Filling out billing paperwork after completing a transthoracic echocardiogram service is a routine and critical part in the business functioning of any cardiology unit. Creating and submitting the claim is one of the first steps in getting paid for providing one of the building block services in the specialty of cardiology. However, getting and keeping control of revenue from the service can be very difficult. There are a number of CPT codes that can be linked to the service for which the CPT 93306 is at the top of the nab. CPT 93306 is a complete transthoracic echocardiogram and is in the highest level of the range of codes that can be assigned to the echocardiogram service.
There is more to look out for in the CPT description, CPT 93306, that the practice has to be more than compliant for, for the service that is to be provided; the practice must be paid for 93306 CPT services that are provided. A2Z Billings has helped you to draft enough documentation regarding CPT 93306 from its clinical to the documentation billing for maximum, without a troublesome way, to bill for resetting to the practice.
What is CPT Code 93306? Breaking Down the Basics
CPT code 93306 means “transthoracic echocardiography, real-time with image documentation (2D), with or without M-mode recording; complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography.”
To put it in simpler words, it charges for an extensive, non-invasive heart ultrasound done through the chest wall. Only one code is charged when billed globally. It covers the whole procedure; clinical component and professional component.
The Four Pillars of 93306: What Makes it “Complete”
For a study to legitimately qualify for 93306, your documentation must prove that all four of these imaging components were performed and analyzed:
- Two-Dimensional (2D) Real-Time Imaging: The standard ultrasound video that shows the heart’s structures in motion.
- M-Mode Recording: A more detailed, one-dimensional view used for precise measurements of heart chambers and wall thickness.
- Spectral Doppler Echocardiography: Measures the speed and direction of blood flow, crucial for assessing valve stenosis or regurgitation.
- Color Flow Doppler: Provides a color-coded map of blood flow direction and turbulence, visualizing leaks or abnormal pathways.
If any of these components is missing, a different, often lower-reimbursement code (like 93307 or 93308) must be used.
When to Use CPT 93306: Establishing Medical Necessity
Correct code selection starts with the patient’s clinical picture. Payers require clear medical necessity to justify a comprehensive echo. Common, well-accepted indications for 93306 include:
- Initial Evaluation of a Heart Murmur: To determine if the sound is caused by a significant valve abnormality.
- Chest Pain or Shortness of Breath (Dyspnea) Workup: To assess heart function, rule out pericardial effusion, or evaluate for heart failure.
- Suspected or Known Heart Valve Disease: For diagnosis and monitoring of conditions like mitral regurgitation or aortic stenosis.
- Evaluation of Ventricular Function: To measure ejection fraction in patients with known or suspected cardiomyopathy or heart failure.
- Pre-operative Cardiac Assessment: For patients with cardiac risk factors undergoing major surgery.
- Monitoring Known Conditions: Such as cardiomyopathy, pulmonary hypertension, or follow-up after a cardiac event, provided there is a documented change in clinical status.
Navigating the Code Family: CPT 93306 vs. Other Echo Codes
One of the most common billing errors is using 93306 when a more specific, limited code is appropriate. Here’s a quick guide to keep your coding precise:
| CPT Code | Description | Key Difference from 93306 |
| 93306 | Complete TTE with 2D, M-mode, Spectral & Color Doppler | The gold standard comprehensive code. |
| 93307 | Complete TTE without spectral or color Doppler | Lacks the critical Doppler components. |
| 93308 | Limited TTE or follow-up study | Focused on a specific question or structure, not a full heart assessment. |
| 93350 | Stress echocardiogram (exercise) | Includes imaging before and immediately after physical stress. |
| 93351 | Stress echocardiogram (pharmacologic) | Includes imaging before and after drug-induced stress. |
Crucial Rule: You generally cannot bill 93306 with 93308, 93350, or 93351 on the same day for the same patient, as this is considered duplicate billing. Modifier -59 may be applicable in rare, distinct circumstances.
The Documentation Checklist: Your Claim’s Foundation
Thorough documentation is your primary defense against denials. The final report must support that a complete study was medically necessary and performed. Ensure it includes:
Clinical Indication: Clearly state the symptom, sign, or diagnosis that prompted the test (e.g., “new systolic murmur,” “dyspnea on exertion”).
Explicit Statement of Components: The phrase “spectral and color flow Doppler were performed” should appear in the report.
Detailed Structural Assessment: Don’t just say “normal.” Report specific measurements and observations for:
- Chambers: Left/right ventricular size and function, atrial sizes.
- Valves: Structure and function of all four valves (mitral, aortic, tricuspid, pulmonary).
- Other: Pericardium, wall motion, adjacent aorta.
