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CPT codes for echocardiogram
Overview of All Types of CPT Codes for Echocardiograms
CPT Code | Description | Medicare Reimbursement (approx.) | Notes |
93306 | Echocardiography, transthoracic, complete, real-time with 2D image, M-mode, spectral Doppler, and color flow Doppler | $500 | Most commonly used for a complete transthoracic echocardiogram with Doppler and color flow |
93307 | Echocardiography, transthoracic, complete, with 2D imaging (no Doppler) | Varies | Complete 2D echo without Doppler |
93308 | Echocardiography, transthoracic, limited or follow-up study with 2D imaging and M-mode | $300 (for limited) | For monitoring or follow-up, less comprehensive than 93306 |
93350 | Stress echocardiography, transthoracic with 2D image including rest and stress portions, with interpretation and report | $350-$500+ | Includes exercise or pharmacologic stress testing with echo imaging |
93351 | Stress echocardiography, technical component only, including continuous ECG monitoring | Varies | Used when only the technical portion is performed |
93325 | Doppler echocardiography, color flow | Separate billing | Can be billed with limited echo codes if color Doppler is medically necessary |
93352 | Use of echocardiographic contrast agent (add-on to primary procedure) | Varies | Requires use with primary echo code such as 93306 or 93350 |
93320 / 93321 | Doppler echocardiography (spectral or limited) | Varies | For detailed blood flow assessment without full imaging |
93312 | Transesophageal echocardiography (TEE), 2D with or without M-mode | Varies | Different modality, ultrasound via esophagus |
1. CPT codes for echocardiogram
The CPT codes for echocardiogram vary by the type and scope of the procedure, with 93306 being one of the most common for a complete transthoracic echocardiogram including Doppler.
CPT Codes
- 93303: Complete transthoracic echocardiogram, 2D with spectral and color Doppler (without contrast).
- 93306: Complete transthoracic echocardiogram with Doppler (often used interchangeably with 93303, sometimes considered more limited).
- Other codes exist for limited, follow-up, transesophageal, and stress echocardiograms.
Reimbursement
- Medicare reimbursement example rates:
- Complete transthoracic echocardiogram (93303): around $500
- Limited transthoracic echocardiogram (93306): around $300
- Doppler echocardiogram study (93350): around $350
- Reimbursement varies by location (geographic adjustment), facility type, and payer policies.
- Facility fees may apply in outpatient settings covering equipment and room costs.
Modifiers
- -26: Professional component (physician interpretation only)
- -TC: Technical component (equipment and technician services only)
- -59: Distinct procedural service (used when multiple echo procedures are done distinctly)
- -50: Bilateral procedure (rare for echo)
- -25: Significant, separately identifiable E/M service with procedure
- -76 & -77: Repeat procedures by the same or different physicians
- Proper use of modifiers prevents denials and ensures full reimbursement.
Usage Statistics
- Echocardiograms are common: In 2010, about 816,500 echocardiograms were performed in hospitals, representing about 2.09% of all hospital admissions.
- The use of echocardiography increased annually by more than 3% over a decade.
- Echocardiograms are utilized in a wide range of cardiac conditions, including heart failure, valvular disease, acute myocardial infarction (AMI), and cardiac dysrhythmias.
- Studies associate echocardiogram use in hospital patients with lower mortality and shorter length of stay.
- Echocardiography is a widely used diagnostic tool reflecting its critical role in clinical cardiology.
2. CPT code for echocardiogram with doppler
The CPT code for an echocardiogram with Doppler is typically 93306 for a complete transthoracic echocardiogram, which includes 2D imaging and spectral Doppler, along with color flow Doppler when performed. Additional codes like 93325 (color flow Doppler) and 93320 (spectral Doppler) may be billed as add-ons in specific cases, but 93306 usually covers the combined imaging and Doppler studies.
Reimbursement:
- Medicare reimbursement for a complete transthoracic echocardiogram (CPT 93306) generally ranges around $300, though the exact amount can vary based on geographic region and facility type.
- Doppler echocardiogram studies (such as code 93350 for Doppler during stress echocardiography) may reimburse differently, often around $350.
