HomeMy WebLinkAbout20240430.tiffRESOLUTION
RE: APPROVE AGREEMENT CONCERNING PATHOLOGY SERVICES AND AUTHORIZE
CHAIR TO SIGN - SUMMIT PATHOLOGY
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with an Agreement Concerning Pathology
Services between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Department of Public Health and Environment,
and Summit Pathology, commencing upon full execution of signatures, with further terms and
conditions being as stated in said agreement, and
WHEREAS, after review, the Board deems it advisable to approve said agreement, a copy
of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Agreement Concerning Pathology Services between the County of
Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on
behalf of the Department of Public Health and Environment, and Summit Pathology be, and
hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said agreement.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 21st day of February, A.D., 2024.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: �.,I 4;
Weld County Clerk to the Board
Ek.---)Alld aietAAJ-(1
Deputy Clerk to the Board
APP ! ED ORM:
ounty Att• rney
Z
9 Date of signature: 7
Kevi . Ross, Chair
Pro-Tem
Perry L. B
EXCUSED
Mike Freeman
Scoff K. James
4004: 2574.,
Saine
cc:I-IL Cr'c/sM)
03/i9/2,1
2024-0430
HL0057
C on-h*a Cf 1D17-7'79
BOARD OF COUNTY COMMISSIONERS
PASS -AROUND REVIEW
PASS -AROUND TITLE: Summit Pathology Services Agreement
DEPARTMENT: PUBLIC HEALTH AND ENVIRONMENT DATE: January 19, 2024
PERSON REQUESTING: Jason Chessher, Executive Director
Shaun May, Public Health Services Director
Brief description of the problem/issue:
The Women's Wellness Connection (WWC) program requires certain pathology services to be provided to
qualified patients. As an example, if a WWC patient is determined by Banner Imaging to need a breast biopsy,
this agreement would allow the WCDPHE to work with Summit Pathology to interpret and report on the results
of that biopsy. Exhibit A lists the types of services to be provided and the 2023 Colorado Medicare
reimbursement rates. Exhibit B is the consultation voucher. The Weld County Department of Public Health and
Environment (WCDPHE) seeks approval of this agreement with Summit Pathology to ensure that our qualified
patients have timely access to the pathology services needed. The pathology services provided by Summit
Pathology are in coordination with Banner Imaging.
This agreement would be effective for one (1) year from the date of execution, and then after that this
agreement shall renew on a yearly basis for up to three (3) more years unless terminated sooner in
accordance with the terms of this agreement.
What options exist for the Board?
Consequences: If the Board declines to approve this agreement, the WCDPHE will not be able to
provide optimal care for our patients. This will result in greater challenges for us to assist qualified
patients at increased risk of breast and cervical cancer to connect with pathology services.
Impacts: With approval of the Board, the WCDPHE will be able to connect our qualified WWC patients
with Summit Pathology resulting in improved health outcomes and increased customer service.
Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): This is a no -cost agreement
with Summit Pathology. The cost of the services provided by Summit Pathology will be invoiced and
paid by WCDPHE. The Colorado Department of Public Health and Environment (CDPHE) Women's
Wellness Connection program will reimburse the WCDPHE. A list of the surgical services to be
provided and their associated cost is listed in Appendix A.
Recommendation: I recommend approval of this agreement with Summit Pathology.
Support Recommendation Schedule
Place on BOCC Agenda Work Session Other/Comments:
Perry L. Buck, Pro-Tem
Mike Freeman
Scott K. James
Kevin D. Ross , Chair
Lori Saine
2024-0430
2/21 41005?
Cheryl Hoffman
From:
Sent:
To:
Cc
Subject:
Approve - thanks!
Scott James
Monday, January 22, 2024 8:43 AM
Cheryl Hoffman
Esther Gesick
Re: New Banner & Summit Pathology Agreement
Scott K. James
Weld County Commissioner, District 2
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
970.336.7204 (Office)
970.381.7496 (Cell)
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or
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have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any
disclosure, copying, distribution or the taking of any action conceming the contents of this communication or any attachments by
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On Jan 22, 2024, at 8:36 AM, Cheryl Hoffman <choffman@weld.gov> wrote:
Scott,
This is #5 of 7.
Do you approve of placement after your review?
Cheryl L. Hoffman
Deputy Clerk to the Board
1150 O Street/P.O. Box 758
Greeley, CO 80632
Tel: (970) 400.4227
choffman@weld.gov
From: Karla Ford <kfordCDweld.tov>
Sent: Sunday, January 21, 2024 1:35 PM
To: Cheryl Hoffman <choffman@weld.eov>
Subject: New Banner & Summit Pathology Agreement
AGREEMENT CONCERNING PATHOLOGY SERVICES BETWEEN SUMMIT
PATHOLOGY AND THE WELD COUNTY BOARD OF COUNTY COMMISSIONERS ON
BEHALF OF THE WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
THIS AGREEMENT is made and entered into this Ol day of Feblru , 2024, by and
between the Board of Weld County Commissioners, on behalf of Weld Cou Department of Public
Health and Environment, hereinafter referred to as "WCDPHE", and Summit Pathology, hereinafter
referred to as "Contractor".
