CPT 93312 reports a complete diagnostic transesophageal echocardiogram (TEE) when one physician places the probe, acquires real-time 2D images, and writes the formal interpretation and report. That last part decides the code. It’s the standard CPT code for transesophageal echocardiography. Payers split or deny it once two physicians share the study.
A clean 93312 claim rests on six decisions: who placed the probe, where the study happened, and whether a formal report exists, plus which add-ons the report supports, which diagnosis your Medicare Administrative Contractor (MAC) accepts, and whether a cardioversion or anesthesia service shares the session. Miss one, and you’re looking at a denial or a recoupment.
Rates below come from the CY 2026 Medicare Physician Fee Schedule published by the Centers for Medicare & Medicaid Services (CMS). Edit rules reflect the October 1, 2026 quarter of the National Correct Coding Initiative (NCCI). Your contracts and your MAC’s articles can differ.
| Key takeawaysOne physician, full study, formal report: bill 93312.Two physicians: 93313 for the probe and 93314 for the images and report, never 93312 with either.Monitoring with no formal report: 93318. Structural heart guidance: 93355.2026 Medicare, national: $239.48 global, or $105.21 for 93312-26 in a hospital or ambulatory surgical center (ASC).TEE before cardioversion: 92960 plus 93312, each with its own documentation.Diagnoses and frequency limits: check your MAC’s TEE billing article, since no national list exists. |
CPT 93312 Quick Facts for 2026
| Field | Value |
|---|---|
| What it reports | Complete diagnostic TEE: probe placement, real-time 2D image acquisition, interpretation, and formal report by one physician |
| CPT section | Medicine: Cardiovascular, Echocardiography |
| Global period | XXX (no surgical global period) |
| 2026 RVUs (non-facility) | Work 2.24, practice expense 4.83, malpractice 0.10, total 7.17 |
| 2026 national Medicare rate, global | $239.48 at the $33.4009 conversion factor; $240.68 at the $33.5675 qualifying APM participant rate |
| 2026 national rate, 93312-26 | $105.21 (3.15 RVUs at $33.4009) |
| 2026 national rate, 93312-TC | $134.27 (4.02 RVUs at $33.4009) |
| Hospital or ASC setting | Physician bills 93312-26; the facility bills its own side |
| Codes for split studies | 93313 (probe placement only), 93314 (image acquisition, interpretation, and report) |
| Related TEE codes | 93318 (monitoring), 93355 (structural heart guidance), 93315 to 93317 (congenital) |
| Doppler add-on codes | +93320, +93321, +93325 |
| 3D codes | +93319, 76376, 76377 |
| Hospital outpatient or ASC with contrast | C8925 |
| Medicare frequency, J6/JK example | Twice a year; four times a year for endocarditis |
| Data source | CMS Physician Fee Schedule Look-Up, national amounts, data dated July 1, 2026 |
What Is CPT Code 93312?
CPT code 93312 reports a complete diagnostic TEE and sits in the Medicine section of the CPT code set. One physician performs all three parts: probe placement, real-time 2D image acquisition, and a formal written interpretation. Split the work between two physicians, or skip the formal report, and a different code applies.
Within the cardiology CPT codes family, 93312 sits beside transthoracic echo (93306 to 93308) and stress echo (93350 and 93351). The TEE CPT code adds a step the others don’t have: a physician passes a probe down the esophagus, and the claim has to show who did it.
The Official 93312 CPT Code Description
The American Medical Association (AMA) owns CPT and publishes the long descriptor. It describes a real-time transesophageal echo with 2D image documentation, with or without M-mode recording, and it closes with the phrase “including probe placement, image acquisition, interpretation and report.” Three pieces of that wording change how you bill:
- Image documentation: the physician stores the images, so a live look with nothing saved won’t support the code.
- M-mode: optional, and adding it doesn’t change the code or the payment.
- The “including” clause: one physician has to do all of it for 93312 to fit.
What CPT 93312 Includes: Three Components
Each component maps to a claim line once the work splits between physicians. Use this table when a note names more than one physician in the TEE.
| Component | What it means on the claim | If another physician does it |
|---|---|---|
| Probe placement | Passing the probe into the esophagus | That physician bills 93313 |
| Image acquisition | Moving the probe to capture and store images | Bill 93314, which covers acquisition, interpretation, and report together |
| Interpretation and report | Formal written findings and impression | Same 93314 line; a third physician can’t bill the report alone |
Why the Formal Written Report Decides the Code
A TEE with no formal report can’t carry 93312. Say the physician watched the images to guide care in the moment and documented them only in the anesthesia or procedure note. Payers read that service as monitoring (93318) or as part of another service, and they won’t pay it as a diagnostic study.
Wellpoint Federal, the Medicare contractor for jurisdictions J6 and JK, expects a complete interpretation and report from the performing physician in its TEE billing article, A52868. NCCI applies the same test to TEE performed during anesthesia.
Is CPT 93312 a Surgery Code?
No. 93312 is a diagnostic code in the CPT Medicine section with an XXX global period, which means CMS applies no surgical global package. That holds even when the TEE happens in an operating room. The code isn’t timed, either, so a long study and a short one bill and pay the same.
When to Bill CPT 93312: Diagnostic TEE Scenarios
Bill 93312 for a standalone diagnostic TEE with a formal report, in an echo lab, an operating room, or an intensive care unit (ICU). TEE that guides a transcatheter structural heart procedure goes to 93355, and continuous monitoring without a report goes to 93318. Picking the right transesophageal echocardiogram CPT code starts with the reason for the study.
