Medicare Coverage of Transthoracic Echocardiography

Published 02/09/2021

Transthoracic Echocardiography (TTE) is a noninvasive study that allows for rapid visualization of the heart for assessment of cardiac anatomy and function.

Echocardiography, also referred to as real-time imaging, is performed using ultrasound transducers to record images in video format. The recorded video provides more complete information for the provider on the cardiac structure and function. Seeing the heart in motion can aid the provider in establishing a diagnosis and creating the plan of treatment.

Table 1: Description for CPT Codes for Transthoracic Echocardiography (TTE)

CPT Code
Complete transthoracic echocardiography with spectral and color flow Doppler
Transthoracic stress echocardiography, without continuous electrocardiographic monitoring
Transthoracic stress echocardiography, with continuous electrocardiographic monitoring

CPT® is a registered trademark of the American Medical Association (AMA). All rights reserved.

CPT code 93306 is reported for a complete evaluation that includes spectral and color flow doppler, which provides information regarding intra-cardiac blood flow and hemodynamics.

Palmetto GBA RRB SMAC has identified CPT 93306 as an area of vulnerability. This code is considered a major risk for overpayments with potential dollars at risk for this service at $5,868,498. The Comprehensive Error Rate Testing Contractor (CERT) listed this code in the Top 30 service types with highest improper payments at 100 percent errors for insufficient documentation.

According to the definition in the IOM Chapter 15, Section 80.6 definition, a “diagnostic test includes all diagnostic X-ray tests, all diagnostic laboratory tests, and other diagnostic tests furnished to a beneficiary. Such tests must be ordered by a practitioner who is consulting or treating the patient for a specific medical problem and who uses the results of a diagnostic test in the management of the beneficiary’s specific medical problem.”

Medicare covers a limited amount of screening tests, such as bone mass measurements, colorectal cancer, and diabetes screenings. Screening consists of testing performed on patients who do not present with signs or symptoms but may have risk factors (such as having predisposition to certain diseases or a positive family history of serious illness.) Screening services for high-risk patients may be considered good medical practice, but not all such services are covered by Medicare. Currently, Medicare does not consider TTE as a screening tool. 

According to the CMS- eGlobal Tech CBR201505: Transthoracic Echocardiography comparative billing report, “Typically, the guidelines dictate that the frequency of a study is guided by the patient’s status for repeat or follow-up studies. Studies are appropriate when used to monitor changes in cardiac structure or function, when the patient presents with clinical changes in status, or when disease progression is suspected for some other reason. Most LCDs state that it is not medically necessary to repeat examinations once the patient’s condition has reached a stable state. Routine examinations of asymptomatic patients with no change in clinical status are not medically necessary and are not reimbursable by Medicare.”

The visual information showing actual heart structure and measurement information provided by the TTE is both unique and valuable as diagnostic testing. The fact that the test is relatively easily performed in an office environment, yields fast results, and is noninvasive for the patient has contributed to an increase in usage. These combine to make the TTE a valuable diagnostic tool. These attributes also make it a service at risk for potential overutilization.

Providers can find more information in the resources of the national CMS and the local Medicare Administrative Contractor (MAC) guidelines.


CMS Resources at

Railroad SMAC Resources at

Cardiology page

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