RECITALS:
WHEREAS, WCDPHE requires that certain pathology services be provided to eligible
WCDPHE patients; and
WHEREAS, CONTRACTOR has the necessary credentials and the appropriate
personnel to provide the services in the State of Colorado, and to provide such services to
eligible WCDPHE patients; and
WHEREAS, WCDPHE would like CONTRACTOR to provide services, and
CONTRACTOR is willing and able to provide such services to eligible WCDPHE patients
consistent with the terms and conditions hereinafter set forth in this Agreement.
NOW THEREFORE, for and in consideration of the covenants, conditions, agreements,
and stipulations hereinafter expressed, the parties do hereby agree as follows:
1. Recitals. The above set forth recitals are hereby incorporated as though set forth herein
verbatim.
2. CONTRACTOR Services. The Services to be provided by CONTRACTOR to WCDPHE
patients are listed in Exhibit A to this Agreement, attached hereto and incorporated herein by
reference.
3. Term of Agreement. This Agreement shall be effective for one (1) year from the date of
final execution by the Board of Weld County Commissioners. At the end of the initial one
year period, this Agreement shall automatically renew on a yearly basis for up to three (3)
more years, unless sooner terminated by notice from either party in accordance with Section
10, Termination, of this Agreement.
4. WCDPHE Responsibilities. WCDPHE shall be responsible for the following requirements
concerning WCDPHE patients who are authorized to receive Services from
CONTRACTOR:
Page 1of8
a. Referrals. All authorizations of WCDPHE patients for CONTRACTOR Services will be
coordinated through WCDPHE and the WCDPHE designated coordinator. WCDPHEwill
determine a patient's eligibility for Services prior to authorizing such patient for CONTRACTOR
Services.
b. Compensation. Within thirty (30) days of receipt of CONTRACTOR's invoice, WCDPHE
shall pay CONTRACTOR for Services in accordance with the effective Medicare
reimbursement rates specific to Colorado and set from time to time by the United States
Federal Government.
c. Vouchers. At the time of registration at Banner MD Anderson facility and prior to
performing Services, Banner MD Anderson will require patients to present a
WCDPHE WWC voucher in substantially the form of Exhibit B, which is attached hereto
and incorporated herein by reference.
d. Funding and Rates for Services. Within thirty (30) days of receipt of CONTRACTORs
invoice, WCDPHE shall pay CONTRACTOR for Services (as defined herein) in accordance with the
reimbursement rates set forth in the current WWC rate sheet attached hereto and incorporated herein as
Exhibit A. If the WWC rate sheet is modified at any time during the term of this Agreement,
WCDPHE shall notify CONTRACTOR immediately of such change, and in any case, no later than
thirty (30) days after such change, giving Notice as provided for in this Agreement.
5. CONTRACTOR Responsibilities. CONTRACTOR agrees to provide the following
services and be responsible for the following:
a. Services. CONTRACTOR agrees to provide certain pathology Services to WCDPHE
patients as more specifically set forth in Exhibit A
b. Timely Clinical Services Report. CONTRACTOR shall use its best efforts to return a
clinical services report within one (1) week of the date of service to allow WCDPHE to
report required information to the State of Colorado. Any disclosure of information will
be in compliance with federal and state law and the terms of Section 8, Confidentiality Of
Patient Information, of this Agreement.
c. Billing. CONTRACTOR will provide to WCDPHE on a monthly basis, a summary of
Services rendered to WCDPHE patients referred or authorized by WCDPHE to receive
such Services. The summary will include the following information: patient name, date of
birth, date of service, services provided, and cost. CONTRACTOR will provide in a timely
manner any additional information which may be required by WCDPHE to process the
billing information.
6. Adjustment of Payment:
a. Request for Adjustment. Either party shall be entitled to request an adjustment of
payment if the requesting party notifies the other party in writing of the overpayment or
underpayment within ninety (90) days of such payment and provides documentation
substantiating such claim. Such requests for payment adjustment must be answered
Page 2 of 8
within thirty (30) calendar days of receipt.
b. Paying Adjustments. If the parties determine that WCDPHE has underpaid
CONTRACTOR, WCDPHE shall pay the underpaid amount to CONTRACTOR within
fourteen (14) calendar days of such determination. If the parties determine that WCDPHE
has overpaid CONTRACTOR, CONTRACTOR shall reimburse WCDPHE for the
overpayment within fourteen (14) days of said determination.
c. Records. The relevant records of CONTRACTOR shall be complete and available for
audit ninety (90) days after final payment for any Services provided pursuant to this
Agreement, and shall be retained and available for audit purposes for at least five (5)
years after such final payment. The parties agree to the additional following provisions
concerning records:
d. Medical Records. Medical records for the Services provided pursuant to this Agreement
will be maintained at CONTRACTOR, but WCDPHE personnel will have access to such
files at all reasonable times during regular business hours.
e. Financial Records. WCDPHE shall have access to the financial records kept by
CONTRACTOR with respect to the Services provided by CONTRACTOR pursuant to this
Agreement at all reasonable times during regular business hours.
7. Confidentiality Of Patient Information. Each party agrees to keep any and all records and
information confidential, and to comply with the privacy obligations applicable to them
under the Health Insurance Portability and Accountability Act of 1996 and the regulations
issued pursuant thereto, as amended (42 USC 1320d and 45 CFR 160.101, et. seq.)
