The echocardiogram CPT code set defines how cardiac ultrasound services are reported for reimbursement in the United States. Accurate selection depends on exam completeness, imaging technique, Doppler use, and clinical context. Errors in code choice or documentation are common causes of denials and audits. This article provides a comprehensive, practical reference for clinicians, coders, and billing teams.
What Is an Echocardiogram
An echocardiogram is a noninvasive ultrasound examination of the heart that evaluates cardiac structure and function. It assesses chamber size, wall motion, valves, blood flow, and pericardial space. Indications include suspected heart failure, valvular disease, cardiomyopathy, ischemia, congenital anomalies, and monitoring therapy response.
Core Echocardiogram CPT Codes (Transthoracic)
CPT 93306 — Complete Transthoracic Echocardiogram
Description: Complete transthoracic echocardiography with 2D imaging, M-mode when performed, spectral Doppler, and color flow Doppler.
Use when: A full diagnostic study is performed with Doppler evaluation of valves and hemodynamics.
Common settings: Initial diagnostic workup, comprehensive assessment.
CPT 93307 — Complete Transthoracic Echocardiogram Without Doppler
Description: Complete 2D transthoracic study without spectral or color Doppler.
Use when: Doppler is not performed or documented.
Note: Less commonly used due to routine Doppler inclusion in modern studies.
CPT 93308 — Limited Transthoracic Echocardiogram
Description: Limited 2D transthoracic echocardiography.
Use when: Focused follow-up (e.g., pericardial effusion check, ventricular function reassessment).
Requirement: Documentation must state the study is limited and specify the focused clinical question.
Doppler Add-On Codes
CPT 93320 — Spectral Doppler
Description: Doppler echocardiography (pulsed or continuous wave) add-on.
Use when: Reporting Doppler with base codes that do not include it.
CPT 93325 — Color Flow Doppler
Description: Color flow velocity mapping add-on.
Use when: Color Doppler is performed and not bundled in the base code.
Bundling Rule: CPT 93306 already includes both 93320 and 93325; do not report add-ons with 93306.
Stress Echocardiography Codes
CPT 93350 — Stress Echocardiogram
Description: Echocardiographic imaging at rest and during stress (exercise or pharmacologic).
Common pairings: Report with appropriate stress test codes when applicable.
Documentation: Must include baseline and stress images and interpretation.
Transesophageal Echocardiography (TEE) Overview
TEE codes (e.g., 93312–93314) apply when the probe is introduced into the esophagus. These are used for detailed valve assessment, endocarditis evaluation, and perioperative monitoring. Proper consent, sedation documentation, and probe placement details are required.
Congenital Echocardiography Codes
Codes such as 93303–93308 (congenital variants) apply when evaluating congenital heart disease. Selection depends on patient age and study completeness. Clear documentation of congenital pathology is essential.
Documentation Requirements for Compliance
- Indication: Clinical reason supporting medical necessity.
- Technique: Transthoracic vs. transesophageal; complete vs. limited.
- Components: 2D, M-mode (if used), spectral Doppler, color flow.
- Findings: Structured interpretation with measurements when applicable.
- Impression: Actionable conclusions tied to the indication.
Incomplete documentation is a primary denial driver.
Modifiers and Billing Considerations
Professional and Technical Components
- Modifier -26: Professional interpretation only.
- Modifier -TC: Technical component only.
Repeat and Distinct Services
- Modifier -76/-77: Repeat procedures.
- Modifier -59 or X-modifiers: Distinct procedural service when appropriate and supported.
Place of Service
Reimbursement varies by inpatient, outpatient hospital, and office settings.
Common Billing Errors to Avoid
- Reporting Doppler add-ons with CPT 93306.
- Using limited codes without documenting focused scope.
- Omitting medical necessity or clinical indication.
- Incorrect modifier application.
Unique Clinical Takeaways
1) Patient-Experience Factors Affect Code Selection
Patient body habitus, lung disease, or chest wall limitations may reduce image quality, prompting a limited study or transition to TEE. Documenting these constraints supports appropriate code selection and defends medical necessity.
2) Differential Diagnosis Drives Completeness
When differentiating cardiomyopathy, valvular disease, or pulmonary hypertension, Doppler assessment is clinically essential. Selecting CPT 93306 aligns with the diagnostic need and reduces downstream repeat testing.
3) Risk Stratification in Follow-Up Imaging
For known heart failure or post-intervention monitoring, a limited echocardiogram can answer targeted questions (ejection fraction trend, effusion presence) while reducing cost and patient burden—when clearly documented.
Coding Scenarios
Scenario A: New murmur with dyspnea → 93306 (complete with Doppler).
Scenario B: Post-pericardiocentesis effusion check → 93308 (limited).
Scenario C: Ischemia evaluation with exercise → 93350 plus appropriate stress test code.
Payer Policy Alignment
Medicare and commercial payers expect alignment with national coverage determinations and local coverage policies. Documentation must reflect why the chosen code matches the clinical question.
Medical Disclaimer
This content is for informational and educational purposes only and does not constitute medical, legal, or billing advice. Coding decisions must be based on complete clinical documentation, payer policies, and current CPT guidelines