- These payments are subject to payer policies, geographic adjustments, and whether the technical component (equipment use) or professional component (physician interpretation) is billed separately.
Modifiers:
- -26: Professional component, used when only the physician’s interpretation is billed.
- -TC: Technical component, used when only the equipment and technical staff are billed.
- -59: Distinct procedural service, sometimes used when multiple echocardiography procedures are performed on the same day to indicate separate services.
- Other modifiers like -50 (bilateral procedure) or -25 (significant, separately identifiable evaluation and management service) might apply in certain billing scenarios.
Modifying codes correctly is crucial to avoid claim denials and ensure appropriate reimbursement, especially when separating professional and technical components or billing multiple cardiac imaging procedures.
Usage Statistics:
- Echocardiograms with Doppler are widely used for assessing cardiac function, valvular disease, and blood flow within the heart chambers and vessels.
- One study noted Doppler echocardiography’s high usage for pulmonary hypertension screening, although about 48% of Doppler estimates can be inaccurate by more than ±10 mm Hg compared to invasive measurements, emphasizing the clinical context.
- The prevalence of echocardiogram use overall reflects widespread cardiac disease screening and management, with Doppler being a standard part of most transthoracic echocardiograms due to its value in detecting abnormal flow velocities.
- The most frequent clinical indication for Doppler echocardiography in studies was suspected pulmonary hypertension, present in up to 67% of ordered tests in that setting.
3. CPT code for a complete 2D transthoracic echocardiogram
The CPT code for a complete 2D transthoracic echocardiogram without Doppler is 93303.
CPT Code 93303 Description
- This code represents a complete transthoracic echocardiography study with real-time 2D imaging and image documentation.
- It includes M-mode recording when performed, but does not include Doppler analysis.
- It is primarily used for anatomical assessment of the heart’s structure and function.
Reimbursement:
- Medicare reimbursement for CPT 93303 typically ranges from approximately $400 to $500, depending on geographic location and facility.
- Reimbursement reflects the comprehensive imaging performed, excluding Doppler flow measurements.
- Facility fees may also apply if the test is performed in an outpatient or hospital setting.
Modifiers:
- -26: Professional component, for physician interpretation only.
- -TC: Technical component, for equipment and technical staff.
- -59: Distinct procedural service, to indicate a separate service from another procedure.
- -25: Significant, separately identifiable evaluation and management service with the procedure.
- Other modifiers like -76 (repeat procedure by the same physician) and -77 (repeat by a different physician).
Proper use of modifiers is essential to avoid claim denials and ensure proper reimbursement when components of the echocardiogram or multiple procedures are involved.
Usage Statistics:
- Echocardiography is widely used for the evaluation of cardiac structure and function.
- The 2D transthoracic echocardiogram (TTE) is one of the most common cardiac imaging procedures globally.
- Trends show increasing utilization by about 3-4% annually over the last decade in hospital settings.
- It is frequently performed to diagnose and monitor heart diseases including valve disorders, cardiomyopathies, and congenital anomalies.
- Use of 2D echo alone (without Doppler) may occur when assessing structural abnormalities without the need for flow assessment, especially in congenital cases.
4. CPT codes for echocardiogram stress
The CPT codes for echocardiogram stress tests are primarily:
- 93350: Transthoracic echocardiography during rest and stress (exercise or pharmacologic), with interpretation and report.
- 93351: Complete stress echocardiography including supervision, ECG monitoring, and imaging when performed by the same provider.
- 93352: Add-on code for use of contrast agent during stress echocardiography.
Description:
A stress echocardiogram evaluates heart function at rest and under stress, either through exercise or pharmacologic agents. The procedure combines ultrasound imaging with an ECG-monitored stress test to assess myocardial function, ischemia, and valve function more dynamically than a resting echo.
Reimbursement:
- For 93350, Medicare reimbursement typically ranges around $500 to $600, depending on location and setting.
- 93351, as a bundled code (supervision, monitoring, imaging), reimburses similarly or slightly higher due to the inclusion of additional services.
- The contrast agent code 93352 is reimbursed additionally if used.
- Reimbursement varies by payer, facility type (hospital, outpatient), and geographic region.
Modifiers:
- -26: Professional component (physician interpretation).