("HIPAA") and to comply with all other laws and regulations concerning the confidentiality
of such records. In the event of a contradiction between this Agreement and federal and state
law, federal and state law shall govern the release of any confidential information. The
parties agree to execute a Business Associate Agreement pursuant to HIPAA requirements, if
such an agreement is requested by either party.
8. Limitations, Liabilities, Indemnification. CONTRACTOR agrees to defend, indemnify,
and hold harmless WCDPHE for any and all liability incurred by the acts, omissions, or
failures to act by CONTRACTOR in relation to this Agreement. CONTRACTOR
acknowledges that WCDPHE is a governmental entity immune from certain liability
pursuant to the Colorado Governmental Immunity Act 024-10-101 C.R.S., et seq. To the
extent WCDPHE may be held liable for its acts, omissions, or failure to act, despite the
application of the aforementioned Colorado Governmental Immunity Act, WCDPHE agrees
to indemnify and hold harmless CONTRACTOR to the extent of the liability incurred by the
acts, omissions, or failures to act by WCDPHE in relation to this Agreement.
CONTRACTOR acknowledges that this agreement to defend, indemnify, and hold harmless
WCDPHE extends to the Board of Weld County Commissioners, and to all Weld County
officers, employees, and agents. The term "liability" includes, but is not limited to, claims,
suits, expenses, damages, and court awards including costs and attorney fees incurred as a
result of any act or omission by the applicable party who acted or failed to act. No term or
condition of this contract shall be construed or interpreted as a waiver, express or implied, of
Page 3 of 8
any of the immunities, rights, benefits, protections or other provisions, of the Colorado
Governmental Immunity Act 024-10-101 C.R.S., et seq., as applicable now or hereafter
amended. This Section 9, Limitations, Liabilities, Indemnification, shall survive termination
of this Agreement.
9. Termination of Agreement. Either party may terminate this Agreement with or without
cause upon thirty (30) days written notice to the other party. If this Agreement is so
terminated, WCDPHE agrees to pay compensation owed to CONTRACTOR for actual
Services rendered to WCDPHE patients during the term of this Agreement and pursuant to its
terms and provisions.
10. No Federal Exclusion.
a. WCDPHE hereby represents and warrants that WCDPHE is not, and at no time has been,
excluded from participation in any federally funded health care program, including
Medicare and Medicaid. WCDPHE hereby agrees to immediately notify CONTRACTOR
of any threatened, proposed, or actual sanction or exclusion from any federally funded
health care program, including Medicare and Medicaid. Such notice shall contain
reasonably sufficient information to allow CONTRACTOR to determine the nature of any
sanction. In the event that WCDPHE is excluded from participation in any federally
funded health care program during the term of this Agreement, or if, at any time after the
effective date of this Agreement, it is determined that WCDPHE is in breach of this
Section, this Agreement shall, as of the effective date of such exclusion or breach,
automatically terminate.
b. CONTRACTOR hereby represents and warrants that CONTRACTOR is not, and at no
time has been, excluded from participation in any federally funded health care program,
including Medicare and Medicaid. CONTRACTOR hereby agrees to immediately notify
WCDPHE of any threatened, proposed, or actual sanction or exclusion from any
federally funded health care program, including Medicare and Medicaid. Such notice
shall contain reasonably sufficient information to allow CONTRACTOR to determine the
nature of any sanction. In the event that CONTRACTOR is excluded from participation in
any federally funded health care program during the term of this Agreement, or if, at any
time after the effective date of this Agreement, it is determined that CONTRACTOR is in
breach of this Section, this Agreement shall, as of the effective date of such exclusion or
breach, automatically terminate.
11. Notices. Any notice or other communication provided for in this Agreement shall be in
writing and shall be served by personal delivery, confirmed facsimile, or by certified mail,
return receipt requested, postage prepaid, at the addresses set forth in this Agreement, until
such time as written notice of a change is received from the party wishing to make a change
of address. Any notice so mailed and any notice served by personal delivery or confirmed
facsimile shall be deemed delivered and effective on the date of delivery if the notice is
personally served or served by facsimile, or on the third business day following the date of
mailing if the notice is mailed by certified mail.
Page 4 of 8
a. Summit Pathology: "�,,�
Address: .3802_ u icht Dc dt, Lod�lcirtci.1 CO .063.15
Attn: Anat euL Dcw.t c#sa n
Phone: q70 _ 12.0530
Fax: ci0 212- 0533
b. WCDPHE:
Greeley, Colorado 80631
Weld County Department of Public Health And Environment
Attn. Jason Chessher
1555 N. 17th Avenue
Greeley, Colorado 80631
FAX: 970-304-6412
12. General Provisions.
a. Section Headings. The headings of sections in this Agreement are for reference only and
shall not affect the meaning of this Agreement.
b. Parties' Relationship. The parties to this Agreement intend that the relationship between
them contemplated by this Agreement is that of independent entities working in mutual
cooperation. No employee, agent, or servant of one party shall be or shall be deemed to
be an employee, agent, or servant of another party to this Agreement.
c. No Waiver of Immunities. Notwithstanding any other provision contained herein,
WCDPHE specifically does not waive any immunities to which it may be entitled by
statute or otherwise, including, without limitation, the Colorado Governmental Immunity
Act H24-10-101 C.R.S., et seq.
d. Non -Assignment. This Agreement shall not be assigned, delegated, or transferred by
either party without the prior written consent of the other party.
e. Binding Effect. This Agreement shall be binding upon, and shall inure to the benefit of,
the parties hereto and their successors and permitted assignees.
f. Governing Law. This Agreement shall be governed under the laws of the State of
Colorado, and any relevant Federal law.
g.
