Do you bill for echocardiograms every day? Are you unsure about CPT 93306? This code is one of the most common. About 15 million echos are performed annually in the US. Medicare pays approximately $200-400 for this code. Proper coding prevents claim denials worth thousands.
CPT 93306 is for a complete transthoracic echocardiogram. This includes 2D imaging with spectral and color Doppler. The code covers both professional and technical components. Over 60% of cardiology practices use this code daily. Insurance companies audit echo claims more than others. Wrong documentation causes 40% of echo claim denials.
This guide explains CPT 93306 in simple terms. We show you proper coding and billing rules. You will learn the documentation requirements needed, too. Facts and data help you bill correctly. Tables make information easy to understand. Follow these guidelines to get paid faster.
CPT 93306 Code Description
CPT 93306 is for a complete heart echo study. This code includes full heart imaging and analysis. Both 2D and Doppler studies are included in this.
What CPT 93306 Includes
| Component | What It Covers | Documentation Needed |
| 2D Imaging | Complete heart structure views | All chambers documented |
| M-Mode | Motion display of structures | Measurements recorded |
| Spectral Doppler | Blood flow velocities | Peak velocities noted |
| Color Flow Doppler | Blood flow visualization | Flow patterns described |
Code Comparison Table
| CPT Code | Study Type | Doppler Included | When to Use |
| 93303 | Limited | No spectral | Quick follow-up |
| 93304 | Complete | Spectral only | No color needed |
| 93306 | Complete | Spectral + Color | Full diagnostic |
| 93307 | Complete | With congenital | Birth defects |
| 93308 | Follow-up | Limited | Progress check |
Billing Requirements for 93306
Proper billing ensures you get paid right. Doc must support the code billed always. Missing elements cause automatic claim denials.
Documentation Requirements
| Required Element | Specific Details | Common Errors |
| Patient Info | Name, DOB, MRN | Missing medical record number |
| Medical Need | Reason for study | Vague or missing reasons |
| Performing Doc | Who did the study | Unsigned or undated reports |
| Measurements | Specific heart values | Incomplete measurement set |
| Interpretation | Findings and conclusions | Missing pro part |
| Image Quality | Tech quality check | Poor images are not explained |
Medical Necessity
Every echo needs a clear medical need justification documented. Common reasons include chest pain and shortness of breath. Abnormal EKG findings often justify an echo performance. Follow-up of known heart conditions needs a doc. Without a proper medical need, claims get denied.
Payment Rates for 93306
Medicare and insurance companies pay different rates. Location affects payment amounts received. Understanding rates helps with money planning.
Medicare Payment by Location
| Location Type | Pro Part | Tech Part | Total Payment |
| Facility | $50-80 | $150-250 | $200-330 |
| Office | $60-100 | $180-300 | $240-400 |
| Rural Areas | $55-90 | $160-280 | $215-370 |
| Urban Areas | $65-110 | $190-320 | $255-430 |
Commercial Insurance Rates
| Insurance Type | Payment Range | Auth Needed | Processing Time |
| Blue Cross | 120-180% Medicare | Often | 2-4 weeks |
| United Health | 130-200% Medicare | Usually | 3-5 weeks |
| Aetna | 110-170% Medicare | Sometimes | 2-3 weeks |
| Cigna | 125-190% Medicare | Often | 2-4 weeks |
| Medicare Advantage | 100-120% Medicare | Always | 3-6 weeks |
Private insurance pays 120-200% of Medicare rates. Some plans pay as low as 80%. Contract rates vary by individual insurance company. Prior authorization may be needed for payment. Verify benefits before doing the study, always.
Modifiers for CPT 93306
Modifiers provide extra info about the service. Using the right modifiers ensures proper payment amounts. Wrong modifiers cause claim denials always.
| Modifier | Purpose | When to Use | Payment Impact |
| 26 | Pro part only | Doc interpretation only | Reduce 30-40% |
| TC | Tech part only | Equipment only | Reduce 60-70% |
| 76 | Repeat the same doc | Medical need repeat | Full if justified |
| 77 | Repeat different doc | New doc repeat | Full if justified |
| 59 | Separate service | Distinct procedure | Full for both |
Prior Authorization Requirements
Many insurance plans need prior auth for echos. Getting authorization prevents claim denials and payment delays.
| Insurance Plan | Auth Needed | Turnaround Time | Valid Period |
| Medicare Original | No | N/A | N/A |
| Medicare Advantage | Yes | 3-5 days | 30-60 days |
| Commercial PPO | Usually | 2-7 days | 60-90 days |
| Commercial HMO | Always | 1-3 days | 30 days |
| Medicaid | Varies | 5-10 days | 30-90 days |
Conclusion
CPT 93306 is for a complete heart echo study. A proper doc ensures you get paid right. Medical needs must be clearly stated. Payment rates vary by location and insurance. Avoid common coding and doc errors. Use the right modifiers for part billing. Prior authorization prevents claim denials completely. Follow quality standards for accurate results.
FAQs
What does CPT 93306 include?
Complete heart echo with 2D and color Doppler. This includes all heart chambers and valves. Both spectral and color flow Doppler are part of this code. All measurements and interpretations are included, too.
How much does Medicare pay for 93306?
Medicare pays about $200-40,0 depending on location. Facility rates are lower than office rates. The pro part is about $50-100, and the tech part is $150-300.
Do I need prior auth for 93306?
Many insurance plans need prior authorization before service. Medicare Advantage always needs authorization first. Most commercial plans need authorization, too.
What modifier is used for interpretation only?
Modifier 26 indicates pro part interpretation only. This is used when the doc only reads the study. Payment is reduced by 30-40% with this modifier. Tech part billed separately with TC modifier.
How often can 93306 be billed?
Frequency depends on medical need and insurance policy. Most plans allow one per year for routine. More frequent if the medical condition changes or worsens. Doc must support the need for repeat studies.
