CPT 93304Cardiology

Echo transthoracic

CPT 93304 covers a follow-up transthoracic echocardiogram, a heart ultrasound performed through the chest wall to evaluate heart structure and function during or after treatment.

Showing rates for

National Average

Base Medicare rate

$146.85

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.75

PE RVU (NF)

3.75

MP RVU

0.04

Total RVU

4.54

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Clearly document congenital vs adult echo indication in medical record before study
Impact: Prevents downcoding from 93304 to 93306; preserves correct $146.85 reimbursement and avoids audits
Ensure report includes all required elements: M-mode, 2D, spectral Doppler, and color flow Doppler with documented congenital anatomy assessment
Impact: Missing any component can trigger modifier 52 or denial, reducing payment by 25-50% or $36-73
Bill 93304 only for congenital heart disease patients; use 93306 for standard adult complete echos
Impact: Incorrect code selection is a top audit trigger; using wrong code risks recoupment of all payments
Verify split billing arrangements and modifier use (26/TC) matches actual ownership and performance location
Impact: Incorrect component billing can result in duplicate payment denials and potential fraud investigation
Document medical necessity for follow-up frequency in patients with stable congenital conditions
Impact: Medicare LCD policies may limit frequency; proper documentation prevents denials for services deemed not reasonable and necessary
Do not separately bill stress echo add-on codes (93350-93352) with 93304 unless specifically performed and documented
Impact: Unbundling violations can trigger 100% denial plus penalties; these are bundled services

Common denials

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Frequently asked questions

What is the Medicare reimbursement rate for CPT 93304 in 2025?

The 2025 Medicare national average payment for CPT 93304 is $146.85 for both facility and non-facility settings. This is based on 4.54 total RVUs multiplied by the conversion factor of 32.3465. Actual payment may vary by geographic location based on locality adjustments.

What is the difference between CPT 93304 and 93306?

CPT 93304 is specifically for transthoracic echocardiography in patients with congenital heart disease and requires evaluation of congenital cardiac anatomy. CPT 93306 is for complete adult transthoracic echocardiograms without congenital focus. The key difference is the patient population and the anatomic structures being evaluated.

How many RVUs is CPT code 93304 worth?

CPT 93304 has 4.54 total RVUs in 2025, broken down as: 0.75 work RVU, 3.75 practice expense RVU (both facility and non-facility), and 0.04 malpractice RVU according to the CMS Medicare Physician Fee Schedule.

Can CPT 93304 be billed with modifier 26?

Yes, modifier 26 can be appended to 93304 when only the professional component (physician interpretation) is being billed, typically when the study is performed at a facility that owns the equipment and bills the technical component separately with modifier TC.

What diagnosis codes support medical necessity for CPT 93304?

CPT 93304 is supported by congenital heart disease diagnosis codes in the Q20-Q26 range including atrial septal defects (Q21.1), ventricular septal defects (Q21.0), tetralogy of Fallot (Q21.3), transposition of great vessels (Q20.3), and other congenital cardiac anomalies. Post-surgical follow-up codes (Z95.8) with history of congenital repair also support medical necessity.

How often can CPT 93304 be billed for the same patient?

There is no specific Medicare frequency limitation for 93304, but medical necessity must be documented for each study. For stable congenital conditions, annual or biannual follow-up is typically considered reasonable. More frequent studies require documentation of clinical change, new symptoms, medication adjustments, or other justification.

Can CPT 93304 and 93350 be billed together?

No, CPT 93350 (stress echocardiography) and similar stress echo add-on codes should not typically be billed with 93304. If a stress echo is performed on a congenital patient, the appropriate base code would be 93350-93351, not 93304 plus stress codes. Billing both creates an unbundling risk and will likely be denied.