Echocardiogram CPT codes: 93306 (complete transthoracic echo with Doppler), 93308 (limited transthoracic echo), 93312 (transesophageal echo). Modifier 26 bills professional interpretation; modifier TC bills technical component. In non-facility settings, physician bills professional component (modifier 26); facility bills technical component separately. Most payers require prior authorization for repeat echos within 12 months. Documentation must include specific clinical indication and comprehensive cardiac assessment.
93306 is most common: complete TTE with 2D imaging, spectral Doppler, and color Doppler. Requires comprehensive examination of all cardiac chambers, valves, and hemodynamics. 93308 is for limited TTE: focused exam of specific structures or limited acoustic windows. Use when complete exam is not obtainable. 93312 is for TEE (transesophageal): advanced imaging through esophageal approach. Select code based on scope of examination performed, not clinical indication. Missing Doppler or incomplete chamber visualization supports 93308, not 93306.
Most payers require prior authorization for repeat echos within 12 months of prior study. Baseline echo is typically approved without question. Subsequent echos require medical necessity documentation: significant clinical change, new symptoms, or therapeutic intervention that warrants reassessment. Medicare covers medically necessary echos. Some payers set frequency limits (e.g., one echo per year unless clinical change documented). Verify payer-specific policies on repeat echo authorization.
Modifier 26 is used in non-facility settings when billing professional interpretation component. Modifier TC applies to technical component in facility billing. Do not bill both modifiers on same code from the same provider; physician bills 26, facility bills TC. Modifier 91 is not applicable to echo codes. Modifier 25 is not needed for echo (it is a separate, unrelated service by definition).
Document specific clinical indication (chest pain, dyspnea, abnormal stress test, heart failure, valvular disease). Include complete cardiac assessment: left and right ventricular size and function, atrial size, valve morphology and function (stenosis/regurgitation degree), pericardial status, and hemodynamic estimates. Report includes ejection fraction, dimensions, and clinical conclusions. For limited studies: clearly document what structures examined and any limitations to assessment.
93306 = complete TTE with spectral and color Doppler. 93308 = limited TTE. Full echo with Doppler justifies 93306. Limited studies missing Doppler or incomplete views use 93308.
Modifier 26 = professional component for non-facility billing. Modifier TC = technical component. In facility settings, facility bills technical; physician bills professional with modifier 26.
Most payers require prior auth for repeat echos within 12 months unless clinical change documented. Baseline exam typically approved. Repeat exams need medical necessity.
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