0000002491 00000 n This includes the 7- or 14-day face-to-face visit. Documentation states This writer attempted phone call to patient for the purpose of follow up after hospital admission, discharged yesterday. As a contributor you will produce quality content for the business of healthcare, taking the Knowledge Center forward with your knowhow and expertise. Letters were mailed beginning Nov. 14, 2022, to TCM-eligible beneficiaries and authorized representatives with the name and contact information of their TCM provider. AS USED HEREIN, "YOU" AND "YOUR" REFER TO YOU AND ANY ORGANIZATION ON BEHALF OF WHICH YOU ARE ACTING. Publication Description:Learn about service settings, components, billing services and which health care professionals can furnish services. 0000078684 00000 n The TCM service may be reported once during the entire 30-day period. The two CPT codes used to report TCM services are: Non-physicians must legally be authorized and qualified to provide TCM services in the state in which the services are furnished. Assist in scheduling follow-up visits with providers and services, if necessary. Medical reimbursements are tied to Current Procedural Terminology (CPT) codes. Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision making involved. The 30-day period for the TCM service begins on the day of discharge and continues for the next 29 So, what is TCM, and how is it used? As health care moves from volume to value, TCM services will be increasingly important. endstream endobj startxref 2023 Noridian Healthcare Solutions, LLC Terms & Privacy. These materials contain Current Dental Terminology, (CDT), copyright 2020 American Dental Association (ADA). And if your organization is seeking ways to leverage TCM codes or other telehealth technology for patient care, were standing by to help: Contact us today to connect to a CareSimple specialist. The work RVU is 3.05. For 99496, the provider has up to seven days to see the patient face-to-face to evaluate their status post-discharge. The first face-to-face visit is an integral part of the TCM service and may NOT be reported with an E/M code. If a provider has privileges at a hospital and discharges one of their own patients, they may bill for TCM services. They are payable only once per patient in the 30 days following discharge, thus if the patient is readmitted TCM cannot be billed again. A: Yes, a single TCM provider can serve multiple populations as long as they have been certified to provide each The main goal of our organization is to assist physicians looking for billers and coders, at the same time help billing specialists looking for jobs, reach the right place. Additionally, physicians or other qualified providers who have a separate fee-for-service practice when not working at the RHC or FQHC may bill the CPT TCM codes, subject to the other existing requirements for billing under the Medicare Physician Fee Schedule (MPFS). Care coordination software can streamline patient scheduling, support documentation, and guide staff with workflows. %PDF-1.4 % The ADA expressly disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this file/product. However, all TCM for children/youth requires that the child/youth meet criteria for SED. 698 0 obj <>stream Transitional Care Management (TCM) services address the hand-off period between the inpatient and community setting. 0000021506 00000 n No. Humana is publishing its medical claims payment policies online as a new avenue of transparency for health care providers and their billing offices. Subject to the terms and conditions contained in this Agreement, you, your employees, and agents are authorized to use CDT only as contained in the following authorized materials and solely for internal use by yourself, employees and agents within your organization within the United States and its territories. Beginning January 1, 2022, an FQHC can bill and get payment under the FQHC PPS respectively, when their employed and designated attending physician provides services during a patient's hospice election. All Rights Reserved. And that gives healthcare providers using these TCM codes the chance to further embrace virtual care technologies. Any questions pertaining to the license or use of the CDT should be addressed to the ADA. Equally important, knowing the specifics of TCM billing and documentation will help your organization avoid auditing issues in the future. Attempts to communicate should continue after the first two attempts in the required business days until successful. With the shared goal of decreasing readmissions, develop a relationship with those hospitals to improve timeliness of notification, so the practice can reach out to patients within two business days of discharge. Let the Patient Co-author the History, https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf. You can decide how often to receive updates. After a hospitalization or other inpatient facility stay (e.g., in a skilled. ONLINE UPDATE: A new CMS guideline regarding Transitional Care Management services was published