- -TC: Technical component (equipment and technician).
- -59: Distinct procedural service, when billing multiple procedures concurrently.
- -25: Significant, separately identifiable E/M service on the day of procedure.
- Other modifiers like -76 and -77 for repeat procedures by the same or different physicians as needed.
Usage Statistics:
- Stress echocardiography is a valuable diagnostic tool widely used in cardiology for ischemic heart disease evaluation.
- About 3-4% annual growth in echocardiography usage includes stress echo procedures.
- It is particularly indicated for chest pain evaluation, coronary artery disease risk assessment, and preoperative risk stratification.
- Use of contrast agents in stress echo improves image quality, especially in technically difficult patients.
- Stress echocardiography has shown high diagnostic accuracy and prognostic value compared to other stress testing modalities.
5. CPT code for a transthoracic echocardiogram (TTE)
The CPT code for a transthoracic echocardiogram (TTE), which is a noninvasive ultrasound imaging study of the heart performed through the chest wall, is primarily 93306.
CPT Code 93306 Description
- Represents a complete transthoracic echocardiogram performed in real-time with 2D imaging and includes spectral and color Doppler imaging.
- The code includes M-mode recording when performed and a comprehensive evaluation of heart structures such as chambers, valves, and vessels.
- It is widely used for diagnosing heart diseases such as valvular defects, cardiomyopathies, congenital abnormalities, and heart function assessment.
Reimbursement:
- Medicare reimbursement for CPT 93306 typically ranges around $400 to $500, subject to geographic adjustments and payer-specific policies.
- Facility fees may apply when performed in outpatient or hospital settings, reflecting resources and equipment used.
- Other payers may reimburse differently, but 93306 usually commands a higher payment due to its completeness compared to limited echo codes.
Modifiers:
- -26: Professional component (physician’s interpretation only)
- -TC: Technical component (use of equipment and technical staff)
- -59: Distinct procedural service (when multiple echocardiograms or related services are done together)
- -25: Significant, separately identifiable E/M service on the day of the procedure
- -76 / -77: Repeat procedure by the same or a different provider, respectively
Correct use of modifiers is crucial to avoid claim denials and ensure proper reimbursement by clearly indicating which components or services are billed.
Usage Statistics:
- Transthoracic echocardiography (TTE) is the most commonly performed echocardiographic examination worldwide.
- Its use has been growing annually by approximately 3-4% in hospital and outpatient settings over the past decade due to broad clinical indications.
- TTE provides essential information for managing heart failure, valve disease, arrhythmias, and other cardiac conditions.
- Studies have shown TTE reduces hospital mortality and length of stay when appropriately utilized.
- National databases show millions of TTE procedures performed annually in the US, reflecting its central role in cardiology diagnostics.
6. CPT code for an echocardiogram with contrast
The CPT code for an echocardiogram with contrast mainly involves the primary echocardiogram code plus an additional code for the contrast agent administration.
CPT Codes:
The primary echocardiogram codes with contrast are still based on the standard echo CPT codes, depending on the procedure type, for example:
- 93306: Complete transthoracic echocardiogram (with or without Doppler) — contrast use is additive.
- 93350: Stress echocardiogram (with or without contrast).
The administration of the contrast agent is reported with:
- 93352: Add-on code for contrast agent during echocardiography (resting or stress), reportable only with the primary echo CPT code.
- Additionally, contrast materials themselves are often billed with HCPCS codes such as A9700 (Supply of injectable contrast material for use in echocardiography, per study) or specific LUMASON codes like Q9950.
Reimbursement:
- Echocardiograms with contrast typically have higher reimbursement rates due to the added complexity and cost of the contrast agent.
- Medicare reimbursement for contrast echocardiography procedure codes (e.g., 93306 with 93352) can range between $600 to $700, depending on locality and facility type.
- The contrast agent supply HCPCS code is reimbursed separately and varies by payer.
- Stress echocardiograms with contrast (93350 + 93352) have similarly increased reimbursement.
Modifiers:
- -26: Professional component only (interpretation/reporting).
- -TC: Technical component only (equipment and technician).
- -59: Distinct procedural service when reporting multiple echo-related services.
- -25: If an unrelated E/M service occurs same day.