Quantitative Data: Include numerical measurements (e.g., ejection fraction 55%, aortic valve velocity 2.0 m/s) with an interpretation of normal vs. abnormal.
Physician Interpretation & Signature: A final synthesis linking findings to the clinical indication, signed by the interpreting cardiologist.
Mastering Modifiers: The Key to Component and Repeat Billing
Modifiers add essential context to your claim. Using them correctly is non-negotiable for accurate reimbursement.
| Modifier | Name | When to Use with 93306 |
| -26 | Professional Component | Billing only for the physician’s interpretation (e.g., when a hospital owns the equipment). |
| -TC | Technical Component | Billing only for the equipment, technician, and supplies. |
| -59 | Distinct Procedural Service | Indicates the echo was separate and distinct from another procedure performed the same day (use sparingly and with caution). |
| -76 | Repeat Procedure by Same Physician | The same provider must repeat the echo on the same day (requires strong medical justification). |
| -77 | Repeat Procedure by Another Physician | A different provider repeats the echo on the same day. |
Important: You should never append both -26 and -TC on the same claim from the same provider. They are used to split the global fee when different entities own the technical and professional components.
Understanding Reimbursement: What to Expect in 2026
Reimbursement for 93306 varies significantly by payer, location, and setting (facility vs. non-facility). Here’s a general overview based on current data:
| Payer Type | Estimated Reimbursement Range (Global 93306) | Key Notes |
| Medicare (National Average) | $220 – $250 | Based on the 2025 Physician Fee Schedule. Adjusted by Geographic Practice Cost Index (GPCI). |
| Medicaid | $180 – $210 | Varies greatly by state; typically lower than Medicare. |
| Commercial Insurance | $250 – $400+ | Depends entirely on negotiated contract rates. Often 120-200% of Medicare. |
| Hospital Outpatient (OPPS) | $340 – $390 | Higher due to inclusion of facility fees. |
Top Reasons for Denial and How to Avoid Them
Most denials for 93306 are preventable. Stay ahead of these common pitfalls:
- Lack of Medical Necessity: The diagnosis code (ICD-10) must align perfectly with the documented clinical indication for a complete echo.
- Incomplete Documentation: Failure to explicitly document all four required components or detailed measurements of all heart structures.
- Incorrect Code Selection: Using 93306 for a truly limited study (use 93308) or billing it with another echo code without proper modifier justification.
- Missing or Improper Modifiers: Especially when splitting professional and technical components or reporting repeat studies.
- Frequency Limitations: Payers often limit how many complete echos are covered in a given time frame. Documentation must show a new or changed clinical condition to justify a repeat study.
Partnering for Success: How A2Z Billings Can Help
Specialty codes, particularly 93306, in cardiology billing require just the right mix of skill, knowledge, and care to avoid costly mistakes. Lost revenue in this field from low accuracy and coding mistakes can be astronomical.
At A2Z Billings, we recognize that this administrative task can be burdensome to practices and can delay revenue cycles, and we are here to remove that from your to-do list. Our certified cardiology billing specialists are kept abreast of the latest coding updates, payer policies, and compliance issues. Before claims are sent to the payer, we do checks to document medical necessity, which dramatically decreases your denial and speeds up your revenue cycle.
Let A2Z Billings do a free billing assessment for your practice so you can rest easy knowing your echocardiography services are billed properly and paid in a timely manner.
FAQs
- What services does CPT code 93306 provide?
CPT code 93306 provides coverage for a complete echocardiogram study with two-dimensional imaging, M-mode imaging, and spectral and color flow Doppler (both types of Doppler imaging). It is also the default billing code for a comprehensive and detailed diagnostic ultrasound of the heart.
- In what conditions is it appropriate to use code 93306 as opposed to a limited echo code?
When attending to a complete set of symptoms, such as newly acquired heart murmur, unexplained chest pain, or symptoms of heart failure, use 93306. Limited code 93308 is appropriate for focus exams on a single issue, or follow up on the echocardiogram.
- What are the leading causes of a claim denial using code 93306?
Insufficient documentation substantiating the medical necessity to perform a comprehensive echo vis-a-vis the patient’s diagnosis is the leading cause. Other common errors are missing all four technical components of the study, or the wrong modifier was used.
- What are the most common modifiers used with CPT 93306?
If billing only for the physician interpretation, use modifier -26. If billing only for the technical component of the echocardiogram, use -TC. -76 or -77 modifiers are essential to use for repeating an echocardiogram on the same day.
- May I submit claim 93306 and a stress echocardiogram code together?
In most cases, no. 93306 is bundled into the stress echocardiogram codes 93350 and 93351. It is not permissible to code them together for the exact same patient encounter unless the studies are for separate and distinct medical reasons, which would call for modifier -59 and substantial justification.