Medical Practices. WCDPHE and CONTRACTOR understand and agree that all
obligations concerning medical practices under this Agreement shall be conducted in
accordance with the applicable standards of care within the community.
Page 5 of 8
h. Severability. If any term or condition of this Agreement shall be held to be invalid,
illegal, or unenforceable, this Agreement shall be construed and enforced without such a
provision, to the extent this Agreement is then capable of execution within the original
intent of the parties.
i. Funding. No portion of this Agreement shall be deemed to create an obligation on the
part of the County of Weld, State of Colorado, or WCDPHE to expend funds not
otherwise appropriated during the term of this Agreement.
J.
No Third Party Enforcement. No portion of this Agreement shall be deemed to have
created a duty of care with respect to any person not a party to this Agreement. It is
expressly understood and agreed that enforcement of the terms and conditions of this
Agreement, and all rights of action relating to such enforcement, shall be strictly reserved
to the undersigned parties, and nothing contained in this Agreement shall give or allow
any claim or right of action whatsoever by any other person not included in this Agreement. It is
the express intention of the undersigned parties that any entity other than the undersigned parties
receiving Services or benefits under this Agreement shall be deemed an incidental beneficiary
only.
k. Conflict of Interest. No officer, member, director, or employee of WCDPHE or
CONTRACTOR, and no member of their governing bodies shall have any pecuniary
interest, direct or indirect, in the approved Agreement or the proceeds thereof.
1. Open Records. Notwithstanding any other language contained in this Agreement,
CONTRACTOR acknowledges that WCDPHE is a department of Weld County
Government, and as such, is subject to the Colorado Open Records Act, which would
most likely recognize this Agreement, its accompanying records, and other records and
information associated with the performance and execution of this Agreement, as open
records available to the public.
m. Non -Exclusive Agreement. This Agreement is not exclusive. Accordingly, either
CONTRACTOR or WCDPHE shall have the right to enter into one or more agreements
relating to the same or similar matters as are covered by this Agreement, and execution
by either party of such agreements shall not constitute a breach of this Agreement.
n. Integration, Modification, and Breach. This Agreement contains the entire Agreement
and understanding between the parties to this Agreement and supersedes any other
agreements concerning the subject matter of this transaction, whether oral or written. No
modification, amendment, novation, renewal, or other alteration of or to this Agreement
and the attached exhibit(s) shall be deemed valid or of any force or effect whatsoever,
unless mutually agreed upon in writing by the undersigned parties. No breach of any
term, provision, or clause of this Agreement shall be deemed waived or excused, unless
such waiver or consent shall be in writing and signed by the party claimed to have waived
or consented. Any consent by any party hereto, or waiver of, a breach by any other party,
whether express or implied, shall not constitute a consent to, waiver of, or excuse for any
other different or subsequent breach.
Page 6 of 8
IN WITNESS WHEREOF, the parties have hereunto set their hands and seals on the dates stated
below.
SUMMIT PATHOLOGY:
Name: ,-re,
J -
Title: %i'Icvckay�,yt
Date: )/2 fat
ATTEST:
BY:
W..42f44,)
erk to the Board
Deputy CI
DATE:
FEB 2 12024
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
0
Kevin D. Ross, Chair
FEB 2 1 2824
Page 7 of 8
c2.0,3-- 60
Exhibit A
Medicare
Rates
and CPT Codes
- Updated
June
2023 (updates
in
Bold)
Cancer Prevention
and
Early
Detecton
Program/Women's Wellness
Connection Clinical Services
Reimbursable
Services and
Procedures
for June 30, 2023
to June 29, 2024
Listed below
Connection
https://www.cros.gov/medicare/physician-fee-schedule/search/overview.
are allowable
(WWC)
Clinical
procedures
Services
and
program.
the
corresponding
These
rates
are
CPT codes
based
on information
for use
Rates
covered
related
in
are incorporated
contact
the
through
to
Cancer
found
cancer
your
Prevention
on the
WWC
screening
CDPHE
Centers
into the
Clinical
and
program's
and
Organizational
for
diagnostics
Services
Early
Medicare
Bundled
Detection
and
Lead
of
and
to
Payment
the
for
Medicaid
aid
approval
(CPED)/Women's
breast
in
negotiating
System
and
website,
of
cervix
(BPS)
subcontracts.
may
any codes
Wellness
at
not
the
be eligible
on
this
list.
beginning
Reimbursement
of each
fiscal
for
through
year.
treatment
the
Codes
services
CPED/WWC
are provided
is not allowed.