Outpatient and Echo Lab TEE
Before your coder picks the CPT code, transesophageal echocardiogram orders need a specific indication. A bare “TEE” on the order won’t hold up. The examples below come from Wellpoint Federal’s TEE billing article, A52868, for jurisdictions J6 and JK, and other MACs list different codes.
- Clot check before cardioversion: I48.0, I48.19, or I48.91; atrial flutter I48.3
- Endocarditis or bacteremia: I33.0, I38, or R78.81
- Embolic source after stroke or transient ischemic attack (TIA): I63.40 or G45.9
- Native or prosthetic valve disease: I34.0, I35.0, or T82.03XA
- Aortic dissection: I71.010
- Intracardiac thrombus or patent foramen ovale: I51.3 or Q21.12
- Inadequate transthoracic study: R93.1 first, then the cardiac abnormality
Intraoperative Diagnostic TEE
A surgeon asks for a diagnostic answer during the case, and the echocardiographer writes a separate formal report. That’s the intraoperative TEE Medicare treats as a diagnostic study. The Duke Anesthesiology TEE billing page quotes the Medicare condition: the surgeon or another physician has to request the echo for a specific diagnostic reason.
Duke’s examples include checking valve placement, judging a valve repair or revascularization, and detecting intravascular air. A TEE the anesthesiologist keeps running to watch filling and function belongs to the anesthesia service instead.
TEE in the ICU and Critical Care
A physician billing critical care (99291 or 99292) can report a diagnostic TEE on the same date, per section I.31 of NCCI Policy Manual, Chapter 11. Subtract the probe placement time from the critical care minutes. For monitoring TEE (93318) without probe placement, NCCI’s answer is “not separately reportable” for that physician.
If the critical care physician places the probe for monitoring on the same date, NCCI allows 93318 with modifier 59 or XU. It’s easy to miss when the TEE shows up as a single line in the critical care note.
Payers decide these claims on setting and indication more than on the images. A cardiology coder who works TEE every week catches those gaps before the claim leaves, and that’s the daily work behind our specialty medical billing services.
TEE CPT Codes: 93312 vs 93313, 93314, 93318, and 93355
CPT 93312 covers a complete diagnostic TEE by one physician when the study isn’t for a congenital anomaly. Split work goes to 93313 and 93314, monitoring to 93318, and structural heart guidance to 93355. Congenital studies use 93315 to 93317. Pick the code by who did each part and why the study happened.
Work down this list and stop at the first match:
- Guidance for a transcatheter structural heart intervention: bill 93355.
- Continuous monitoring with no formal diagnostic report: bill 93318.
- A congenital cardiac anomaly: use 93315, 93316, or 93317.
- Two physicians shared the study: bill 93313 and 93314.
- One physician, full study, formal report: bill 93312.
Use the table below to match the CPT code for TEE to each physician’s role. The American Society of Anesthesiologists (ASA) covers training and separate reporting in its statement on TEE, last amended October 26, 2022.
| Code | What it reports | Who bills it | Key rule |
|---|---|---|---|
| 93312 | Complete diagnostic TEE: probe, images, and report | The physician who did the whole study | 93312 never goes with 93313 or 93314 for the same study |
| 93313 | Probe placement only | The physician who placed the probe, often the anesthesiologist | 93313 has PC/TC indicator 0, so modifier 26 is invalid |
| 93314 | Image acquisition, interpretation, and report only | The physician who read a study someone else started | 93314 takes modifier 26 in a facility |
| 93315 | Complete congenital TEE | A congenital cardiologist doing the whole study | 93315 applies to congenital anomalies only |
| 93316 | Congenital probe placement only | The physician who placed the probe | 93316 has PC/TC indicator 0 |
| 93317 | Congenital acquisition, interpretation, and report only | The reading congenital cardiologist | 93317 pairs with 93316 |
| 93318 | Monitoring TEE that guides immediate treatment | Anesthesiologist or intensivist | NCCI treats 93318 as part of anesthesia |
| 93355 | TEE guidance for structural heart interventions | An imaging physician who isn’t doing the intervention | Bill 93355 once per intervention, with no modifier 26 |
93312 vs 93313 and 93314: When Two Physicians Share the Study
Picture a TEE before cardiac surgery. The anesthesiologist places the probe and bills 93313, with modifier 59 when anesthesia is on the same claim. Then the cardiologist acquires the images, reads them, and bills 93314-26 in the hospital. Neither physician can bill 93312 for that study.
The split also pays less. At 2026 national rates, 93313 pays $10.35 and 93314-26 pays $88.51, for $98.86 combined. One physician billing 93312-26 for the same study receives $105.21. Both figures use the $33.4009 conversion factor.
At One O Seven RCM, the first question our coders ask on a TEE claim is who placed the probe. The answer sets the codes for both physicians, and it has to match the procedure note.
93312 vs 93318: Diagnostic Study or Intraoperative Monitoring?
93318 covers TEE that an anesthesiologist or intensivist watches throughout the case to adjust treatment, such as fluids or drugs during surgery. Under Wellpoint Federal’s A52868, the anesthesiologist doesn’t bill 93318 on top of anesthesia. A diagnostic question with a formal report moves the service to 93312.
Medicare’s 2026 national rate for 93318-26 is $101.87. The global and technical lines are carrier priced, so your MAC sets those amounts.
