CPT 93318Cardiology

Echo transesophageal intraop

CPT 93318 covers transesophageal echocardiography (TEE) performed during surgery, where a specialized ultrasound probe is placed in the esophagus to provide real-time images of the heart while the patient is already under anesthesia for another procedure.

Showing rates for

National Average

Base Medicare rate

$97.04

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

2.15

PE RVU (NF)

0.7

MP RVU

0.15

Total RVU

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

NCCI bundling edits

Loading bundling edits…

Billing tips

Bill 93318 only when TEE is performed during the intraoperative period of a separate surgical procedure; pre-operative or post-operative TEE in the OR uses different codes (93312-93317)
Impact: Prevents denials for incorrect code selection; wrong code may result in $50-200 payment difference or complete denial
Document precise timing showing TEE was performed while patient was already anesthetized for primary procedure and was medically necessary for surgical decision-making
Impact: Addresses most common denial reason; clear documentation reduces denial rate by 60-70% in audits
Verify the primary surgeon's CPT code does not include intraoperative TEE monitoring as a bundled service (check NCCI edits quarterly)
Impact: NCCI bundling edits may prevent separate payment; checking edits prevents $97.04 automatic denial
For cardiac surgery cases, confirm medical necessity beyond routine monitoring by documenting specific indications such as valve repair assessment, unexplained hemodynamic instability, or structural defect evaluation
Impact: Payers increasingly scrutinize routine use; specific medical necessity documentation increases clean claim rate by 40%
When billing globally (without modifiers), ensure your facility/practice owns the equipment and provides both professional interpretation and technical components
Impact: Incorrect component billing can trigger overpayment recovery or underpayment; proper modifier use ensures full $97.04 payment distribution
Report 93318 with diagnosis codes that support medical necessity (congenital heart disease, valve disorders, hemodynamic instability) rather than only the surgical indication

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Frequently asked questions

What is the difference between CPT 93318 and 93312 for TEE?

CPT 93318 is specifically for TEE performed during the intraoperative period while the patient is already under anesthesia for another surgical procedure. CPT 93312 is for a complete diagnostic TEE performed as a standalone procedure, typically in an outpatient or pre-operative setting. The key distinction is whether the TEE is concurrent with surgery (93318) or a separate diagnostic session (93312). Using 93318 for pre-op TEE will result in denial.

How much does Medicare pay for CPT 93318 in 2025?

Medicare pays $97.04 for CPT 93318 in 2025 based on the national average rate (both facility and non-facility rates are identical at $97.04). This is based on 3.0 total RVUs (2.15 work RVU + 0.7 PE RVU + 0.15 MP RVU) multiplied by the 2025 conversion factor of 32.3465. Actual payment may vary by geographic locality based on the GPCI adjustment factors for your area.

Can 93318 be billed with cardiac surgery codes?

Yes, but with caution. CPT 93318 can be billed separately from cardiac surgery codes when the TEE serves a distinct diagnostic purpose beyond routine intraoperative monitoring and is not bundled per NCCI edits. You must document specific medical necessity (such as valve repair assessment, unexpected hemodynamic findings, or structural evaluation) and verify current NCCI edits for the specific surgical CPT code. Modifier 59 may be required to indicate a distinct procedural service, and many payers require pre-authorization or have specific coverage policies.

Who can perform and bill for intraoperative TEE?

Intraoperative TEE can be performed and billed by board-certified cardiologists, cardiac anesthesiologists, or cardiovascular surgeons who have documented competency in transesophageal echocardiography. Most facilities require National Board of Echocardiography certification or equivalent institutional credentialing demonstrating completion of required training cases and ongoing competency. The physician performing and interpreting the TEE must personally document the findings and medical necessity; the service cannot be delegated to non-physician providers for billing purposes, though assistants can be used with modifier AS.

What diagnosis codes support medical necessity for 93318?

Diagnosis codes that support medical necessity for intraoperative TEE include congenital heart defects (Q20-Q26 series), acquired valve disorders (I34-I37), infective endocarditis (I33), aortic aneurysm (I71), hemodynamic instability during surgery (R57.9), heart failure requiring surgical intervention (I50 series), and specific conditions requiring valve assessment or structural evaluation. The diagnosis should reflect the cardiac pathology being monitored, not just the surgical indication. Weak or non-specific diagnoses are a leading cause of medical necessity denials.

Do I need modifier 26 or TC when billing 93318?

Use modifier 26 (professional component) when you are only providing the physician interpretation and the hospital or facility owns the TEE equipment and provides technical staff. Use modifier TC (technical component) when the facility bills for equipment and technologist services separately from the physician interpretation. Bill 93318 without modifiers (globally) only when your group owns the equipment, provides all technical resources, and performs the professional interpretation. Incorrect component billing can result in overpayment recovery or underpayment.

What are the most common reasons for 93318 claim denials?

The most common denial reasons for CPT 93318 are: (1) bundling denials where the payer considers TEE included in the primary surgical procedure's global payment, (2) medical necessity denials due to inadequate documentation of why TEE was required beyond routine monitoring, (3) timing issues where documentation doesn't clearly show the TEE was performed during the intraoperative period, and (4) NCCI edit violations when billed with certain cardiac surgery codes without appropriate modifiers. Approximately 30-40% of initial 93318 claims face some form of payer challenge, making documentation quality critical.