- No specific modifier is needed for contrast usage; it is appended separately with the add-on code 93352.
Usage Statistics:
- Contrast-enhanced echocardiography improves visualization of the left ventricular endocardial borders, which is crucial, especially in patients with poor acoustic windows.
- Its use is indicated when standard echo images are suboptimal and precise left ventricular function assessment is critical for management.
- Contrast echo is increasingly adopted, with studies showing improved diagnostic accuracy and patient outcomes.
- Use of contrast agents can increase the quality and confidence of cardiac imaging, particularly in stress echo.
- Although utilization varies, the trend is rising due to clinical benefits.
7. CPT code for an echocardiogram with color flow
The CPT code for an echocardiogram with color flow Doppler is typically:
- 93306: This code represents a complete transthoracic echocardiogram with 2D imaging, spectral Doppler, and color flow Doppler all included in the single code. When a full study with color Doppler is performed and interpreted, no separate add-on code for color Doppler (such as 93325) is necessary.
- 93325: This is an add-on code for Doppler echocardiography color flow velocity mapping that may be billed separately in limited or specific studies where color flow Doppler is performed along with other echo codes (e.g., limited echo with code 93308).
Reimbursement
- Medicare reimbursement for 93306 generally ranges from $400 to $500, depending on the region and the facility setting.
- Use of 93325 as an add-on code results in additional reimbursement, typically ranging from $100 to $150, depending on payer policies.
- Stress echocardiograms or contrast-enhanced procedures will reimburse higher.
Modifiers:
- -26: Professional component (physician interpretation).
- -TC: Technical component (equipment and technician).
- -59: Distinct procedural service (if performed on the same day as other procedures).
- -25: Significant, separately identifiable E/M service on the same day as procedure.
- -76 and -77: Repeat procedure by the same or a different provider.
Usage Statistics:
- Color flow Doppler echocardiography is a key tool for visualizing blood flow direction and speed in the heart chambers and valves.
- It is essential in diagnosing valvular regurgitation, congenital heart defects, cardiomyopathies, and other blood flow abnormalities.
- Echocardiograms with color flow Doppler are widely used in clinical cardiology, with usage increasing due to its noninvasive nature and detailed hemodynamic information.
- Studies highlight its role in improved detection and evaluation of cardiac diseases, often leading to better treatment planning and outcomes.
- As a standard part of complete transthoracic echocardiograms, it is performed in millions of patients annually in the US and worldwide.
8. CPT code for an exercise stress echocardiogram
The CPT code for an exercise stress echocardiogram, which involves transthoracic echocardiography performed at rest and during exercise stress (treadmill, bicycle, or pharmacologic), is:
- 93350: Echocardiography, transthoracic, real-time 2D imaging with image documentation, including M-mode when performed, during rest and cardiovascular stress test using exercise or pharmacologic stress, with interpretation and report.
- 93351: Similar to 93350 but includes continuous electrocardiographic monitoring and supervision by a physician or other qualified healthcare professional (usually used in non-facility settings).
Reimbursement:
- Medicare reimbursement for 93350 commonly ranges from $500 to $600, depending on geographic location and facility.
- Facilities bill separately for the stress test ECG components using CPT codes 93016 (interpretation and report), 93017 (technical component for tracing), and 93018 (supervision and interpretation).
- Stress echocardiography with contrast uses add-on code 93352 for contrast agent administration, which increases reimbursement accordingly.
Modifiers:
- -26: Professional component (physician interpretation only).
- -TC: Technical component (equipment and technician services).
- -59: Distinct procedural service, if billing multiple procedures on the same day.
- -25: Significant, separately identifiable evaluation and management service on the same day as procedure.
- -76 and -77: Repeat procedure by the same or a different provider.
Usage Statistics:
- Exercise stress echocardiography is widely used for diagnosing coronary artery disease, evaluating chest pain, assessing exercise tolerance, and guiding treatment.
- It combines cardiac ultrasound imaging with exercise to detect ischemia and abnormalities in heart wall motion under stress.
- National trends show increasing use, with thousands of procedures performed annually in hospitals and outpatient settings.