93312 vs 93355: Diagnostic TEE or Structural Heart Guidance?
The 93355 CPT code description covers TEE guidance for transcatheter structural interventions such as TAVR, mitral repair, and left atrial appendage closure. It already includes the diagnostic TEE, Doppler, color flow, 3D, and contrast when performed. CPT code 93355 goes on the claim once per intervention, and neither 93312 nor the Doppler add-ons go on top.
Two more rules apply here. Wellpoint Federal’s A52868 bars 93314 and 93317 during TAVR, mitral repair, appendage closure, and similar procedures. Section D.41 of NCCI Policy Manual, Chapter 5 blocks the physician performing TAVR or TMVR from reporting 93306 to 93308, 93312 to 93314, or 93320 to 93325.
A diagnostic TEE on a different date is a separate service. Bill follow-up imaging weeks after an appendage closure, for example, as 93312 when a formal report supports it.
Congenital TEE: 93315, 93316, and 93317
The congenital codes follow the same logic for patients with congenital cardiac anomalies. 93315 is the complete study, 93316 is probe placement, and 93317 is acquisition, interpretation, and report. Medicare’s 2026 national rates are $123.58 for 93315-26 and $85.84 for 93317-26, and MACs price the technical side.
Transthoracic Echocardiogram vs Transesophageal Echocardiogram: 93306 or 93312?
The sonographer holds the probe on the chest wall for a transthoracic study. TEE needs a physician to pass it down the esophagus, and you bill the two studies in different ways as a result.
| Feature | TTE (93306) | TEE (93312) |
|---|---|---|
| Probe position | Chest wall | Esophagus |
| Typical setting | Office, echo lab, or bedside | Echo lab, operating room, or ICU, with sedation |
| Doppler | Spectral and color Doppler included | Billed as add-ons: +93320, +93321, +93325 |
| Split billing | 93306-26 and 93306-TC | 93312-26 and 93312-TC, or 93313 plus 93314 |
| 2026 national global rate | $196.73 | $239.48 |
| Diagnosis after an inadequate TTE | Not applicable | R93.1 first, then the cardiac finding |
Intracardiac echo during an ablation is a different service altogether. It’s add-on CPT 93662, which sits outside the transesophageal echo CPT code family. For the transthoracic side, our 93306 echocardiogram guide covers the complete TTE rules.
CPT 93312 Modifiers: 26, TC, 59, XU, 52, and 53
CPT code 93312 needs a modifier only when the setting or a second service calls for one. An office that owns the equipment and does the full TEE bills 93312 with no modifier. In a hospital or ASC, the physician adds 26. Anesthesiologists add 59 or XU to set a diagnostic TEE apart from the anesthesia service.
| Modifier | When it goes on 93312 | Setting | Common mistake |
|---|---|---|---|
| None | The practice owns the equipment and does the full study | POS 11 | Billing global for a hospital TEE |
| 26 | Physician interpretation only; a facility owns the equipment | POS 19, 21, 22, or 24 | Leaving 26 off a facility claim |
| TC | A non-facility entity bills the technical side only | Rare for TEE | Hospitals adding TC, when they bill their side on the UB-04 |
| 59 or XU | Anesthesiologist’s diagnostic TEE, distinct from anesthesia | Operating room | Adding 59 to a monitoring TEE |
| 52 | Limited or focused TEE, such as a left atrial appendage check only | Any | Assuming every payer accepts 52 on 93312 |
| 53 | The physician stopped the study for patient safety | Any | Using 73 or 74, which only facilities report |
| 25 | Never on 93312; it belongs on the E/M visit | Any | Appending 25 to the TEE line |
| 26 on 93313 or 93355 | Invalid, since both codes carry PC/TC indicator 0 | Any | Adding 26 out of habit |
Match the Modifier to the Place of Service
The place of service code and the modifier have to agree. POS 11 with no modifier tells the payer your practice owns the equipment and the room. With POS 19, 21, 22, or 24, a facility owns them, so the physician line carries 26. A mismatch invites a CO-4 denial.
Our modifier 26 guide covers professional component billing across specialties, including the split between the physician claim and the facility claim.
Modifier 59 or XU on Anesthesiologist TEE Claims
An anesthesiologist who provides anesthesia and also performs a diagnostic TEE needs 59 or XU on the TEE line. ASA agrees. Its statement supports 59 in that case and adds 26 when the anesthesiologist doesn’t own the TEE equipment. Some commercial payers prefer XU, so check the payer’s modifier policy before you set a default.
Limited or Discontinued TEE: 52 vs 53
CPT has no separate code for a limited TEE. Duke’s billing page uses 93312-52 for a focused exam, such as a left atrial appendage or pericardial effusion check. Confirm that your top payers accept 52 on 93312 before you build a charge rule around it.
A different problem comes up when a patient gags or desaturates after probe insertion and the physician stops. Bill 93312-53 and document why the study ended and how far it got. Payment on a 53 line varies by payer, so send the procedure note when the payer asks for it.
Modifier 25 goes on a significant, separately identifiable E/M service the same physician provides on the day of the TEE, and our modifier 25 rules page explains when the visit qualifies.
If payers keep sending your TEE claims back over modifiers, a focused medical billing audit of your last 90 days of echo claims can show whether the problem is the modifier, the report, or the split.