Clinical
to show
Additional
Services
what
program.
services
CPT
are
codes
Please
for reimbursement
CPT CODES
OFFICE VISITS
End
Notes
2023 CO
Rates
2023 Prof
(26)
2023 Tech
(TC)
99202
New patient; expanded history, exam, straightforward decision -making; 15-29 minutes
$74.40
99203
New Patient;
detailed
history, exam, straightforward
decision -making; 30-44 minutes
$114.59
99204
New Patient; comprehensive history, exam, moderate complexity decision -making; 45-59 minutes
1
$169.84
99205
New patient; comprehensive history, exam, high complexity decision -making;
60-74 minutes
1
$224.00
99211
Established patient; evaluation and management, may not require presence of physician;
problems are minimal
presenting
$24.19
99212
Established patient;
history, exam, straightforward
decision -making; 10-19 minutes
$58.20
99213
Established Patient; expanded history, exam, straightforward decision -making;
20-29 minutes
$92.52
99214
Established
Patient; detailed
history, exam, moderately complex decision -making; 30-39 minutes
$130.73
99385
Initial comprehensive preventive medicine
counseling and guidance, risk factor reduction,
procedures, 18 to 39 years of age
evaluation
ordering
and management; history, examination,
of appropriate immunizations and lab
2
intentionally
left
blank
99386
Same as 99385, but 40 to 64 years of age
2
intentionally
left blank
99387
Same as 99385, but 65 years of age or older
2
intentionally
left
blank
99395
Periodic
counseling
procedures;
comprehensive
and
18
preventive medicine evaluation
guidance, risk factor reduction, ordering
to 39 years of age
and management; history, examination,
of appropriate immunizations and
lab
2
intentionally
left
blank
I
99396
Same as 99395 but 40
to 64 years of age
2
intentionally
left
blank
99397
Same as 99395, but 65 years of age or older
2
intentionally
left. blank
CPT CODES
BREAST
SCREENING
AND DIAGNOSTIC SERVICES
End
Notes
2023 CO
Rates
2023 Prof
(26)
2023 Tech
(TC)
76098
Radiological
examination, surgical specimen
$44.10
$15.37
$28.74
76641
Ultrasound, complete examination of breast including axilla, unilateral
$109.12
$35.55
$73.57
76642
Ultrasound, limited examination of breast including walla, unilateral
3
$89.62
$33.13
$56.49
76942
Ultrasonic guidance for needle placement, imaging supervision and interpretation
3
$60.46
$30.66
$29.80
19000
Puncture aspiration of cyst of breast
$106.66
19001
Puncture aspiration of cyst of breast, each additional cyst, used with 19000
$26.77
19100
Breast biopsy, percutaneous, needle core, not using imaging guidance
$157.03
19101
Excision Procedures on the Breast
$341.80
19120
Excision of cyst, tibroadenoma or other benign or malignant tumor, aberrant breast tissue, duct lesion,
nipple or areolar lesion; open; one or more lesions
$534.05
19125
Excision of breast lesion identified by preoperative placement of radiological marker; open; single
lesion
$587.57
19126
Excision of breast lesion identified by preoperative placement of radiological marker, open; each
additional lesion separately identified by a preoperative radiological marker
$158.37
19081
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
stereotactic guidance; first lesion
7
$532.20
19082
Breast biopsy, with placement oflocalization device and imaging of biopsy specimen, percutaneous;
stereotactic guidance; each additional lesion
7
$414.74
19083
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
ultrasound guidance; first lesion
7
$532.74
19084
Breast biopsy, with placement o f localization device and imaging of biopsy specimen, percutaneous;
ultrasound guidance; each additional lesion
7
$408.93
19085
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
magnetic resonance guidance; first lesion
7
$821.20
19086
Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous;
magnetic resonance guidance; each additional lesion
7
$640.86
19281
Placement of breast localization device, percutaneous; mammographic guidance; first lesion
8
$253.73
19282
Placement of breast localization device, percutaneous; mammographic guidance; each additional
lesion
8
$181.22
19283
Placement of breast localization device, percutaneous; stereotactic guidance; first lesion
8
$274.20
19284
Placement of breast localization device, percutaneous; stereotactic guidance; each additional lesion
8
$203.19
19285
Placement of breast localization device, percutaneous; ultrasound guidance; first lesion
8
$395.45
19286
Placement of breast localization device, percutaneous; ultrasound guidance; each additional lesion
8
$325.91
19287
Placement of breast localization device, percutaneous; magnetic resonance guidance; fast lesion
8
$683.08
19288
Placement of breast localization device, percutaneous; magnetic resonance guidance; each additional
lesion
8
$530.47
10021
Fine needle aspiration without imaging guidance, first lesion
$105.75
10004
Fine needle aspiration biopsy without imaging guidance, each additional lesion
$51.92
10005
Fine needle aspiration biopsy including ultrasound guidance, first lesion
$141.13
10006
Fine needle aspiration biopsy including ultrasound guidance, each additional lesion
$61.31
10007
Fine needle aspiration biopsy including fluoroscopic guidance, first lesion
$312.29
10008
Fine needle aspiration biopsy including fluoroscopic guidance, each additional lesion
$150.10
10009
Fine needle aspiration biopsy including CT guidance, first lesion
$459.72
10010
Fine needle aspiration biopsy including CT guidance, each additional lesion
$250.62
10011
Fine needle aspiration biopsy including MRI guidance, first lesion
9
(see end note)
10012
Fine needle aspiration biopsy including MRI guidance, each additional lesion
9
(see end note)
88172
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s), first evaluation episode
$57.49
$35.51
$21.98
88177
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine
adequacy of specimen(s), each separate additional evaluation episode
$30.23
$21.69
$8.54
88173
Cytopathology, evaluation of fine needle aspirate; interpretation and report
$168.51
$69.94
$98.57
88305
Surgical pathology, gross and microscopic examination
$74.12
$37.20
$36.92
88307
Surgical pathology, gross and microscopic examination; requiring microscopic evaluation of surgical
margins
$304.31
$82.27
$222.04
400
Anesthesia for procedures on the integumentary system, anterior trunk, not otherwise specified.