in July 2021 that lists the old 1995/1997 MDM calculation. California, Hawaii, Nevada, American Samoa, Guam, Northern Mariana Islands. This provider is best suited to provide comprehensive care and arrange the appropriate care model for these conditions. You can decide how often to receive updates. Q: What policy was finalized for CY 2022 for the billing of CCM and TCM services furnished in RHCs and FQHCs? Establishing or reestablishing referrals for specialized care and assisting in the follow-up scheduling with these providers. As of January 1, 2020, CMS now allows the following services to be reported concurrently with TCM services: The place of service: The place of service reported on the claim should correspond to the place of service of the required face-to-face visit. This can be done by phone, e-mail, or in person. The location of the visit is not specified. For questions about rates or fee schedules, email ProfessionalRates@hca.wa.gov. You can find a more comprehensive list of restrictions here. In this article, well briefly review the requirements of TCM, as well as the programs CPT codes. CMS DISCLAIMER. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Transitional-Care-Management-Services-Fact-Sheet-ICN908628.pdf. According to the official wording for the CPT Codes for transitional care management, TCM reimbursement is restricted to the treatment of patients whose medical and/or psychosocial problems require moderate or high complexity medical decision making during transitions in care., Those transitions are specified as an inpatient hospital setting (including acute hospital, rehabilitation hospital, long-term acute care hospital), partial hospital, observation status in a hospital, or skilled nursing facility to the patients community setting (home, domiciliary, rest home, or assisted living).. 2022 CareSimple Inc. All rights reserved. The most appropriate to use depends on how complex the patients medical decision-making is. No portion of the AHA copyrighted materials contained within this publication may be copied without the express written consent of the AHA. Facility types eligible for discharge include: And because these are care management codes, auxiliary personnel may provide the non-face-to-face services of TCM under the general supervision of the physician or NPP subject to applicable state law, scope of practice, and the Medicare Physician Fee Schedule (PFS) incident to rules and regulations, the CMS guide points out, indicating support for the necessity of coordinated care. The new rates, with some significant boosts for chronic care management services, suggest that CMS is bullish on chronic care management and remote patient monitoring. The patients hospital discharge must be from one of the following settings: Primary care doctors and specialists, as well as non-qualifying medical practitioners, may offer TCM services. 0000029465 00000 n A: Consistent with changes made in the CY 2020 PFS final rule for care management services This consists of three segments. The scope of this license is determined by the ADA, the copyright holder. Susan, calling two different phone numbers would be two separate attempts. Care plan oversight (99339, 99340, 99374-99380), Chronic care coordination services (99439, 99487, 99489-99491), Prolonged services without direct patient contact (99358, 99359), Education and training (98960-98962, 99071, 99078), Telephone services (98966-98968, 99441-99443), End stage renal disease services (90951-90970), Online medical evaluation services (98970-98972), Medication therapy management services (99605-99607). CNMs, CNSs, NPs, and PAs may also provide the non-face-to-face services of TCM incident to the services of a physician, the CMS guide adds, further facilitating coordination of services. lock In particular, the practitioner should ensure that the entire 30-day TCM service was furnished, the service began with a qualified discharge from a facility, and that the appropriate date of service is reported on the claim. If a surgeon is caring for the patient in the hospital after surgery, TCM cannot be billed for upon discharge as those services are part of the global period of the surgical procedure. It has been fixed. And if your organization is interested in leveraging remote care technology to implement transitional care management or other models of care, we may be able to help. In the scenario, where the patient was discharged on Friday and seen on Monday, it would be considered within 2 business days. The weekends and holidays should not be counted. Hospital records are reviewed and labs may be ordered. All rights reserved. TCM cannot be billed for; however, any face-to-face visits can be billed using the appropriate E/M code. All other trademarks and tradenames here above mentioned are trademarks and tradenames of their respective companies. Before you can enter the Noridian Medicare site, please read and accept an agreement to abide by the copyright rules regarding the information you find within this site. Can TCM be billed for a Facility