CPT 93312 Reimbursement: 2026 Medicare Rates and RVUs
CPT 93312 pays $239.48 at the 2026 national Medicare rate for the global service: 7.17 total RVUs times the $33.4009 conversion factor. The professional component, 93312-26, pays $105.21, and the technical component pays $134.27. Medicare then adjusts each amount for your locality.
| Line | Work RVU | Practice expense RVU | Malpractice RVU | Total RVU | 2026 rate at $33.4009 | 2026 rate at $33.5675 |
|---|---|---|---|---|---|---|
| 93312 (global) | 2.24 | 4.83 | 0.10 | 7.17 | $239.48 | $240.68 |
| 93312-26 | 2.24 | 0.84 | 0.07 | 3.15 | $105.21 | $105.74 |
| 93312-TC | 0.00 | 3.99 | 0.03 | 4.02 | $134.27 | $134.94 |
The math works the same way on each line. Total RVUs times the conversion factor equals the national payment, so 3.15 times $33.4009 gives the $105.21 physicians see for 93312-26 in a hospital. Figures come from the CMS Look-Up data dated July 1, 2026.
How to Pull Your Exact 93312-26 and 93312-TC Rates
National figures give you a benchmark for 93312 CPT code reimbursement, but your remittance follows your locality. Pull the local number for the CPT code for transesophageal echo in four steps:
- Open the CMS Physician Fee Schedule Look-Up and accept the AMA license.
- Choose 2026 and enter HCPCS code 93312.
- Select “All Modifiers” so the global, 26, and TC lines show together.
- Switch the MAC option from the national amount to your locality.
What Changed for 2026
CMS set two conversion factors for 2026: $33.4009 for most physicians, up 3.26%, and $33.5675 for qualifying alternative payment model (APM) participants, up 3.77%. Both started from $32.3465 in 2025. The CMS 2026 fee schedule fact sheet explains both updates.
CMS also applied a 2.5% efficiency reduction to work RVUs for services that aren’t timed. You can see it in the 93312 file: the work RVU fell from 2.30 in 2025 to 2.24 in 2026. A higher practice expense value and the new conversion factor more than offset the cut, so the global rate still rose.
| Line | 2025 national rate ($32.3465) | 2026 national rate ($33.4009) | Change |
|---|---|---|---|
| 93312 (global) | $225.46 | $239.48 | +$14.02 (6.2%) |
| 93312-26 | $100.92 | $105.21 | +$4.29 (4.3%) |
| 93312-TC | $124.53 | $134.27 | +$9.74 (7.8%) |
93312, 93314, and 93306 carry multiple procedure indicator 6. If the same physician or group bills two diagnostic cardiovascular studies for one patient on one day, such as an office TTE and a TEE, Medicare pays the highest technical component in full. Medicare cuts each additional technical component by 25%.
What a TEE Costs the Patient Under Medicare
Medicare Part B coinsurance is 20% after the deductible. On the $239.48 national global amount, that’s about $47.90. A TEE in a hospital outpatient department also carries a separate facility charge, and the patient owes coinsurance on that claim too.
Benchmarking Commercial Payer Rates
Divide each commercial payer’s allowed amount for 93312 by the 2026 Medicare figure for the same line. That percentage is the number to bring into contract talks. Pull the allowed amounts from your own 835 remittance files, since published averages don’t reflect your contracts or your region.
If you want someone checking every TEE payment against the 2026 fee schedule each month, that’s part of our end-to-end revenue cycle management work.
CPT Code for TEE With Cardioversion: Billing 92960 With 93312
Bill 92960 for the cardioversion and CPT 93312 for the TEE when the TEE checks for left atrial appendage thrombus right before an external cardioversion. They’re distinct procedures, and each needs its own documentation. In practice, the CPT code for transesophageal echocardiogram with cardioversion is two codes on two claim lines.
Is There One CPT Code for TEE Cardioversion?
No. The TEE and the cardioversion are separate services with separate codes. The cardiologist decides whether a TEE comes first. If the physician does one, the TEE indication should say why, such as atrial fibrillation of unknown duration or a gap in anticoagulation.
Documentation for a TEE and Cardioversion Session
Auditors look for two sets of findings. Each service needs its own:
- TEE report: whether left atrial appendage thrombus is present, plus spontaneous echo contrast and appendage velocities if measured.
- Cardioversion note: synchronized shock, energy used, number of attempts, and the resulting rhythm.
- Combined dictation: acceptable when each service has its own labeled section, though two notes make audits easier.
Do 92960 and 93312 Need a Modifier Together?
Don’t add 59 out of habit. Check the 92960 and 93312 pair in the October 1, 2026 NCCI practitioner procedure-to-procedure file, then check your commercial payers’ own edits. You’ll need a modifier only when an edit exists and its modifier indicator allows a bypass.
Repeat TEE Before a Repeat Cardioversion
The Wellpoint Federal TEE article A52868 caps TEE frequency but allows a repeat study before cardioversion for recurrent atrial fibrillation or flutter. Put the recurrence and the new cardioversion plan in the TEE indication. That line is what an auditor checks when a second TEE shows up within the year.
E/M on the Day of Cardioversion and the 92960 Global Period
92960 carries a 000 global period in the 2026 CMS file, with national rates of $154.65 non-facility and $94.86 facility. The assessment and decision to cardiovert on that day fall inside 92960. A significant, separately identifiable E/M for a different problem takes modifier 25 on the E/M line.
