Echo transthoracic
CPT code 93303 is used when a healthcare provider performs a transthoracic echocardiogram (echo), which is an ultrasound of the heart performed through the chest wall. This test creates moving images of the heart to evaluate its structure and function.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify component billing: 93303 is a complete code that can be split into professional (26) and technical (TC) components. Hospital-based physicians should append modifier 26, while office-based practices owning equipment bill globally without modifier.
Impact: Incorrect component billing results in overpayment/underpayment. Global reimbursement is $208.63; improper modifier use can reduce payment by 40-60%.
Do not bill 93303 with 93306 or 93308 on the same date of service for the same encounter. Use 93306 for complete echo with color flow, or 93308 for limited studies. 93303 is the base complete echo code.
Impact: Bundling edits will deny duplicate payment. This is the most common unbundling error costing practices 100% of the duplicate claim.
Document all required elements: 2D imaging of all chambers and valves, M-mode when performed, pericardial assessment, and spectral/color Doppler evaluation. Include measurements, quantitative assessments, and comparison to prior studies when available.
Impact: Missing any required element downgrades to 93308 (limited study), reducing reimbursement by approximately 30-40% or triggering complete denial.
Bill same-day E/M services with modifier 25 only when separately identifiable and medically necessary. The decision to order the echo alone does not justify a separate E/M.
Impact: Appropriate E/M billing adds $75-200 per encounter, but improper use triggers payer audits with potential recoupment of 12-24 months of claims.
For Medicare, ensure medical necessity is documented with appropriate ICD-10 codes. Screening echos without symptoms or risk factors are typically denied as not medically necessary.
Impact: Lack of medical necessity is the #1 denial reason, resulting in 100% claim denial ($208.63 loss per study).
When performing echo during a stress test, bill the appropriate stress echo codes (93350-93352) instead of 93303. These codes bundle the echo with stress testing and reimburse at higher rates.
Impact: Using correct stress echo codes increases reimbursement by $100-300 per study versus billing components separately.
Common denials
Medical necessity not established - payer determines the diagnosis code does not support the need for a complete transthoracic echo
How to appeal: Submit appeal with clinical notes documenting specific signs, symptoms, or clinical findings that warranted the complete study. Include relevant patient history, physical exam findings, and how results changed management. Reference LCD/NCD guidelines for covered indications.
Duplicate service - another echo code (93306, 93308, or 93307) already billed for the same date of service
How to appeal: If studies were truly separate encounters, submit documentation showing distinct sessions with different clinical indications. Add modifier 76 or 77 with clear explanation. If incorrectly coded, withdraw one claim and ensure correct code is billed.
Incomplete documentation - report does not include all required elements of a complete transthoracic echo per CPT definition
How to appeal: Submit complete echo report showing 2D evaluation of all chambers/valves, Doppler assessment, and measurements. If study was actually limited, consider accepting downgrade to 93308 or resubmit with correct code from the start.
Global/component billing error - modifier 26 or TC used incorrectly based on place of service and equipment ownership
How to appeal: Submit documentation proving equipment ownership and location of service. Include attestation of whether provider owns equipment or is hospital-employed. Correct future claims to prevent ongoing denials.
Frequently asked questions
What is the Medicare reimbursement rate for CPT 93303 in 2025?
The 2025 Medicare national average reimbursement for CPT 93303 is $208.63 for both facility and non-facility settings. This includes 6.45 total RVUs (1.3 work RVU, 5.08 practice expense RVU, and 0.07 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
What is the difference between CPT 93303 and 93306?
CPT 93303 is the base code for a complete transthoracic echo with or without color flow Doppler, while 93306 specifically includes a complete study with spectral and color Doppler. In current coding practice, 93306 has largely replaced 93303 for complete studies. Verify payer preferences, as some require 93303 while others prefer 93306 for the same service.
Can you bill an E/M code with 93303 on the same day?
Yes, you can bill an E/M service with 93303 on the same day using modifier 25 on the E/M code, but only if the E/M service is separately identifiable and medically necessary beyond the decision to order the echo. The E/M must involve significant evaluation or management of a condition separate from simply ordering or interpreting the echocardiogram.
How many RVUs is CPT code 93303 worth?
CPT code 93303 has 6.45 total RVUs in 2025, consisting of 1.3 work RVUs, 5.08 practice expense RVUs (both facility and non-facility), and 0.07 malpractice RVUs. This RVU value is based on the CMS Medicare Physician Fee Schedule released December 23, 2024.
What diagnosis codes support medical necessity for 93303?
Common supporting diagnoses include heart failure (I50.x), chest pain (R07.x), heart murmur (R01.x), valvular disorders (I34.x-I37.x), cardiomyopathy (I42.x), arrhythmias (I48.x, I49.x), dyspnea (R06.0x), hypertension with cardiac involvement (I11.x), and coronary artery disease (I25.x). Always document specific clinical findings that justify the complete study.
Do I need modifier 26 or TC when billing 93303?
Use modifier 26 when billing only the professional component (interpretation) if you don't own the equipment. Use modifier TC when billing only the technical component (equipment and staff) if another physician interprets. Bill without modifiers (global) only when you own the equipment, employ the sonographer, and perform the interpretation. Hospital-employed physicians typically use modifier 26.
What is included in a complete transthoracic echo for 93303?
A complete transthoracic echo for 93303 must include 2D imaging of all four cardiac chambers, evaluation of all four valves, pericardial assessment, spectral Doppler evaluation of blood flow velocities, M-mode recordings when performed, and quantitative measurements. The report must document assessment of ventricular function, valve function, and chamber sizes with interpretation by a qualified physician.