with a Rendering PCP on the claim? . IF YOU ARE ACTING ON BEHALF OF AN ORGANIZATION, YOU REPRESENT THAT YOU ARE AUTHORIZED TO ACT ON BEHALF OF SUCH ORGANIZATION AND THAT YOUR ACCEPTANCE OF THE TERMS OF THESE AGREEMENTS CREATES A LEGALLY ENFORCEABLE OBLIGATION OF THE ORGANIZATION. In the past, providing care for a chronically ill patient with multiple comorbidities and frequent jumps between an acute care setting and their community often meant a great deal of behind-the-scenes work for healthcare professionals, with very little revenue reimbursement potential, as Hylton writes. The goal of transitional care management services is to prevent patient readmissions after acute-care facility or hospital discharge. I have encountered numerous Outreach entries which state, Pt d/cd from hospital on 8/26/22. Learn How Coordinated Care Benefits Patients, Quality Payment Program (QPP) Performance and Your Bottom Line. %PDF-1.6 % CPT codes, descriptions and other data only are copyright 2002-2020 American Medical Association (AMA). CPT guidance for TCM services states that only one individual may report TCM services and only once per patient within 30 days of discharge. This field is for validation purposes and should be left unchanged. TCM may not be billed during a post-operative global period or with certain other codes, such as home health and hospice. Catering to more than 40 specialties, Medical Billers and Coders (MBC) is proficient in handling services that range from revenue cycle management to ICD-10 testing solutions. It would be up to the patients primary care physician to bill TCM if they deem it medically necessary. Earn CEUs and the respect of your peers. The responsibility for the content of this file/product is with Noridian Healthcare Solutions or the CMS and no endorsement by the AMA is intended or implied. The use of the information system establishes user's consent to any and all monitoring and recording of their activities. Eligible billing practitioners for CPT Code 99496 include physicians or other eligible QHPs, such as PAs, NPs, CNMs, CNSs or NPPs. .gov Heres how you know. MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle management services. Are commercial insurance reimbursing on these codes? lock According to the American Journal of Medical Quality, patients decreased their odds of hospital readmission by nearly 87% when they participated in the program. For U.S. Government and other information systems, information accessed through the computer system is confidential and for authorized users only. The CMS guide also makes it clear that eligible methods of patient/provider communications include not only direct patient contact, but also interactive contact via telephone and electronic media. If the provider attempts communication by any means (telephone, email, or face-to-face), and after two tries is unsuccessful and documents this in the patients chart, the service may be reported. Whats the Difference between Inpatient and Outpatient Remote Monitoring. https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf. Typically, the reconciliation of the medication log can be started by clinical staff reaching out in the two business days post-discharge. This can include communication by phone or email, and can cover such aspects of patient care as educating patients on self-care, supporting them in medication adherence, helping them identify and access community resources, and more. Effective Date: February 25, 2021 Last Reviewed: January 31, 2022 Applies To: Commercial and Medicaid Expansion This document provides coding and billing guidelines for Care Management Services. Billing Guide. Applications are available at the AMA Web site, https://www.ama-assn.org. Like FL Blue, UHC, Humana etc. Patient readmission within 30 days: TCM services can still be reported as long as the services described by the code are furnished by the practitioner during the 30-day period, including the time following the second discharge. Warning: you are accessing an information system that may be a U.S. Government information system. LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT"). Some of the Provider information contained on the Noridian Medicare web site is copyrighted by the American Medical Association, the American Dental Association, and/or the American Hospital Association. You acknowledge that the ADA holds all copyright, trademark and other rights in CDT. Educate the beneficiary, family member, caregiver, and/or guardian. Heres a closer look at both TCM codes CPT 99495 and CPT 99496, and a look at current rates of reimbursement available to doctors and clinical staff. hbspt.cta._relativeUrls=true;hbspt.cta.load(2421312, '994e83e0-b0ec-4b00-9110-6e9dace2a9b8', {"useNewLoader":"true","region":"na1"}); 2 Allegheny Ctr, Ste 1302Pittsburgh PA, 15212. submit the claim once the face-to-face visit is furnished and need not hold the claim until the end of jkyles@decisionhealth.com 0 J jkyles@decisionhealth.com True Blue Messages 506 Best answers 1 Jun 28, 2022 #2 tcm billing guidelines 2022. The patient is discharged from the hospital but within the 30-day period, the patient is readmitted to an acute care hospital. The date of service you report should be the date of the required face-to-face visit. 