Medicare Base Units = 3
14
(see end note)
77053
Mammary ductogram or galactogram, single duct
$56.12
$17.43
$38.70
77046
Magnetic resonance imaging (MRI), breast, without contrast, unilateral REQUIRES WWC
PREAPPROVAL.
6
$232.92
$69.78
$163.15
77047
Magnetic resonance imaging (MRI), breast, without contrast, bilateral REQUIRES WWC
PREAPPROVAL.
6
$241.15
$77.29
$163.86
77048
Magnetic resonance imaging (MRI), breast, including CAD, with and without contrast, unilateral
REQUIRES WWC PREAPPROVAL.
6
$370.54
$101.53
$269.01
77049
Magnetic resonance imaging (MRI), breast, including CAD, with and without contrast, bilateral
REQUIRES WWC PREAPPROVAL.
6
$377.98
$111.10
$266.88
77063
Screening digital breast tomosynthesis, bilateral (3D mammography)
4
$54.96
$29.34
$25.62
77065
Diagnostic Mammography, unilateral, includes CAD
$132.12
$38.99
$93.14
77066
Diagnostic Mammography, bilateral, includes CAD
$166.70
$47.95
$118.76
77067
Screening Mammography, bilateral
$135.40
$36.93
$98.48
G0279
Diagnostic digital breast tomosynthesis, unilateral or bilateral (diagnostic 3D mammography)
5
$54.96
$29.34
$25.62
Various
To include any pre -operative testing procedures medically necessary for the planned surgical
procedure (e.g., complete blood count, urinalysis, pregnancy test, pre -operative CXR, etc.)
a`'
n
88164
Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System,
manual screening under physician supervision
$17.31
88165
Cytopathology (conventional Pap test), slides cervical or vaginal reported in Bethesda System,
manual screening and rescreening under physician supervision
$42.22
88141
Cytopathology (conventional Pap test), cervical or vaginal, any reporting system, requiring
interpretation by physician
$23.71
=,
1 -'
88142
Cytopathology (liquid -based Pap test) cervical or vaginal, collected in preservative fluid, automated
thin layer preparation; manual screening under physician supervision
$20.26
88143
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
manual screening and rescreening under physician supervision
$23.04
88174
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
screening by automated system, under physician supervision
$25.37
88175
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer preparation;
screening by automated system and manual rescreening, under physician supervision
$26.61
:-
87624
Human Papillomavirus (HPV) high -risk types
10
$35.09
87625
Human Papillomavirus, types 16 and 18 only
10
$40.55
57452
Colposcopy of the cervix
$131.49
57454
Colposcopy of the cervix, with biopsy and endocervical curettage
$174.03
57455
Colposcopy of the cervix, with biopsy
$166.88
57456
Colposcopy of the cervix, with endocervical curettage
$157.57
57460
Colposcopy with loop electrode biopsy(s) of the cervix Requires WWC Preapproval Unless Done
After HSIL or AIS Pap test.
$330.48
57461
Colposcopy with loop electrode Ionization ofthe cervixRequires WWC Preapproval unless done
after HSIL or AIS Pap test.
$367.49
57500
Cervical biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate
procedure) Use this code for cervical polyp removal
$162.00
[.
57505
Endocervical curettage (not done as part of a dilation and curettage)
$163.43
57520
Conization of cervix, with or without fulguration, with or without dilation and curettage, with or
without repair; cold knife or laser
11
$367.29
57522
Loop electrode excision procedure
11
$314.92
58100
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical
dilation, anmethod (separate procedure). Only for diagnostic purposes following AGC Pa
Y ( p p ) Y g p P g p•
$105.41
58110
Endometrial sampling (biopsy) performed in conjunction with Colposcopy (List separately in addition
to code for primary procedure). Only for diagnostic purposes following AGC Pap.
$50.81
88305
Surgical pathology, gross and microscopic examination
$74.12
$37.20
$36.92
88331
Pathology consultation during surgery, first tissue block, with frozen section(s), single specimen
$105.74
$62.06
$43,68
88332
Pathology consultation during surgery, each additional tissue block, with frozen section(s)
$56.93
$30.68
$26.25
88341
Immunohistochemistry antibody slide
$90.51
$28.24
$62.27
88342
Immunohistochemistry antibody slide
$104.79
$34.78
$70.01
88360
Morphometric analysis, tumor immunohistochemistry, pre specimen; manual
$123.78
$41.67
$82.11
88361
Morphometric analysis, tumor immunohistochemistry, pre specimen; using computer -assisted
technology
$123.63
$43.65
$79.97
99070
Supplies
included
provided)
and materials (except spectacles), provided
with the office visit or other services rendered
by the physician over and
(list drugs, trays, supplies,
above
those usually
or materials
Various
Ike -operative testing;
necessary for the
CBC,
planned
urinalysis, pregnancy test, etc. These
surgical procedure.
procedures should
be medically
1)-11
CODE
.
