Echo transesophageal intraop
CPT 93318 covers an ultrasound of the heart performed during surgery using a probe placed down the throat (transesophageal echocardiogram). This allows surgeons to see real-time images of heart structures and function while the patient is under anesthesia.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Document exact start and stop times of the intraoperative TEE monitoring, clearly distinguishing from any preoperative or postoperative TEE studies
Impact: Prevents denials for duplicate services; ensures full $97.04 payment rather than bundled denial
Include a complete interpretation report with images stored in the medical record, documenting findings that influenced surgical management
Impact: Required for payment; absence of formal interpretation results in 100% denial or recoupment
When multiple TEE studies are performed same day (preop, intraop, postop), use appropriate modifiers and separate documentation for each distinct session
Impact: Without modifier 59 or proper documentation, subsequent studies may be denied as duplicates, losing $97.04 per denied study
Verify that 93318 is billed by the physician performing and interpreting the study, not automatically included in surgical or anesthesia global packages
Impact: Prevents loss of the entire 3.0 RVUs and $97.04 payment when incorrectly assumed to be bundled
For split billing scenarios, clearly identify whether billing modifier 26 or TC based on contractual arrangements between anesthesia and cardiology groups
Impact: Incorrect modifier selection results in underpayment or overpayment; proper split ensures both parties receive appropriate portion of $97.04
Link to appropriate ICD-10 codes documenting the indication for intraoperative monitoring (e.g., valve disease, heart failure, aortic pathology)
Impact: Medical necessity documentation prevents denials; unclear indication may result in full denial of $97.04 as not medically necessary
Common denials
Bundled with surgical procedure code or anesthesia services as inclusive to the global package
How to appeal: Submit documentation showing 93318 is a separately identifiable service with distinct interpretation and report; cite CMS guidelines that intraoperative TEE is separately reportable; include operative note showing surgeon did not perform TEE and anesthesiologist/cardiologist provided independent service
Lack of separate interpretation and report distinct from operative note or anesthesia record
How to appeal: Provide complete TEE interpretation report with standard echocardiographic elements (chamber sizes, valve function, wall motion, hemodynamics); demonstrate report was generated by qualified physician and filed separately in medical record; emphasize clinical impact on surgical decision-making
Denial as duplicate service when preoperative or postoperative TEE also performed same date of service
How to appeal: Submit documentation clearly delineating timing and distinct clinical purpose of each TEE session; append modifier 59 to indicate separate procedure; provide separate reports for each session showing different findings or clinical questions addressed
Medical necessity denial when indication for intraoperative monitoring not clearly documented
How to appeal: Provide clinical documentation supporting need for continuous intraoperative monitoring (complex valve repair, assessment of surgical result, hemodynamic instability); cite published guidelines recommending intraoperative TEE for the specific procedure; include correspondence from surgical team requesting intraoperative TEE guidance
Frequently asked questions
What is the Medicare reimbursement rate for CPT code 93318 in 2025?
The 2025 Medicare national average payment rate for CPT 93318 is $97.04 for both facility and non-facility settings. This is based on 3.0 total RVUs (2.15 work RVU, 0.7 practice expense RVU, 0.15 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
Can CPT 93318 be billed with cardiac surgery codes on the same day?
Yes, CPT 93318 can be billed separately with cardiac surgery codes when performed by a different physician (typically anesthesiologist or cardiologist) who provides a complete interpretation and report distinct from the surgical procedure. Modifier 59 may be needed to indicate this is a separate, non-bundled service with independent documentation.
Who can bill for intraoperative transesophageal echocardiography?
CPT 93318 is typically billed by anesthesiologists with advanced cardiac training, cardiologists, or cardiac anesthesiologists who have appropriate credentials and certification in echocardiography. The billing physician must personally perform or supervise the study and provide a complete interpretation report separate from anesthesia or surgical documentation.
What documentation is required to bill CPT 93318?
Required documentation includes a complete interpretation report with assessment of cardiac structures and function, timing of the service, indication for intraoperative monitoring, images stored in the medical record, and evidence that findings influenced surgical or anesthetic management. The report must be separate from the operative note and anesthesia record.
Is CPT 93318 bundled into anesthesia services?
No, CPT 93318 is not bundled into anesthesia base units or time. It is separately reportable when a qualified physician performs a complete transesophageal echocardiogram during surgery with full interpretation and documentation. However, proper documentation is essential to demonstrate this is a distinct service beyond routine anesthesia monitoring.
What is the difference between CPT 93318 and 93355?
CPT 93318 is specifically for intraoperative transesophageal echocardiography performed during surgery, while CPT 93355 is for complete transesophageal echocardiography performed in other settings (pre-op, post-op, diagnostic). The intraoperative code 93318 reflects monitoring during the surgical procedure itself with continuous or intermittent imaging to guide surgical decisions.
How many RVUs is CPT code 93318 worth in 2025?
CPT 93318 has 3.0 total RVUs in 2025, consisting of 2.15 work RVUs, 0.7 practice expense RVUs (both facility and non-facility), and 0.15 malpractice RVUs. These values are from the CMS Medicare Physician Fee Schedule RVU25A released December 23, 2024.