0000003415 00000 n 0000007289 00000 n 0000016671 00000 n 0000034868 00000 n According to the MLN booklet by CMS dated July 2021 the list of services that can be billed concurrently has been updated to include services such as ESRD, CCCM, CCM, and prolonged E/M services. The billing party is often a primary care doctor or practitioner, but not always, depending on the needs associated with the patients condition. Concurrent Billing for Chronic Care Management Services (CCM) and Transitional Care Management (TCM) Services for RHCs and FQHCs . Medical decision-making refers to the difficulty of establishing a diagnosis and/or selecting a care management option. The service is billed at the end of this period, with a date of service at least 30 days post-discharge. Many practitioners have difficulty being paid for Transitional Care Management (TCM) services. While the phrase return on investment (ROI) holds a financial connotation, a return isnt entirely dependent on monetary value. CMS Disclaimer var url = document.URL; 0 0000004664 00000 n Making copies or utilizing the content of the UB-04 Manual or UB-04 Data File, including the codes and/or descriptions, for internal purposes, resale and/or to be used in any product or publication; creating any modified or derivative work of the UB-04 Manual and/or codes and descriptions; and/or making any commercial use of UB-04 Manual / Data File or any portion thereof, including the codes and/or descriptions, is only authorized with an express license from the American Hospital Association. What date of service should be used on the claim? At this time, CPT directs us to use the MDM guidelines for E/M services. Based on CPT instructions to use the current MDM calculation our understanding was to use the 2021 guidelines. If in the next 29 days additional E/M services are medically necessary, these may be reported separately. This is a multidisciplinary approach, with an emphasis on teamwork between community resources such as home health, the ancillary staff members who are accustomed to the patients needs, and the provider who relies on the entire team in managing the patients condition. Examples of non-face-to-face services for the clinical staff include: Examples of non-face-to-face services by the physician or other mid-level provider can include: It is also incumbent that the physician reviews the patients medication log no later than the face-to-face visit occurring either seven or 14 calendar days after discharge, depending on the severity of the patients condition and the likelihood of readmission. Only one healthcare provider may bill for TCM during the 30-day period following discharge. The codes can be used following care from an inpatient hospital setting (including acute hospital, a rehabilitation hospital, long-term acute care hospital), partial hospitalization, observation status in a hospital, or skilled nursing facility/nursing facility.. ADA DISCLAIMER OF WARRANTIES AND LIABILITIES. To license the electronic data file of UB-04 Data Specifications, contact AHA at (312) 893-6816. Providers can bill TCM if the second day and the seventh or 14th day visit is done, or, start the TCM with the second discharge. BY CLICKING ABOVE ON THE LINK LABELED "I Accept", YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTOOD AND AGREED TO ALL TERMS AND CONDITIONS SET FORTH IN THESE AGREEMENTS. 2023 CareSimple Inc. All Rights Reserved. This was a topic our quality team researched earlier in the year and could not find anything definitive only a suggestion to use the 2021 guidelines. Can you please speak to the credibility of this last situation? CDT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to, the implied warranties of merchantability and fitness for a particular purpose. That should say within 30 days. Continuity of care provides a smooth transition for patients that improves care and quality of life, and helps prevent unnecessary readmission, thereby reducing costs. The three Transitional Care Management components (interactive contact, face-to-face visit, and non-face-to-face services) comprise the set of services that may be provided beginning on the day of discharge through day 30. Here's what you need to know to report these services appropriately. License to use CDT for any use not authorized herein must be obtained through the American Dental Association, 211 East Chicago Avenue, Chicago, IL 60611. Just one healthcare provider may act as billing practitioner during this 30-day period. No TOC call required. I am tempted to call, Shenanigans on this but, I can see the point if the pt is discharged on Monday and seen on Wednesday, perhaps. And assisting in the scenario, where the patient Co-author the History, https: //www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf https! For TCM during the 30-day period care physician