- Stress echocardiography has strong diagnostic and prognostic value, offering a non-invasive, radiation-free alternative to nuclear stress tests.
- Continual growth in use and technological advancements, including the use of contrast agents, enhance image quality and diagnostic accuracy.
9. CPT Code for Echocardiogram with Bubble Study
The CPT coding for an echocardiogram with a bubble study can be summarized as follows:
CPT Code for Echocardiogram with Bubble Study:
- There is no specific CPT code for the bubble study itself.
- The bubble study is considered part of a standard echocardiogram where agitated saline contrast (“bubbles”) is injected intravenously to detect intracardiac shunts like patent foramen ovale (PFO) or atrial septal defect (ASD).
- The procedure is billed using the regular echocardiogram CPT codes based on the type of echo performed, most commonly:
- 93306: Complete transthoracic echocardiogram with Doppler and color flow Doppler.
- Or other transthoracic echo codes like 93303, 93307 for limited or follow-up studies.
- The bubble study contrast agent itself (agitated saline) is usually not separately billed as it is considered part of the standard procedure.
Reimbursement:
- Reimbursement is based on the primary echocardiogram CPT code used (like 93306).
- Medicare average reimbursement for 93306 is around $400 to $500, influenced by geographic and facility variables.
- Since a bubble study is bundled with the echo procedure, there is no additional payment specifically for the bubble portion.
- In some settings, if a commercial contrast agent is used (not saline), a separate HCPCS or CPT code for contrast might apply.
Modifiers:
- Use standard modifiers applicable to echocardiogram billing:
- -26: Professional component (physician interpretation).
- -TC: Technical component (equipment and technician).
- -59: Distinct procedural service when appropriate.
- -25: Significant, separately identifiable E/M service same day.
- The bubble study itself does not require a separate modifier.
Clinical Usage and Statistics:
- Bubble studies are principally used to detect right-to-left shunts such as PFOs and ASDs, which may not be visible on standard echo imaging.
- The saline bubbles help visualize abnormal flow between heart chambers.
- This is a common complementary diagnostic procedure in cardiology for patients with cryptogenic stroke, unexplained hypoxia, or suspected shunts.
- The addition of bubble contrast improves diagnostic accuracy for shunt detection without significant added risk or complexity.
- While exact procedure volume statistics for bubble studies are merged within echocardiogram counts, this technique is widely used and considered a standard supplementary test when indicated.
9. CPT code for an echocardiogram ultrasound
The CPT code for an echocardiogram ultrasound, specifically a transthoracic echocardiogram (TTE), is 93306.
CPT Code 93306 Description:
- This code represents a complete transthoracic echocardiogram performed with real-time 2D imaging and image documentation.
- It includes M-mode recording when performed, spectral Doppler echocardiography, and color flow Doppler echocardiography.
- The examination must document evaluation of nine required heart structures: left and right atrium, left and right ventricle, aortic valve, mitral valve, tricuspid valve, aorta, and pericardium.
- Optional structures like the pulmonary valve or inferior vena cava may be included but are not mandatory for this code.
Reimbursement:
- Medicare reimbursement for CPT 93306 typically ranges from $400 to $500, depending on geographic location and facility setting.
- Other payers may have variable reimbursement, but this code is widely recognized as the primary code for transthoracic echocardiogram ultrasound.
- Technical fees may apply separately for facility use of equipment and staff.
Modifiers:
- -26: Professional component (physician’s interpretation and report).
- -TC: Technical component (use of equipment and technician services).
- -59: Distinct procedural service modifier when multiple related procedures are performed.
- -25: Significant, separately identifiable evaluation and management service on the same day.
- -76 or -77: Repeat procedure by same or different provider.
Usage Statistics:
- Transthoracic echocardiography (TTE) is the most frequently performed cardiac ultrasound worldwide.
- Millions of TTE procedures are done annually in the United States, reflecting its widespread use in diagnosing and managing heart conditions.
- The procedure is invaluable for assessment of cardiac anatomy, valve function, chamber function, congenital defects, and pericardial disease.
- Studies show increased use of TTE over the years due to its safety, noninvasive nature, and diagnostic value.
- TTE is associated with improved clinical outcomes, including reduced hospital stay and mortality in heart failure patients.