ICD-10 Codes for TEE Cardioversion Claims
Code the atrial fibrillation type the cardiologist documents. Payers don’t like unspecified codes when the note supports more detail. Common choices for this pairing:
- Paroxysmal atrial fibrillation: I48.0
- Longstanding persistent atrial fibrillation: I48.11
- Other persistent atrial fibrillation: I48.19
- Typical or atypical atrial flutter: I48.3 or I48.4
- Unspecified atrial fibrillation or flutter: I48.91 or I48.92, only when the note gives no type
Our guide to atrial fibrillation ICD-10 codes covers each I48 code, from paroxysmal to permanent, and the denials that follow common coding mistakes.
How Anesthesiologists Bill CPT 93312 for Intraoperative TEE
An anesthesiologist bills 93312 during surgery only when the TEE is diagnostic and has a formal written report. NCCI treats TEE used for monitoring as part of the anesthesia service. A diagnostic study can stand as its own service, and in a hospital the claim line reads 93312-26 with modifier 59 or XU.
TEE Anesthesia Billing: Diagnostic vs Monitoring Under NCCI
Section B.6 of NCCI Policy Manual, Chapter 2, revised January 1, 2026, lists 93312 to 93317 as part of anesthesia when the TEE serves monitoring. The same section lists 93318 and 93355 as part of anesthesia outright.
With documentation that includes a formal report, NCCI says the diagnostic TEE “may be considered a significant, separately identifiable, and separately reportable service.” Without that report, the anesthesiologist has no TEE line to bill.
The Claim Lines That Work
Each scenario below maps to one code string. Put the pricing modifier, 26, before 59 or XU.
- Anesthesiologist performs the full diagnostic TEE in a hospital: 93312-26-59, or 93312-26-XU
- Anesthesiologist places the probe and a cardiologist reads: 93313-59 and 93314-26
- Complete spectral Doppler on the anesthesiologist’s hospital study: 93320-26-59
- Color flow mapping on the anesthesiologist’s hospital study: 93325-26-59
Add-on lines follow the base code’s modifiers. If the base line carries 26 and 59, the Doppler lines need them too, or the payer denies the add-on line.
Why Payers Still Deny 93312-26-59
Check these five causes first when an intraoperative TEE claim comes back denied:
- The record reads like monitoring and has no separate formal report.
- Modifier 26 is missing even though the hospital owns the equipment.
- The anesthesia record is the only documentation of the TEE.
- The diagnosis doesn’t fit; J6/JK wants Z01.89 first for TEE during an open-chest procedure, then the reason for surgery.
- The plan treats all intraoperative TEE as monitoring and ignores NCCI’s diagnostic exception.
That last cause needs a policy check before any appeal. Some commercial and Medicaid plans write their own anesthesia bundling rules, and an NCCI citation won’t move them.
93355 in Structural Heart Cases
NCCI lists 93355 as part of anesthesia, so the anesthesiologist providing anesthesia for a TAVR or appendage closure can’t bill it. An imaging physician who isn’t performing the intervention bills it instead. The 2026 national rate is $192.06, down from $213.49 in 2025, a drop of about 10%.
Credentialing Before You Bill
ASA’s statement says only physicians trained and credentialed by their institution for perioperative TEE should perform it. Wellpoint Federal’s A52868 adds that documentation of personnel qualifications has to be available on request. Keep the credentialing file current before the first claim goes out, since auditors ask for it in postpayment reviews.
If intraoperative TEE denials keep landing in your queue, our denial management services team works them by payer policy instead of resubmitting the same claim.
Doppler, 3D, and Contrast Add-On Codes With CPT 93312
Bill Doppler add-ons with 93312 when the report documents them: +93320 for complete spectral Doppler, +93321 for a limited spectral study, and +93325 for color flow. None of them can go on a claim alone, and they never go with 93306, since the complete TTE code already includes both types of Doppler.
| Code | What it reports | The report must show | 2026 national global / 26 |
|---|---|---|---|
| +93320 | Complete pulsed or continuous wave spectral Doppler | Velocities and flow direction across the structures studied | $51.44 / $17.37 |
| +93321 | Limited or follow-up spectral Doppler | The focused velocities measured | $25.38 / $7.35 |
| +93325 | Color flow velocity mapping | A recorded flow velocity, such as peak systolic velocity | $23.71 / $3.34 |
| +93319 | 3D imaging and postprocessing during TEE | The reason for 3D and what it showed | $55.78 non-facility, $20.71 facility; no 26 |
| 76376 | 3D rendering without an independent workstation | 3D rendering, interpretation, and report | $25.38 / $9.35 |
| 76377 | 3D rendering on an independent workstation | Workstation postprocessing and report | $78.83 / $37.07 |
CPT Code 93325 and 93320 Documentation After March 2026
The 93325 CPT code description covers color flow velocity mapping, while the 93320 CPT code description covers complete spectral Doppler. In its March 2026 issue, the AMA’s CPT Assistant said 93325 needs a documented flow velocity measurement, such as peak systolic velocity, and a color image with nothing measured won’t support the line.
Bill a TEE with spectral Doppler but no color mapping as 93312 plus 93320. That leaves CPT code 93320 as the right add-on when the physician measured velocities but didn’t map color flow. Wellpoint Federal’s A52868 also wants the report to name each Doppler mode and give qualitative and quantitative findings.
Can You Bill 93320 and 93325 Together With 93312?
Yes, when the physician performs both and the report documents both. Each add-on carries the same ICD-10 code as the base TEE line, per A52868. Different diagnoses on the add-on lines invite a CO-11 denial.
