Echo transesophageal
CPT code 93317 covers transesophageal echocardiography (TEE), an ultrasound procedure where a probe is passed down the esophagus to obtain detailed images of the heart's structure and function. This provides clearer images than traditional chest ultrasounds because the esophagus sits directly behind the heart.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Verify whether 93317 is the appropriate code or if you should bill the complete TEE codes (93312-93316) which include probe placement, image acquisition, and interpretation as a bundled service
Impact: Billing the wrong code family can result in 100% denial; 93312-93316 reimburse $175-$350 for complete procedures versus $83.78 for 93317 alone
When billing 93317 for intraoperative TEE monitoring, ensure documentation clearly separates the pre-bypass, intra-bypass, and post-bypass evaluations to support medical necessity for extended monitoring
Impact: Inadequate documentation of continuous monitoring can trigger downcoding or denial; proper documentation supports the 2.59 RVU value
Always append modifier 26 when you are only providing the interpretation service and do not own the equipment or employ the technical staff performing the image acquisition
Impact: Failure to use modifier 26 when appropriate results in claim rejection and recovery demands; correct use ensures accurate payment split between technical and professional components
Document the specific indication for TEE rather than transthoracic echo in the medical record, such as inadequate transthoracic windows, need for higher resolution, or intraoperative requirement
Impact: Medical necessity audits frequently target TEE procedures; clear documentation of why TEE was required prevents denials and supports the higher reimbursement compared to TTE codes
For Medicare patients, verify that the TEE is being performed for a covered indication and not for screening purposes, as routine screening TEE is not covered
Impact: Non-covered services must have an Advance Beneficiary Notice (ABN) on file or the provider cannot collect from the patient; prevents compliance violations
When performed during cardiac surgery, coordinate with the surgical team to ensure proper code selection and avoid duplicate billing with surgeon's intraoperative services
Impact: Prevents bundling denials and compliance issues; improper coordination can result in 100% denial of either the TEE or surgical monitoring component
Common denials
Bundling denial when billed with complete TEE codes (93312-93316) or with comprehensive echocardiography codes on the same date of service
How to appeal: Submit documentation showing that 93317 represents a separate and distinct study performed at a different time or for a different clinical indication; include operative notes showing timing and medical necessity for multiple studies; consider whether modifier 59 was appropriately appended
Medical necessity denial stating that transthoracic echocardiography (TTE) would have been sufficient for the clinical indication provided
How to appeal: Provide documentation of specific clinical factors requiring TEE such as inadequate transthoracic windows due to body habitus or lung disease, need for higher resolution imaging for suspected endocarditis or small vegetations, or intraoperative monitoring requirements; include previous TTE reports showing inadequate visualization if applicable
Denial for lack of physician interpretation and report in the medical record when billing with or without modifier 26
How to appeal: Submit the complete signed and dated interpretation report with detailed findings including assessment of all cardiac chambers, valves, and flow patterns; ensure report is separately identifiable from operative or procedure notes; demonstrate compliance with CPT requirements for interpretation and report
Duplicate service denial when multiple TEE studies are performed on the same day without appropriate modifiers (76 or 77)
How to appeal: Provide documentation showing change in clinical status necessitating repeat study, such as post-surgical complication, hemodynamic instability, or inadequate initial study; include timestamps demonstrating separate encounters; append appropriate repeat procedure modifier with detailed explanation
Frequently asked questions
What is the difference between CPT 93317 and 93312-93316 for transesophageal echo billing?
CPT 93317 represents only the image acquisition, interpretation, and report component of TEE, typically used when billing separately from probe placement. Codes 93312-93316 are complete procedure codes that bundle probe placement, image acquisition, and interpretation together. Use 93312-93316 when the physician performs or supervises all components; use 93317 when only providing the imaging and interpretation service as part of a larger surgical or procedural case where probe placement is reported separately.
How much does Medicare pay for CPT 93317 in 2025?
The 2025 Medicare national average reimbursement for CPT 93317 is $83.78 for both facility and non-facility settings. This is based on 2.59 total RVUs (1.84 work RVU, 0.63 practice expense RVU, 0.12 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary based on geographic location and local Medicare Administrative Contractor (MAC) adjustments.
Can CPT 93317 be billed with modifier 26 for professional component only?
Yes, modifier 26 should be appended to 93317 when billing only the professional component (physician interpretation and report) without the technical component (equipment, supplies, sonographer time). This is common when a cardiologist interprets a TEE study performed using hospital-owned equipment and staff. When billing 26, ensure the technical component is billed separately by the facility or that you have a clear agreement about component splitting.
What documentation is required to bill CPT 93317 for intraoperative TEE monitoring?
Intraoperative TEE documentation must include a separate, signed interpretation report that details pre-bypass, intra-bypass, and post-bypass findings; specific indication for TEE monitoring; assessment of all cardiac structures; evaluation of surgical repair adequacy; and how the findings influenced surgical management. The report must be distinguishable from the anesthesia record and operative note. Document any changes in clinical status that required additional imaging and the timing of each evaluation phase.
When should I use modifier 59 with CPT code 93317?
Modifier 59 should be used with 93317 when billing a distinct TEE study that might otherwise be considered bundled with another procedure performed on the same day. Examples include when a diagnostic TEE is performed separately from an intraoperative TEE, when TEE is performed in addition to other imaging studies that have NCCI edits, or when medical necessity requires multiple separate TEE examinations. Always document the distinct nature and separate medical necessity of each service.
Is CPT 93317 covered for routine screening by Medicare?
No, Medicare does not cover CPT 93317 for routine screening purposes. TEE must be medically necessary for diagnosis or management of a specific cardiac condition. Covered indications include evaluation of suspected endocarditis, assessment before cardioversion, evaluation of prosthetic valves, assessment of cardiac source of embolism, intraoperative monitoring during cardiac surgery, or when transthoracic imaging is inadequate. If performing for non-covered screening, obtain an Advance Beneficiary Notice (ABN) before the procedure.
What are the most common billing errors with CPT 93317?
Common errors include: billing 93317 with complete TEE codes (93312-93316) causing bundling denials; failing to append modifier 26 when only providing interpretation; billing without adequate separate interpretation documentation; using 93317 instead of complete codes when all components are performed; billing multiple same-day studies without modifiers 76/77; and failing to document medical necessity for TEE versus transthoracic approach. Each of these errors can result in denials, recoupment demands, or compliance violations.