Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study

CPT 93304 is the billing code for "Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study". For limited or follow-up transthoracic echocardiography for specific evaluation

Medicare pays approximately $146.85 for CPT 93304 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.

CPT 93304 has a total RVU of 4.85, broken down as: Work RVU 1.50, Practice Expense RVU 3.20, and Malpractice RVU 0.15. RVUs (Relative Value Units) determine Medicare reimbursement rates.

Key documentation requirements for CPT 93304 include: Indication for limited or follow-up study; Specific structures evaluated; Comparison to previous studies; Findings of limited evaluation. Missing or incomplete documentation is a leading cause of claim denials for this code.

Bundling considerations for CPT 93304: Includes limited echocardiography. Follow-up studies coded separately Use an NCCI bundling checker to verify specific code combinations before billing.

Common modifiers for CPT 93304 include: 26 (Professional component only (interpretation)), TC (Technical component only (equipment/staff)), 59 (Distinct procedural service if performed separately). Modifiers indicate special circumstances and can affect reimbursement or prevent claim denials.

The typical time requirement for CPT 93304 is 15-25 minutes typical procedure time. Time-based codes require documentation of the actual time spent providing the service.