CPT code 93321 fits a limited or follow-up spectral study. The 93321 CPT code description covers Doppler aimed at specific structures, not the full exam. Pick 93320 or 93321 for a given study, since the complete study includes the limited one.
3D Echo CPT Codes: 93319, 76376, and 76377
A52868 lists the base codes each 3D code can follow:
- 76376 and 76377: 93312, 93314, C8925, 93315, C8926, or 93317
- +93319: 93312, 93314, 93315, C8926, or 93317
Report one 3D code for one piece of 3D work, and read the CPT parenthetical notes before you pair any of them. Duke’s billing page lists reasons for 3D that belong in the report, including reduced ejection fraction, moderate or greater valve regurgitation, a cardiac mass, and imaging before or after chemotherapy or radiation.
Contrast During TEE
Section I.23 of NCCI Chapter 11 says you can’t bill the contrast injection codes alongside the echo. Hospitals report TEE with contrast as a C-code from C8921 to C8930, and that C-code includes the noncontrast study from the same encounter, so the matching CPT code can’t go on the same claim.
Bill the contrast agent on its own HCPCS line; the TEE article A56505 from Novitas Solutions lists Q9955 to Q9957. Contrast during stress echo is a separate story: +93352 applies only there, and our CPT 93350 stress echo guide covers it.
Hospital Outpatient and ASC Billing for CPT 93312: C8925 and 2026 Changes
In a hospital outpatient department, the physician bills 93312-26 on the CMS-1500 and the hospital bills its side on the UB-04: 93312 without contrast, or C8925 when the study uses contrast. Novitas Solutions, the MAC for jurisdictions JH and JL, applied the same C8925 rule to ASCs in its February 26, 2026 revision of article A56505.
Outside the office, you’ll see the TEE on two claims: the physician’s and the facility’s. Match the place of service to the table, and our guide to POS 22 billing rules covers outpatient departments on the hospital campus.
| Setting | POS | Physician claim | Facility claim |
|---|---|---|---|
| Office or independent practice | 11 | 93312 (global) | None |
| Outpatient hospital, on campus | 22 | 93312-26 | UB-04: 93312, or C8925 with contrast |
| Outpatient hospital, off campus | 19 | 93312-26 | UB-04: 93312, or C8925 with contrast |
| Inpatient | 21 | 93312-26 | The hospital’s payment sits inside the inpatient DRG |
| Ambulatory surgical center | 24 | 93312-26 | ASC claim; C8925 with contrast per A56505 |
C8925, C8926, and C8927 for TEE With Contrast
Under the Outpatient Prospective Payment System (OPPS), hospitals swap the CPT code for a C-code when the TEE uses contrast. C8925 replaces 93312, C8926 replaces 93315, and C8927 replaces 93318, per both A52868 and A56505. Without contrast, the hospital reports the regular CPT code on the UB-04 claim form.
Watch for one charge master trap. C8929 is the transthoracic contrast code and has nothing to do with TEE, so a C8929 on a TEE encounter points to a mapping error.
What Changed for ASCs in 2026
Revision R8 of the Novitas TEE article A56505, dated February 26, 2026, added ASC billing language. The American Society of Echocardiography (ASE) announced that CMS allowed certain echo services in ASCs starting January 1, 2026.
On the physician side, nothing changes: the cardiologist still bills 93312-26 under the physician fee schedule. Check the CY 2026 ASC Addendum BB for the facility payment indicator on 93312 and C8925 before you build the ASC charge.
One Claim per Date of Service Under OPPS
Wellpoint Federal’s A52868 tells hospitals to report every service from the same date of service on one claim. The MAC returns separate claims for the same date unless they’re duplicates or carry condition code 20 or 21. Echo, cardioversion, and sedation from one morning belong together.
Facility and professional claims run on different rules, and TEE sits where the two meet. Our hospital revenue cycle management team works both sides of that split.
CPT 93312 Medical Necessity, ICD-10 Codes, and Frequency Limits
Medicare has no national diagnosis list for 93312. Each MAC publishes covered ICD-10 codes, sequencing rules, and frequency limits in its TEE billing article, and commercial plans follow their own policies. Match the diagnosis to what the formal report documents, then check it against your MAC’s list before the claim goes out.
Find Your MAC’s TEE Billing Article
Wellpoint Federal’s A52868, effective April 1, 2026, sets the TEE rules for J6 and JK. For JH and JL, Novitas Solutions publishes A56505, which ties to LCD L35016. Coders in other jurisdictions can search the CMS Medicare Coverage Database for “transesophageal” and filter by their MAC.
MACs revise these articles without much notice, so check the version date each quarter. Our local coverage determination guide explains how LCDs and billing articles fit together.
TEE ICD-10 Sequencing Rules
Two sequencing rules in A52868 trip up coders, because the article’s code references don’t line up:
- After an inadequate TTE: list R93.1 or R93.89 first and the cardiac abnormality second. The article says “R93.8,” but that’s a category header, and payers reject it.
- TEE during an open-chest procedure: list Z01.89 first and the reason for surgery second. The article’s diagnosis paragraph shows Z01.30 and Z01.31, which describe blood pressure exams in ICD-10-CM, while its coding instructions point to Z01.89.
