Echo transesophageal
CPT 93312 covers transesophageal echocardiography (TEE), an ultrasound procedure where a probe is inserted through the mouth into the esophagus to capture detailed images of the heart from behind. This provides clearer images than traditional chest ultrasounds, especially for structures like heart valves and chambers.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always verify complete TEE study component coding: 93312 (probe placement and imaging), 93318 (interpretation and report), and 93355 (stress echo addition if applicable). These are separate reportable services.
Impact: Failing to bill 93318 separately results in loss of additional $90-120 in professional fees. Together, complete study yields approximately $315-340 in total reimbursement.
Document exact time of probe insertion and removal, plus physician presence during image acquisition. Medicare requires physician attendance during the actual imaging for 93312.
Impact: Absence of physician attendance documentation during imaging leads to 100% denial of $225.46. Anesthesiologist performing probe placement without cardiologist present may not bill this code.
For intraoperative TEE, ensure surgical indication is clearly linked in documentation. TEE must be medically necessary for surgical decision-making, not routine monitoring.
Impact: Medical necessity denials for routine intraoperative monitoring without specific indication result in $225.46 loss. Document specific valvular or structural questions guiding surgical approach.
Use place of service code 21 (inpatient hospital) or 22 (outpatient hospital) appropriately. Both have same facility rate of $225.46, but incorrect POS triggers claim rejections.
Impact: Incorrect place of service causes claim rejection requiring resubmission, delaying payment 30-45 days. For ASC procedures, verify payer-specific coverage as not all cover TEE in ASC setting.
When billing with cardiac surgery codes, append modifier 59 to 93312 if payer has edit in place. Check NCCI edits quarterly as these change.
Impact: NCCI bundling edits may deny 93312 when billed with certain surgical codes. Modifier 59 with proper documentation prevents $225.46 denial when procedures are truly distinct.
For contrast-enhanced TEE studies, verify payer policy on perflutren contrast agent billing. Report A9700 (contrast supply) separately when allowed.
Impact: Contrast supply reimbursement adds $150-250 when properly billed and documented. Many payers require specific prior authorization for contrast TEE studies.
Common denials
Missing or incomplete interpretation report (93318) leading payer to consider 93312 as incomplete service
How to appeal: Submit appeal with complete TEE report including measurements, interpretation, and physician signature. Include operative note showing probe placement and imaging performed. Cite that 93312 specifically covers image acquisition component per CPT guidelines.
Medical necessity denial for intraoperative TEE during non-cardiac or low-complexity cardiac procedures
How to appeal: Provide literature supporting TEE use for specific surgical indication. Submit operative note highlighting specific structural or functional question requiring TEE guidance. Include any unexpected findings that justified the study. Reference ACC/AHA appropriateness criteria for intraoperative TEE.
Denial for lack of physician presence during image acquisition, particularly when anesthesiologist places probe but cardiologist not documented as present
How to appeal: Submit anesthesia record and operative note with timestamps showing cardiologist presence during imaging. Provide facility privileging documentation showing which physician is credentialed for TEE interpretation. If cardiologist was consulted for specific findings, document this was real-time consultation during procedure.
Bundling denial when billed same day as transthoracic echo (93306) or stress echo, claimed as duplicate service
How to appeal: Document distinct clinical indication for TEE beyond transthoracic findings. Note inadequate transthoracic windows or specific structures requiring TEE visualization. Include interpretation reports for both studies showing different diagnostic information obtained. Append modifier 59 to 93312 on corrected claim.
Frequently asked questions
What is the difference between CPT 93312 and 93318 for transesophageal echo?
CPT 93312 covers the probe placement and real-time image acquisition during TEE, requiring physician attendance during the procedure. CPT 93318 represents the separate physician interpretation and written report of those images. Both codes are reportable for a complete TEE study, with 93312 reimbursed at $225.46 and 93318 typically around $90-120, for total study payment of approximately $315-340.
How much does Medicare pay for CPT 93312 in 2025?
Medicare pays $225.46 for CPT 93312 in 2025 under the national average physician fee schedule. This rate applies to both facility and non-facility settings and is based on 6.97 total RVUs multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment.
Can CPT 93312 be billed with a transthoracic echo on the same day?
Yes, but requires careful documentation of medical necessity for both studies. The TEE must address a specific clinical question that the transthoracic echo could not answer, such as inadequate acoustic windows, need for detailed valve assessment, or evaluation for endocarditis. Append modifier 59 to CPT 93312 and ensure both reports clearly document distinct diagnostic information obtained from each modality.
Who can bill CPT 93312 for intraoperative TEE monitoring?
The physician who is present during image acquisition and has specific TEE privileges can bill 93312. This is typically a cardiologist or cardiac anesthesiologist with documented competency in TEE. The physician must be physically present during the imaging, not just available for interpretation. If an anesthesiologist places the probe but a cardiologist performs and interprets the imaging, the cardiologist bills 93312 and 93318.
What modifiers are needed when billing CPT 93312 in a hospital setting?
In hospital settings, modifier 26 (professional component) is used when billing only for physician services without providing equipment or technical staff. The hospital bills modifier TC (technical component) separately. For complete service in a physician office setting, no modifier is needed. Modifier 59 may be required when billing with other procedures to indicate distinct services and prevent bundling denials.
What documentation is required to support medical necessity for CPT 93312?
Documentation must include a specific clinical indication such as suspected endocarditis, pre-cardioversion thrombus evaluation, detailed valve assessment for surgical planning, or intraoperative monitoring for cardiac surgery. For intraoperative use, document how TEE findings will guide surgical decision-making. Include inadequate transthoracic imaging if TEE follows TTE. General cardiac monitoring without specific structural questions is typically not considered medically necessary.
Can TEE probe placement by an anesthesiologist and interpretation by a cardiologist both be billed?
The services should not be split this way for separate billing. CPT 93312 includes probe placement AND physician-attended image acquisition as a single service. If an anesthesiologist places the probe and acquires images with a cardiologist present, the cardiologist typically bills both 93312 and 93318. If the anesthesiologist performs the complete imaging acquisition and interpretation independently, the anesthesiologist bills both codes. Splitting components between providers is not supported by CPT definitions.