CPT Code 93306 Ultimate Guide to Transthoracic Echocardiograms
CPT code 93306 is used to bill a complete transthoracic echocardiogram (TTE) with real-time 2D imaging, M-mode, spectral Doppler, and color Doppler. This noninvasive ultrasound evaluates heart structure, function, blood flow, and valve performance. It does not include contrast agents.
What is a Transthoracic Echocardiogram (TTE)?
A TTE is a non-invasive ultrasound performed through the chest wall to visualize the heart’s chambers, valves, blood vessels, and overall function. It serves as an initial evaluation method for addressing conditions such as:
- Heart failure
- Valve disorders (e.g., stenosis, regurgitation)
- Congenital heart defects
- Pericardial effusion
- Cardiomyopathy
Why CPT 93306 Matters
This code represents a complete TTE with advanced Doppler studies, making it critical for accurate reimbursement. Missing components (e.g., Doppler) or misusing modifiers can lead to claim denials.
Breaking Down CPT 93306: What’s Included?
- Real-Time 2D Imaging
- Creates cross-sectional views of the heart.
- Evaluates chamber size, wall thickness, and valve motion.
- M-Mode Recording
- Tracks movement of heart structures over time (e.g., mitral valve opening/closing).
- Measures dimensions like left ventricular ejection fraction (LVEF).
- Spectral Doppler
- Measures blood flow velocity and direction.
- Diagnoses stenosis (narrowing) or regurgitation (leaky valves).
- Color Flow Doppler
- Visualizes blood flow in color (red = toward the probe, blue = away).
- Detects turbulence caused by valve defects or shunts.
   5. ExclusionsÂ
- Contrast agents (use +93352 if contrast is administered).
- Stress echocardiograms (use 93350 for exercise/pharmacologic stress).
When to Use CPT 93306 vs. Similar Codes
CPT Code  | Description                                 | Key Difference |
93306 | Complete TTE with Doppler | Includes spectral/color Doppler |
93307 | Limited TTE | No Doppler studies |
93308 | Transesophageal echo (TEE) | Probe inserted into the esophagus |
93350 | Stress echocardiogram | Combines TTE with exercise/drug-induced stress |
Coding Guidelines for 93306
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Modifiers
- -26: Billing for physician interpretation only (e.g., cardiologist’s report).
- -TC: Technical component (facility equipment/staff costs).
- Example: A hospital bills 93306-TC for the scan, while the cardiologist bills 93306-26 for the interpretation.
- Medical Necessity
Medicare and insurers require documentation of symptoms or conditions justifying the test, such as:
- Chest pain
- Shortness of breath
- Abnormal EKG findings
- Heart murmur
Sample ICD-10 Codes Linked to 93306:
- I50.9 (Heart failure)
- I34.0 (Mitral valve stenosis)
- I35.0 (Aortic valve stenosis)
Private insurers like Cigna and Aetna often require authorization for non-emergency TTEs. Check payer-specific policies to avoid denials.
Reimbursement & Costs
- Average Cost: 300–300–800 (varies by facility and geographic location).
- Medicare Reimbursement: ~150–150–250 (varies by region; check your Local Coverage Determination [LCD]).
- Denial Risks:
- Missing Doppler documentation.
- Using 93306 for a limited study (use 93307 instead).
Best Practices for Providers & Coders
- Document Thoroughly: Note all components (2D, M-mode, Doppler) in the report.
- Avoid Unbundling: Do not bill 93306 with 93320 (Doppler add-on) – it’s included.
- Audit Regularly: Review charts for overcoming (e.g., using 93306 for limited studies).
Common FAQs about CPT 93306
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1. Does CPT 93306 Require Contrast?
No. For contrast-enhanced TTEs, use 93306 + 93352.
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2. Can 93306 Be Billed With Modifier 59?
Rarely. Modifier 59 (distinct procedural service) applies only if a separate, unrelated service is performed.
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3. Is 93306 Covered by Medicare?
Yes, if medically necessary. Document symptoms like dyspnea or syncope to support claims.
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4. What’s the LCD for CPT 93306?
Medicare’s LCD varies by MAC (Medicare Administrative Contractor). For example, Novitas Solutions requires proof of suspected valve disease or heart failure.
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5. How to Appeal a Denied 93306 Claim?
Submit:
- A detailed physician report.
- Evidence of Doppler studies.
- Relevant ICD-10 codes linked to medical necessity.