Covered Diagnosis Examples in J6/JK
These transesophageal echocardiogram ICD-10 examples come from A52868. It’s a starting point for common indications for TEE, and the article’s full list runs much longer.
| Condition group | Example codes |
|---|---|
| Atrial fibrillation and flutter | I48.0, I48.11, I48.19, I48.20, I48.21, I48.3, I48.4, I48.91, I48.92 |
| Endocarditis | I33.0, I38, M32.11 |
| Bacteremia and sepsis | R78.81, A41.9 |
| Stroke and TIA | I63.40, G45.9 |
| Valve disease and prosthetic valves | I34.0, I35.0, T82.03XA |
| Aorta | I71.010, I70.0 |
| Thrombus and septal defects | I51.3, Q21.12 |
| Cardiomyopathy, tamponade, and shock | I42.9, I31.4, R57.0 |
Heart failure codes (I50) don’t appear on the J6/JK list, so a claim with I50.9 as the primary diagnosis won’t pass there. For valve cases, our aortic stenosis ICD-10 codes guide covers I35.0 and the codes around it.
Frequency Limits for TEE
Wellpoint Federal’s A52868 sets these limits for J6 and JK:
- Standard limit: two TEEs a year
- Endocarditis: four TEEs a year
- Recurrent atrial fibrillation or flutter before cardioversion: a repeat study qualifies
- Beyond the limit: document a change in the patient’s status or a new condition
- Hospital inpatients: the limits don’t apply
Prior Authorization Before Scheduling a TEE
Medicare Advantage, Medicaid managed care, and commercial plans can require prior authorization for TEE, and some route it through an imaging benefit manager. Run the check at scheduling, because a plan can deny a TEE done without its approval. Our prior authorization services team handles that check for cardiology practices before the patient arrives.
Can You Bill Moderate Sedation With CPT 93312?
It depends on your MAC. The 2017 CPT code set removed moderate sedation from the procedures that used to include it, so physicians can report 99152 on its own in general. Wellpoint Federal’s A52868 still says 93312 to 93318 include conscious sedation, so that MAC bundles sedation into the TEE in J6 and JK.
How to Decide on a TEE Sedation Claim
Run these four checks in order before you add 99152 to a TEE claim:
- Read your MAC’s TEE article for sedation language.
- Check the 93312 and 99152 pair in the current NCCI practitioner procedure-to-procedure file.
- Confirm the CPT requirements: the physician performing the TEE gives the sedation, an independent trained observer is present, and intraservice time reaches at least 10 minutes.
- Hand off the sedation line when a separate anesthesia provider sedates the patient; that provider bills it, and the TEE physician doesn’t report 99152.
That fourth check covers any TEE with anesthesia from a separate provider. The anesthesia group bills anesthesia for TEE under its own codes, and the cardiologist bills only the echo. For 2026, 99152 pays $51.44 non-facility and $11.02 facility at national rates, so an office TEE has more riding on the sedation line than a hospital TEE.
Documentation Checklist for CPT 93312 Claims
Payers asking what documentation is required for CPT 93312 want to see a signed formal report with measurements, stored images, and an indication specific to the patient. They also look for the ordering physician’s name and NPI and a record of who placed the probe and who interpreted the study.
Build your TEE template around these seven items:
- The order and the patient’s indication, with the ordering physician’s name and NPI on the claim, per A52868
- A probe placement statement: who placed it, how the patient tolerated it, and who gave sedation
- The views acquired, with images stored and available on request
- Findings with the measurements each structure calls for
- Each Doppler mode used, with quantitative values for every add-on billed
- For intraoperative TEE, the surgeon’s diagnostic question and the phase of the case
- The impression, signature, and date, plus the reason for any repeat study
Transesophageal Echo Procedure Note vs Formal Report
Your transesophageal echo procedure note records sedation, probe passage, and how the patient tolerated the study. The formal report holds the interpretation: findings, measurements, and the impression. One document can hold both, as long as each part carries its own label.
Documentation Gaps Auditors Flag
Auditors keep finding the same four gaps in TEE records:
- Template reports with no findings specific to the patient
- A Doppler checkbox with no velocities behind it
- A missing ordering physician NPI
- A repeat study with no reason given
Pull a sample of recent TEE reports and you’ll see which gaps you have before a payer does. Our coding and documentation audit service checks each report against the codes billed on it.
CPT 93312 Denials and How to Fix Them
The 93312 denials we work come down to five causes: bundling with anesthesia or 93355, a wrong modifier for the setting, a diagnosis the MAC doesn’t cover, add-ons without documented measurements, and a TEE past the frequency limit. Each cause maps to a claim adjustment reason code (CARC) on the remittance.
The meanings below paraphrase the official X12 claim adjustment reason codes list. Read the remark codes on the same line, since they narrow down which rule the payer applied.
| CARC | Meaning, paraphrased | Typical 93312 trigger | Fix |
|---|---|---|---|
| CO-97 denial code | Another paid service already includes this one | Anesthesia TEE, 93312 with 93355, or 93312 with 93313 or 93314 | Show diagnostic intent and the formal report; add 59 or XU where the edit allows |
| CO-236 | NCCI says the code pair can’t go together that day | A procedure-to-procedure pair billed without a valid modifier | Check the pair’s modifier indicator in the current NCCI file |
| CO-4 | The modifier doesn’t fit the procedure | 26 missing, TC on a hospital claim, or 25 on 93312 | Match the modifier to the setting |
| CO-50 | The payer finds no medical necessity for the service | A diagnosis outside the MAC list, such as I50.9 in J6/JK | Recode from the report; see our guide to CO-50 medical necessity denials |
| CO-11 | The diagnosis doesn’t fit the procedure | An add-on with a different diagnosis from the base line | Give the add-on the base line’s diagnosis |
| CO-151 or CO-119 | Frequency or benefit maximum reached | A third TEE in a year in J6/JK | Document the status change; see CO-151 frequency denials |
Appeal Checklist for a Denied TEE
Work a denied TEE in this order, and stop resubmitting the same claim unchanged:
- Pull the formal report and the order.
