lead, Mercury, and maybe cadmium
Page 2 of 24000001576 Page 25 of 26
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EXHIBIT 2 MULTNOMAH COUNTY SERVICES CONTRACT
Contract No. [Insert Contract Number] INSURANCE REQUIREMENTS
Contractor shall at all times maintain in force at Contractor’s expense, each insurance noted below: **
Workers Compensation insurance in compliance with ORS 656.017, which requires subject employers to provide workers’ compensation coverage in accordance with ORS Chapter 656 or CCB (Construction Contractors Board) for all subject workers. Contractor and all subcontractors of Contractor with one or more employees must have this insurance unless exempt under ORS 656.027 (See Exhibit 4). Employer’s Liability Insurance with coverage limits of not less than $500,000 must be included. THIS COVERAGE IS REQUIRED. Attach Certificate of Insurance. If Contractor does not have coverage and claims to be exempt, attach Exhibit 4 in lieu of Certificate.
Professional Liability insurance with a combined single limit of not less than $1,000,000 each claim, incident, or occurrence, with an annual aggregate limit of $2,000,000. This is to cover damages caused by error, omission, or negligent acts related to professional services provided under this Contract. The policy must provide extended reporting period coverage for claims made within two years after this Contract is completed.
Required by County Not required by County (Needs Risk Manager’s Approval)
Commercial General Liability insurance, on an occurrence basis, with a combined single limit of not less than $1,000,000 each occurrence for Bodily Injury and Property Damage, with an annual aggregate limit of $2,000,000. This insurance must include contractual liability coverage.
Required by County Not required by County (Needs Risk Manager’s Approval)
Commercial Automobile Liability insurance with a combined single limit, or the equivalent of not less than $1,000,000 each occurrence for Bodily Injury and Property Damage, including coverage for owned, hired or non-owned vehicles.
Required by County Not required by County (Required if vendor is transporting and/or driving as part of performing the duties specified in the contract)
Additional Requirements. Coverage must be provided by an insurance company authorized to do business in Oregon or rated A- or better by Best’s Insurance Rating. Contractor shall pay all deductibles and retentions. A cross-liability clause or separation of insureds condition must be included in all commercial general liability policies required by this Contract. Contractor’s coverage will be primary in the event of loss. The County must be listed as an Additional Insured by Endorsement on to any General Liability Policy on a primary and non-contributory basis. Such coverage will specifically include products and completed operations coverage. Certificate of Insurance Required. Contractor shall furnish a current Certificate of Insurance to the County. The Contractor shall immediately notify the County of any change in insurance coverage. The Certificate shall also state the deductible or retention level. For general liability the Certificate shall also state the following: “Additional Insured Form (include form number) attached. This form is subject to policy terms, conditions and exclusions.” A copy of the additional insured endorsement shall be attached to the certificate of insurance required by this contract. If requested, complete copies of insurance policies shall be provided to the County. Where in the County to send your Certificate of Insurance. Risk Management has an email address that all insurance certificates should be sent to: [email protected]. Additional originals, hard copies, or faxes are not necessary.
Completed by:___________________ Contract Originator
**Note to Contract Originator: For certain types of contracts additional insurance may be required. Refer to the Contract Insurance and Indemnification Manual or contact Risk Management/ Property & Liability Programs.
4000001576 Page 26 of 26