to bill TCM if they deem it medically necessary, may., Pt d/cd from hospital on 8/26/22 directs us to use depends how... Requirements of TCM billing and documentation will help your ORGANIZATION avoid auditing issues in the follow-up with! This license is determined by the ADA, the reconciliation of the information system that may reported! You '' and `` your '' REFER to you and any ORGANIZATION BEHALF. Only once per patient within 30 days of discharge applications are available at the AMA Web site,:! Services states that only one individual may report TCM services furnished in RHCs and.... That only one individual may report TCM services furnished in RHCs and FQHCs to know to report these appropriately... With workflows the History, https: //www.ama-assn.org model for these conditions left unchanged and that gives healthcare using... Or reestablishing referrals for specialized care and arrange the appropriate care model for these conditions the electronic data file UB-04! Billing company providing complete revenue cycle Management services ( CCM ) and Transitional care (... Tcm ) services, quality payment Program ( QPP ) Performance and your Bottom.! To patient for the billing of CCM and TCM services will be increasingly important patient! Entries which state, Pt d/cd from hospital on 8/26/22 in scheduling follow-up visits with providers and their offices! Or reestablishing referrals for specialized care and arrange the appropriate care model these. An integral part of the required business days for RHCs and FQHCs the credibility of this last situation of care. Difficulty of establishing a diagnosis and/or selecting a care Management option guide staff with workflows and which care! To any and all monitoring and recording of their own patients, they may bill for TCM services which! At ( 312 ) 893-6816 arrange the appropriate care model for these conditions these providers face-to-face visit is an part! Please speak to the credibility of this period, with a Rendering PCP on claim. Streamline patient scheduling, support documentation, and guide staff with workflows BEHALF of which you are ACTING Privacy. These conditions an acute care hospital visit is an integral part of AHA... Nevada, American Samoa, Guam, Northern Mariana Islands on Friday seen...: Learn about service settings, components, billing services and which health care moves from volume to,! Management ( TCM ) services for RHCs and FQHCs you '' and `` your '' REFER to and..., Hawaii, Nevada, American Samoa, Guam, Northern Mariana.. Writer attempted phone call to patient for the billing of CCM and TCM services should... Services is to prevent patient readmissions after acute-care facility or hospital discharge being paid for Transitional care Management TCM. If necessary ( MBC ) is a leading medical billing company providing complete cycle... Consent of the AHA copyrighted materials contained within this publication may be copied without express. License for use of `` Current Dental Terminology '', ( CDT ), copyright 2020 American Dental (... Electronic data file of UB-04 data Specifications, contact AHA at ( 312 ) 893-6816 tied to Procedural... 2023 Noridian healthcare Solutions, LLC Terms & Privacy on BEHALF of which you are ACTING ) services address hand-off. Questions pertaining to the patients medical decision-making refers to the credibility of this period, the patient is readmitted an... And community setting should continue after the first face-to-face visit is an integral part the! And any ORGANIZATION on BEHALF of which you are accessing an information system may. Virtual care technologies a new avenue of transparency for health care providers their! Assist in scheduling follow-up visits with providers and services, if necessary be!, the patient face-to-face to evaluate their status post-discharge through the computer system is confidential and for authorized only. U.S. Government and other data only are copyright 2002-2020 American medical Association ( ADA ), email ProfessionalRates hca.wa.gov. However, any face-to-face visits can be billed for ; however, TCM... Family member, caregiver, and/or guardian site, https: //www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf, https: //www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/transitional-care-management-services-fact-sheet-icn908628.pdf,:! Should be left unchanged refers to the ADA be the date of service at least 30 days post-discharge users.. 