- Recheck the code: who did each part, and whether a formal report exists.
- Confirm the modifiers match the place of service.
- Confirm the diagnosis appears on your MAC’s covered list.
- Cite the MAC article section in the appeal letter.
- File a Medicare redetermination within 120 days of receiving the initial determination.
Overturning a CO-97 on an anesthesia TEE takes the formal report and the surgeon’s diagnostic question. For a CO-50 caused by a coding error, ask for a reopening with the corrected diagnosis before you file an appeal. If these denials pile up faster than your team can work them, our claim denial management team can take the queue.
CPT 93312 FAQs
What Is the CPT Code for TEE?
The main CPT code for TEE is 93312, which covers a complete diagnostic study by one physician. If two physicians split the work, the one who placed the probe bills 93313, and the one who acquired and read the images bills 93314.
Monitoring TEE is 93318, and TEE guidance for a transcatheter structural heart procedure is 93355. Congenital studies use 93315 to 93317. Each TEE CPT code carries its own modifier and documentation rules, so match the code to who did each part.
What Is the 93314 CPT Code Description?
The 93314 CPT code description covers image acquisition, interpretation, and report for a TEE when a different physician placed the probe. It’s the second half of a split study, paired with 93313 for probe placement.
In a hospital or ASC, the reading physician bills 93314-26, which pays $88.51 at the 2026 national Medicare rate ($33.4009 conversion factor). The report needs the same detail as any full TEE report: views, measurements, findings, and an impression.
What Is the 93318 CPT Code Description?
The 93318 CPT code description covers TEE for monitoring, with probe placement, image acquisition, and interpretation used for ongoing assessment of cardiac function during surgery or critical care. Medicare’s 2026 national rate for 93318-26 is $101.87, and MACs price the technical side.
NCCI treats 93318 as part of the anesthesia service, and Wellpoint Federal’s A52868 says the anesthesiologist doesn’t bill it on top of anesthesia. A critical care physician who places the probe can report 93318 with modifier 59 or XU.
What Is the 93317 CPT Code Description?
The 93317 CPT code description covers image acquisition, interpretation, and report for a congenital TEE when another physician placed the probe. It’s the congenital version of 93314, and it pairs with 93316 for probe placement.
Medicare’s 2026 national rate for 93317-26 is $85.84, while MACs price the technical component. Use 93317 only when the study evaluates a congenital cardiac anomaly. Wellpoint Federal’s A52868 also bars 93317 during TAVR, mitral repair, and left atrial appendage closure.
What Is the Difference Between CPT 93312 and 93355?
93312 is a diagnostic TEE, while 93355 is TEE guidance during a transcatheter structural heart intervention, such as TAVR or left atrial appendage closure. CPT 93355 already includes the diagnostic TEE, Doppler, color flow, 3D, and contrast when performed, so you can’t add 93312 for the same session.
An imaging physician who isn’t performing the intervention bills 93355 once per intervention, with no modifier 26. The 2026 national Medicare rate for 93355 is $192.06, down from $213.49 in 2025.
What Is the Difference Between 93350 and 93312?
93350 covers a transthoracic echo at rest and during exercise or drug stress, while 93312 covers a transesophageal study with no stress component. The 93312 CPT code needs a probe in the esophagus and, in most cases, sedation, so its documentation centers on probe placement and the formal report.
Contrast rules differ as well: +93352 applies only to stress echo, and hospitals report TEE with contrast as C8925. A patient can have both studies for different clinical questions.
How Often Does Medicare Pay for a TEE?
Medicare pays for TEE (93312) as often as your MAC’s billing article allows, since no national limit exists. In jurisdictions J6 and JK, Wellpoint Federal’s A52868 covers two TEEs a year, or four a year for endocarditis.
A repeat study before cardioversion for recurrent atrial fibrillation or flutter also qualifies. Going past the limit takes documentation of a change in the patient’s status or a new condition, such as a new embolic event. The limits don’t apply to hospital inpatients, and commercial plans set their own rules.
What Does Medicare Pay for the 93312 CPT Code in 2026?
Medicare pays $239.48 for the 93312 CPT code in 2026 at the national rate for the global service, using the $33.4009 conversion factor. The professional component, 93312-26, pays $105.21, and the technical component pays $134.27.
Qualifying APM participants receive $240.68 for the global service at the $33.5675 conversion factor. Medicare adjusts each figure for your locality, so pull local rates from the CMS Physician Fee Schedule Look-Up. These amounts come from CMS data dated July 1, 2026.
Getting TEE Claims Paid the First Time
CPT 93312 comes down to two questions: who did each part of the study, and whether a formal report exists. From those answers, your coder settles the code, the modifiers, and any bundling with anesthesia or structural heart work. Your MAC’s billing article then sets the covered diagnoses and frequency limits.
If you’d rather have cardiology billing specialists handle TEE, echo, and cardioversion claims from order to payment, that’s the work we do.
