Are you satisfied that your cardiology practice is billing CPT Code 93306 correctly? Billing issues involving this code are a leading cause of claim denial. According to a CMS analysis in 2023, echocardiography CPT codes, including 93306, are among the top ten services refused due to inappropriate modifier usage and poor documentation. With an average reimbursement of 93306 of more than $230 per research in non-facility settings, repeated mistakes might result in significant revenue loss.
Most of these billing errors are caused by misunderstandings between 93306 and comparable codes, such as 93307 and 93308, as well as the overuse of modifiers 26 (professional) and TC (technical). These errors impact both reimbursements and payer compliance. Billing internationally or dividing claims among providers requires demanding CMS and payer-specific standards. For example, failure to document the supervising physician during technical service results in reimbursement refusal, even if the test was medically required.
This guide explains how to charge CPT Code 93306 appropriately. We address the clinical components it covers, whether to utilize it over other echocardiography codes, which modifiers to employ, and how to secure Medicare coverage.
What Is CPT Code 93306?
This section discusses the clinical and billing aspects of CPT Code 93306. It defines the code’s purpose and specifies when it should be used in cardiology practice billing.
CPT Code 93306 Description and Purpose
CPT Code 93306 refers to full transthoracic echocardiography (TTE) with 2D imagery and Doppler ultrasonography. Doppler ultrasound is used to study heart anatomy, function, and hemodynamics. This code includes both imaging and Doppler components, however, it excludes different tests such as stress echocardiograms and transesophageal echocardiography.
Cardiology centers often use this code to describe diagnostic cardiac ultrasound. Proper usage assures appropriate reimbursement and reflects therapeutic work completed. In 2025, the Medicare Physician Fee Schedule specifies an average non-facility payment of about $235 for CPT 93306.
When to Use CPT 93306
When performing a complete transthoracic echocardiography with Doppler assessment, use CPT code 93306. This implies the investigation will involve 2D imaging and Doppler flow analysis of the heart chambers and valves. It applies to initial and follow-up assessments that include these components.
This code should not be utilized in restricted or follow-up investigations without Doppler imaging. Partial or restricted echocardiograms should be coded 93307 or 93308. Knowing the distinction prevents claim denials and promotes proper clinical reporting.
CPT Code 93306 vs. CPT Codes 93307 and 93308
This section compares CPT code 93306 to the echocardiography codes 93307 and 93308. Understanding the distinction helps to avoid miscoding and claim denials.
CPT 93306 vs. 93307
CPT Code 93306 covers two-dimensional (2D) echocardiography and spectral/color flow Doppler. It is utilized to carry out a comprehensive transthoracic echocardiography, which includes full imaging and Doppler examination.
CPT Code 93307 refers to a full 2D transthoracic echocardiography without Doppler tests. It applies when Doppler imaging is not done or reported.
Failing to identify these codes might result in improper billing. For example, charging 93306 without actually conducting a Doppler might result in recoupment or payer audits. The additional imaging work raises the average Medicare payment for 93306 over that of 93307.
CPT 93306 vs. 93308
Limited transthoracic echocardiography is coded CPT 93308. It consists of an intended or follow-up examination, which may or may not include Doppler, depending on the therapeutic necessity.
When doing a specific evaluation, such as screening for pericardial effusion following an intervention, use 93308. It should not be used in place of 93306 or 93307 when a thorough study is required and has been done.
Billing 93306 instead of 93308, lacking adequate documentation, may result in payer rejections or overpayment recovery. Always document the clinical justification for comprehensive or partial research to aid the code selection.
Billing CPT Code 93306 with Modifier 26 or TC
This section discusses how to bill CPT Code 93306 correctly using modifier 26 or TC. Each modifier indicates which component of the service was provided, assisting in preventing refused or reduced claims.
Modifier 26: Professional Component
When charging for the physician’s interpretation and report, use modifier 26 with CPT Code 93306. This modification is used if the provider does not own the equipment or location where the test was conducted.
For example, if a cardiologist analyzes an echocardiography obtained at an outpatient imaging center, the billing code should be 93306-26. Medicare reimbursement for the professional component alone averages about $85.
Modifier TC: Technical Component
When paying simply for the technical component, which includes the usage of ultrasound equipment, technician time, and supplies, use the modifier “TC.” This happens when the provider administers the test but does not read it.
For example, a diagnostic imaging center that performs the test but does not interpret the data should bill 93306-TC. The technical part of Medicare normally reimburses around $150.
Global Billing Without Modifiers
If the same provider or group provides the technical and professional components, CPT Code 93306 is invoiced without modification. This is considered worldwide billing.
This scenario occurs when the test is performed and evaluated at the same institution or by the same physician. Global reimbursement is higher than split billing, with an average of $235 under Medicare’s Physician Fee Schedule for 2025.
Medicare Coverage for CPT Code 93306
This section explains when Medicare will fund CPT Code 93306, including medical necessity, frequency restrictions, and documentation requirements. Incorrect usage may result in rejections or audits.
Coverage Criteria
Medicare covers CPT Code 93306 when the procedure is medically necessary to evaluate suspected or known cardiac issues. Covered indicators include:
- Suspected heart failure or valve disorder
- Abnormal heartbeat or chest pain
- Pre-operative clearance for heart surgery.
- Follow-up on chronic cardiovascular diseases.
Frequency Guidelines
Medicare does not establish a specific frequency restriction instead, it expects each therapy to be medically necessary. Frequent echocardiograms without a clinical rationale may result in rejections or targeted medical evaluations.
In 2024, the Office of Inspector General (OIG) identified excessive echocardiogram billing as a possible source of overutilization. Providers should establish a strong basis for repeating CPT 93306.
Medicare Reimbursement
As of 2025, the national average Medicare allowed for CPT Code 93306 (global service) is about $235. Reimbursement varies by area and payment location.
- To prevent reimbursement issues:
- Use suitable ICD-10 codes to establish medical necessity.
- Record all technical and professional components of the study.
- Bill divided utilities with modifier 26 or TC.
Conclusion
To accurately bill CPT Code 93306, sufficient documentation, proper code selection, and appropriate modifier use are required. Misuse might result in claim rejections, compliance audits, or missed reimbursement. Medicare covers this code if the clinical indications are proper and well-documented. Avoid utilizing 93306 in situations that do not require both 2D imaging and Doppler. Always check whether 93307 or 93308 is more suited. Regular evaluation of payer regulations reduces the possibility of billing challenges.
FAQs
What does CPT Code 93306 include?
CPT 93306 includes a complete transthoracic echocardiogram with 2D imaging and Doppler flow studies. It covers both anatomical and functional heart assessment.
When should I use CPT Code 93306 instead of 93307?
Use 93306 when Doppler studies are performed with 2D imaging. Use 93307 if Doppler is not performed or documented.
What is the difference between modifier 26 and TC for 93306?
Modifier 26 is for the professional interpretation only. Modifier TC is for the technical part, including equipment and staff.
How much does Medicare reimburse for CPT Code 93306?
In 2025, Medicare reimburses about $235 for global billing. The payment is split if billing with modifiers 26 or TC.
Can CPT 93306 be billed more than once for a patient?
Yes, if medically necessary and documented. Repeated use without clinical justification may lead to denials or audits.