'NUM
- - - . _ --
.._ -
Notes
2023 ( 1)
Raft•,
(26)
2023 Prof
21)23 Feel'
( I.()
ID! ' ski) \ I It)\ ANESTHESIA ,,
400
Anesthesia for procedures
on the integumentary system, anterior trunk, not otherwise
sped, lied
99156
10-22 minutes for individuals 5 years or older
$75.64
99157
For each
additional 15 minutes
12
$62.27
(TT ('Oifl:S
119 t INC AND
—DIM; NOS I'IcS aili ._
land
utcs ....1Zltes
rinir15 illir21)23
_
Prof
(26)
21)23 Tech
( 1(')
87426
CO\ 11)- I9 infectious agent detection by nuclei acid I )NA or RNA; amplified
probe
technique
15
$35.33
15
$51.31
87635
CU VID-19 infectious agent antigen detection by immunoassay technique; qualitative or
semiquantitative
88365
In situ hybridization (eg,FISH), per specimen; initial
single
probe
stain procedure
$189.83
$43.05
$146.78
88364
In situ hybridization
(eg,FISH), per specimen; each
additional single probe stain procedure
$143.58
$34.07
$108.51
88366
In situ hybridization (eg,FISH), per specimen; each multiplex probe stain
procedure
$293.45
$61.98
$231.46
88367
Morphometric analysis, in situ hybridization, computer -assisted, per specimen, initial
stain procedure
single
probe
4
$119.34
$33.32
$86.02
88373
Morphometric
stain
analysis, in situ hybridization, computer -assisted, per specimen, each additional probe
procedure
$71.70
$25.09
$46.66
88374
Morphometric
procedure
analysis, in situ by hriclization, computer -assisted, per specimen, each multiplex
stain
$320.07
$42.62
$277
45
88368
Morphometric analysis,
procedure
in situ hybridization,
manual, per specimen, initial single probe stain
$149.27
$41
63
$107.64
88369
Morphometric analysis, in situ hybridization,
procedure
manual, per specimen, each
additional
probe
stain
$128.28
$33.01
$95.27
88 377
Morphometric analysis, in situ
hybridization,
manual,
per specimen, each multiplex stain procedure
$417.83
$63 61
$354.22
Various
Pre -operative testing; CBC, urinalysis, pregnancy test, etc. These procedures should
necessary for the planned surgical procedure.
be medically
\►>>
Treatment of breast carcinoma in situ,
cancer.
breast cancer, cervical intraepithelial neoplasia and cervical
77061.
77062
Breast tomosynthesis, as screening, diagnostic, unilateral/bilateral. These procedures have not been
approved for coverage by CPED/WWC.
13
I
87623
1 luman Papillomavirus, low -risk types
END NOTES FOR WWC CLINICAL SERVICES
1
All consultations should be billed through the standard "new patient" office visit CPT codes 99202-99205 Consultations billed as 99204 or 99205 must meet
the criteria for these codes These codes (99204-99205) are typically not appropriate for CPED/WWC screening visits However, they may be used when
provider spends extra time to do a detailed risk assessment
2
The 9938X codes shall be reimbursed at or below the 99203 rate, and 9939X codes shall be reimbursed at or below the 99213 rate The type and duration of
office visits should be appropriate to the level of care needed to accomplish screening and diagnostic follow-up within the CPED/WWC While some
programs may need to use 993XX-series codes, Preventive Medicine Evaluation visits are not covered by Medicare and not appropriate for the CPED/WWC
3
Fora bilateral breast ultrasound, a modifier 50 maybe added to either 76641 or 76642 to indicate a bilateral procedure The Medicare Physician Fee Schedule
assigns a "1" bilateral indicator to both CPT codes 76641 and 76642 which means that Medicare will allow 150 percent of the standard reimbursement rate
4
List separately in addition to code for primary procedure 77067
5
List separately in addition to 77065 or 77067
6
Breast MRI can be reimbursed by the in conjunction with a mammogram when a client has a BRCA gene mutation, a first -degree relative who is a BRCA
carrier, or a lifetime risk of 20% or greater as defined by risk assessment models such as BRCAPRO that depend largely on family history Breast MRI also
can be used to assess areas of concern on a mammogram, or to evaluate a client with a history of breast cancer after completing treatment Breast MRI should
never be done alone as a breast cancer screening tool Breast MRI cannot be reimbursed to assess the extent of disease in a women who has just been newly
diagnosed with breast cancer in order to determine treatment
7
Codes 19081-19086 are to be used for breast biopsies that include image guidance, placement of localization device, and imaging of specimen These codes
should not be used in conjunction with 19281-19288
8
Codes 19281-19288 are for image guidance placement of localization device without image -guided biopsy These codes should not be used in conjunction
with 19081-19086
9
For CPT 10011 use the reimbursement rate for CPT code 10009 For CPT 10012 use the reimbursement rate for CPT code 10010
10
HPV DNA testing is not a reimbursable test for women under 30 years of age
11
A LEEP or conization of the cervix, as a diagnostic procedure, maybe reimbursed based on ASCCP recommendations Pre -approval of this procedure for
reimbursement is required A LEEP or conization of the cervix as a treatment procedure cannot be reimbursed by CDPHE
