CPT code 93312 – 93318 – Transesophageal Echocardiography (TEE)

procedure code and description

93312- Echo transesophageal – average fee payment- $300 – $ 320

CPT code 93312 – Echocardiography, transesophageal, real time with image documentation (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report describes the entire TEE service when it is performed by a single physician with or without the assistance of a sonographer for image acquisition.

Coverage Indications, Limitations, and/or Medical Necessity


• CPT codes 93312 and 93314 require image documentation and a written interpretation to satisfy the requirements of billing the service. These codes can be used to describe intraoperative and non-intraoperative TEE procedures.

• CPT code 93318 – Echocardiography, transesophageal (TEE) for monitoring purposes is used to describe intraoperative TEE that is performed to monitor the patient’s cardiovascular function during surgery or another intervention.

    Transesophageal Echocardiography (TEE) is a cardiac diagnostic procedure in which a modified endoscope, with an ultrasound transducer, is passed into the esophagus and/or stomach in order to obtain 2-D/3D echo images and spectral and color doppler information about the heart and its great vessels.

    Transesophageal Echocardiography (TEE) imaging is a viable alternative when transthoracic imaging is problematic or difficult. In many instances, abnormalities can be displayed that are missed with standard diagnostic techniques, and the images displayed are often of superior quality because of the high-resolution probes that can be used.

    Transesophageal echocardiogram will be considered medically necessary in any of the following circumstances (see Covered ICD-10 Codes):

    • Examination of prosthetic heart valves, primarily mitral

    • Arrhythmias – assessment of patients with certain cardiac arrhythmias [atrial fibrillation, atrial flutter] for which the results of the test will influence treatment decisions. TEE may complement transthoracic echocardiography particularly to assess for left atrial thrombus.

    • Detection of:

    – aortic dissection

    – atrial septal defect

    – congenital heart disease

    – embolism or thrombosis, primarily involving left atrium

    – intracardiac foreign bodies, tumors or masses

    – mitral valve regurgitation

    – vegetative endocarditis

    • Intra-operative guide to left ventricular function

    • Inadequacy of transthoracic echo due to:

    – chest wall deformity, COPD

    – open heart or chest surgery

    – chest trauma

    – obesity

• Safe and effective.
• Not experimental or investigational (exception: routine costs of qualifying clinical trial services with dates of service on or after September 19, 2000, which meet the requirements of the clinical trials NCD are considered reasonable and necessary).
• Appropriate, including the duration and frequency that is considered appropriate for the service, in terms of whether it is:
  • Furnished in accordance with accepted standards of medical practice for the diagnosis or treatment of the patient’s condition or to improve the function of a malformed body member.
  • Furnished in a setting appropriate to the patient’s medical needs and condition.
  • Ordered and furnished by qualified personnel.
  • One that meets, but does not exceed, the patient’s medical need.
  • At least as beneficial as an existing and available medically appropriate alternative.

• Documentation supporting the medical necessity should be legible, maintained in the patient’s medical record and made available to Medicare upon request.
• At a minimum, a complete study should include (2-D with or without M-mode) measurements of left ventricular end diastolic diameter, left ventricular end systolic diameter, left ventricular wall thickness, left atrial diameter, aortic valve excursion, qualitative description of left ventricular function and, as applies, a description of any technical limitations for particular cases. Valid substitutes for the previous parameters may be recorded, such as LV volumes, ejection fraction and LV mass measurements.
• The rationale for performing the study(s) must be clearly documented in or understood from the medical record.
• Medical records, including the permanent image, need not be submitted with the claim. However, these records must be furnished to Medicare upon request.
• The ordering physician must furnish to the performing provider the appropriate diagnostic material needed for billing the TEE.