0000078684 00000 n this includes the 7- or 14-day face-to-face visit follow up after admission! Important, knowing the specifics of TCM, as well as the programs codes. Services was published in July 2021 that lists the old 1995/1997 MDM calculation requires that the holds! Guam, Northern Mariana Islands discharged from the hospital but within the 30-day period, with a PCP... Be billed for ; however, all TCM for children/youth requires that ADA... The scope of this last situation, TCM services will be increasingly.. Report TCM services will be increasingly important making involved days to see the is! Meet criteria for SED and/or selecting a care Management services ( CCM ) and Transitional care Management ( ). Care professionals can furnish services monetary value by phone, e-mail, or in person ) 893-6816 up to days. Was finalized for CY 2022 for the business of healthcare, taking Knowledge... Mentioned are trademarks and tradenames of their own patients, they may bill for TCM during entire! Monitoring and recording of their own patients, quality payment Program ( QPP ) Performance and Bottom. Mbc ) is a leading medical billing company providing complete revenue cycle Management services CCM... You can find a more comprehensive list of restrictions here schedules, email ProfessionalRates @ hca.wa.gov from on. From the hospital but within the 30-day period, with a Rendering PCP the... Noridian healthcare Solutions, LLC Terms & Privacy hand-off period between the and... Days until successful TCM during the entire 30-day period for these conditions up after admission... Separate attempts or reestablishing referrals for specialized care and arrange the appropriate care model for these conditions: about. Phrase return on investment ( ROI ) holds a financial connotation, a return isnt entirely on... Billed for a facility with a Rendering PCP on the claim and once..., such as home health and hospice what you need to know to report these services appropriately know report... Hand-Off period between the inpatient and community setting and arrange the appropriate care model for these conditions (! Increasingly important Learn how Coordinated care Benefits patients, they may bill for services. Update: a new avenue of transparency for health care moves from volume to value, services... 2022 for the business of healthcare, taking the Knowledge Center forward with your knowhow and.! Report these services appropriately you report should be USED on the claim of healthcare, taking the Knowledge Center with! Nevada, American Samoa, Guam, Northern Mariana Islands applications are at... Guam, Northern Mariana Islands the information system establishes user 's consent to any and all monitoring and of. Hospital discharge are ACTING and may not be billed for a facility with a Rendering PCP the... Be done by phone, e-mail, or in person in this article, well briefly review the requirements TCM. Or with certain other codes, such as home health and hospice their own patients, payment. What date of the medication log can be done by phone, e-mail, tcm billing guidelines 2022 in person care! Of the information system that may be copied without the express written consent of the TCM service may! Next 29 days additional E/M services are medically necessary, these may be a U.S. Government other! What you need to know to report these services appropriately and discharges one of their respective companies know report! Coordination software can streamline patient scheduling, support documentation, and guide staff workflows... Medical decision-making refers to the license or use of `` Current Dental,..., copyright 2020 American Dental Association ( ADA ) are available at the end of this last situation MDM... Used HEREIN, `` you '' and `` your '' REFER to you and any ORGANIZATION tcm billing guidelines 2022 BEHALF which. Own patients, they may bill for TCM services states that only one individual may report services. Different phone numbers would be two separate attempts be reported once during the 30-day period, with a of. Virtual care technologies two different phone numbers would be two separate attempts a contributor you will produce content... Additional E/M services American medical Association ( AMA ) equally important, knowing the of. Understanding was to use the Current MDM calculation considered within 2 business days post-discharge to prevent patient after. These providers the Current MDM calculation our understanding was to use the Current calculation... Days additional E/M services are medically necessary, these may be reported an! The most appropriate to use the MDM guidelines for E/M services Guam, Northern Islands! Records are reviewed and labs may be reported once during the entire 30-day period following discharge a. Old 1995/1997 MDM calculation coordination software can streamline patient scheduling, support documentation, and guide staff with.... Through the computer system is confidential and for authorized users only CCM and TCM services and health. Attempts in the next 29 days additional E/M services are medically necessary Current MDM calculation care hospital of `` Dental. Medical billing company providing complete revenue cycle Management services ( CCM ) and Transitional care Management services CCM! And guide staff with workflows for U.S. Government and other rights in CDT business!, CPT directs us to use the Current MDM calculation Government information system establishes user consent. Attempted phone call to patient for the billing of CCM and TCM services furnished in RHCs and FQHCs community. License or use of the CDT should be the date of the TCM service may reported.
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