12
Example If procedure is 50 minutes, code 99156 + (99157 x 2) No separate charge allowed if procedure
<10 minutes
13
These procedures have not been approved for coverage by Medicare Please see code 77063 as the approved code for screening digital breast tomosynthesis,
bilateral 3D mammography
14
The carner specific Medicare anesthesia conversion rates are available here https //www ems gov/Center/Provider-Type/Anesthesiologists-Center html
Medicare's methodology for the payment of anesthesia services are outlined in the Medicare Claims Processing Manual, Chapter 12, pages 99-107, available
here http //www cros hhs gov/manuals/downloads/c1m104c12 pdf
15
States have received federal funding and test kits for free COVD-I9 testing These were specifically provided so that uninsured people could get free testing
Since WWC/CPED is payor of last resort, this should be the first resource for any COVID-19 testing required by a provider prior to any procedure When
testing cannot be covered by those resources for reasons such as the free testing only be administered to people who are symptomatic, then W WC/CPED can
cover the required COVID-19 antigen testing If your organization pays for COVID testing, your organization should be able to track all tests results and link
them to an actual screening or diagnostic procedure if the COVID-19 test is negative If the COVID-19 testis positive, your organization will need to have a
plan for following up to make sure the required procedure gets done at a later date
14.1/4 it
!86?=-�
WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
1555 North 17th Avenue, Greeley, CO 80631 www.weldhealth.org
Consultation Voucher
This voucher is for the following patient who has been confirmed as eligible for:
Este cupon es para las personas que son confirmadas elegible para:
11 Women's Wellness Connection Program
Patient: Please present this voucher, as well as any other paperwork given to you, as you arrive for your
appointment to ensure proper billing. Your appointment is scheduled at:
Al Ilegar a su cita por favor presence este cupon y otros documentos necesarios entregados a usted, para ase€urar la
facturacion apropiada. Su cita es programada en:
Banner MD Anderson Cancer Center
1801 16th Street
Greeley, CO 80631
970-810-3894
970-810-3897 Fax
Appointment date/time:
Fecha de la cita
Patient's name:
Summit Pathology
5802 Wright Drive
Loveland, CO 80538
970-212-0518
970-267-6941 Fax — Attn: Andrea
Patient's Date of Birth:
Fecha de nacimiento
Nombre del paciente
Covered service for this visit:
Servicio cubierto para esta cita
*
*All other services will require prior authorization.
Todos otros servicios se requieren autorizacion previa.
NOTE: This voucher expires 60 days after date of issue.
Issue date: Authorized Signature:
Service Provider: please bill Weld County as an insurance for the above listed service only:
Weld County Department of Public Health
Attn: Contract Billing
1555 North 17th Avenue, Greeley, CO 80631
If you have any questions or need to reschedule, please call (970) 304-6420.
Si usted tiene alguna pregunta o tiene que cancelar la cita, por favor Ilame (970) 304-6420.
Health Administration
Vital Records
Tele: 970-304-6410
Fax: 970-304-6412
Public Health &
Clinical Services
Tele: 970-304-6420
Fax: 970-304-6416
Environmental Health
Services
Tele: 970-304-6415
Fax: 970-304-6411
Communication,
Education 8 Planning
Tele: 970-304-6470
Fax: 970-304-6452
Emergency Preparedness
& Response
Tele: 970-304-6470
Fax: 970-304-6452
Public Health
Contract Form
Entity Information
Entity Name *
SUMMIT PATHOLOGY
Entity ID*
@00035140
Contract Name *
SUMMIT PATHOLOGY SERVICES AGREEMENT
Contract Status
CTB REVIEW
Contract Description
SUMMIT PATHOLOGY SERVICES AGREEMENT
Contract Description 2
Contract Type *
AGREEMENT
Amount*
$1.00
Renewable*
YES
Automatic Renewal
Grant
IGA
Department
HEALTH
Department Email
CM-Health@weldgov.com
Department Head Email
CM-Health-
DeptHead@weldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@WEL
DGOV.COM
If this is a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Q New Entity?
Contract ID
7779
Contract Lead *
BFRITZ
Contract Lead Email
bfritz@weld.gov;Health-
Contracts@weld.gov
Parent Contract ID
Requires Board Approval
YES
Department Project #
Requested BOCC Agenda Due Date
Date* 01 /25/2024
01/29/2024
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be
included?
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts
are not in OnBase
Contract Dates
Effective Date
Termination Notice Period
Contact Information
Review Date *
11/01/2024
Renewal Date*
02/01/2024
Committed Delivery Date Expiration Date
Contact Info
Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head Finance Approver Legal Counsel
JASON CHESSHER CHERYL PATTELLI BRUCE BARKER
DH Approved Date Finance Approved Date Legal Counsel Approved Date
02/09/2024 02/09/2024 02/12/2024
Final Approval
BOCC Approved Tyler Ref #
AG 022124
BOCC Signed Date Originator
BFRITZ
BOCC Agenda Date
02/21/2024
Hello