Echo transesophageal (tee)
CPT 93355 covers transesophageal echocardiography (TEE), an ultrasound procedure where a probe is inserted through the esophagus to get detailed images of the heart. This provides clearer views than standard chest ultrasound because the probe is positioned directly behind the heart.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Distinguish between 93355 (complete TEE), 93356 (placement of probe only), and 93350 (interpretation only) - never bill the complete code when only one component is performed
Impact: Prevents 100% denials and potential fraud allegations; coding 93355 instead of components can result in $150-200 overpayment per claim
Document whether TEE was performed intraoperatively versus as standalone diagnostic procedure - intraoperative TEE may require modifier 59 to prevent bundling with surgical procedure
Impact: Prevents automatic denials averaging $213.49 per claim when billed with cardiac surgical procedures
Bill facility versus non-facility rates appropriately - both rates are identical at $213.49 for 2025, but ensure place of service code matches actual location
Impact: Incorrect POS codes trigger audits even when payment is identical; can delay payment by 30-60 days pending review
Verify medical necessity documentation includes specific indication for TEE versus transthoracic echo - payers require justification for the more invasive procedure
Impact: Missing medical necessity documentation results in 30-40% denial rate; appeals success drops below 50% without clear clinical indication
When performed with cardioversion or other procedures, document separate decision-making and distinct timing to support modifier 59 if needed
Impact: Proper documentation of temporal separation increases modifier 59 acceptance rate from 60% to 90%, recovering approximately $213 per previously denied claim
For serial TEE monitoring during complex procedures, document each separate interpretation with distinct findings rather than continuous monitoring
Impact: Distinguishes billable repeat studies from continuous monitoring; potential additional payment of $213.49 per documented distinct study
Common denials
Bundled with surgical or interventional procedure performed on same date - payer considers TEE inclusive to primary procedure
How to appeal: Submit operative report showing TEE was separately identifiable service with distinct diagnostic purpose; cite CPT guidelines allowing separate reporting; append modifier 59 with detailed documentation of medical necessity for separate procedure
Medical necessity not established - payer requires justification for TEE versus less invasive transthoracic echocardiogram
How to appeal: Provide clinical notes documenting inadequate visualization with transthoracic approach, specific clinical questions requiring TEE resolution, or urgent clinical scenario; reference published appropriateness criteria supporting TEE indication
Incomplete documentation - report lacks required elements such as all cardiac structures examined, measurements, or complete interpretation
How to appeal: Submit complete TEE report with detailed findings for all standard views, measurements, Doppler data, and comparison to prior studies; ensure report is signed and dated by interpreting physician with credentials
Duplicate claim denial - same provider billed complete procedure (93355) and component codes (93356/93350) for same date
How to appeal: Clarify billing error and withdraw incorrect claim; if legitimately separate studies, provide documentation showing distinct sessions with separate clinical indications and time stamps demonstrating temporal separation
Frequently asked questions
What is the Medicare reimbursement rate for CPT 93355 in 2025?
The 2025 Medicare national average payment rate for CPT 93355 is $213.49 for both facility and non-facility settings. This rate is based on 6.6 total RVUs (4.66 work RVU, 1.61 practice expense RVU, 0.33 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.
Can CPT 93355 be billed with cardiac surgery on the same day?
Yes, but requires careful documentation and typically modifier 59. The TEE must be performed as a separately identifiable diagnostic service with distinct medical necessity from intraoperative monitoring. Documentation must clearly demonstrate the diagnostic purpose and timing relative to the surgical procedure. Many payers require pre-authorization for TEE billed separately from cardiac surgery.
What is the difference between CPT 93355, 93356, and 93350?
CPT 93355 represents the complete transesophageal echo including probe placement, image acquisition, and interpretation. CPT 93356 covers only the placement of the probe and acquisition of images (technical component). CPT 93350 is for interpretation only. Never bill 93355 together with 93356 or 93350 for the same study - use component codes only when services are split between providers.
Does CPT 93355 include moderate sedation?
No, moderate sedation is not included in CPT 93355 as of current coding guidelines. If moderate sedation is provided and documented separately, you may bill appropriate moderate sedation codes (99151-99153 or 99155-99157) in addition to 93355, ensuring all documentation requirements for sedation are met including time-based reporting.
What documentation is required to bill CPT 93355?
Required documentation includes medical necessity/indication, informed consent, systematic evaluation of all cardiac structures, measurements and Doppler data, image interpretation with findings, comparison to prior studies when available, complications if any, and stored images with proper labeling. The report must be signed by a qualified physician and demonstrate complete examination of cardiac structures in multiple imaging planes.
How many RVUs is CPT code 93355 worth in 2025?
CPT 93355 has a total of 6.6 RVUs in 2025, broken down as follows: 4.66 work RVUs, 1.61 practice expense RVUs (same for facility and non-facility), and 0.33 malpractice RVUs. This makes it a moderately valued cardiovascular diagnostic procedure.
When should modifier 26 be used with CPT 93355?
Modifier 26 should be appended to CPT 93355 when the physician provides only the professional component (interpretation and report) but does not own the equipment or employ the technical staff. This is common when a cardiologist interprets a TEE performed at a hospital that owns the equipment. Using modifier 26 reduces payment to the professional component only, typically 40-50% of the total allowable.