Reimbursement Information
General guidance on coding and reimbursement pathways for echocardiography procedures and AI-enabled coded indications, including relevant CPT/HCPCS codes and payment methodologies by care setting.
Reimbursement Landscape
Echocardiography procedures and specific AI-enabled coded indications may be eligible for reimbursement through established Medicare payment pathways across multiple care settings.
Established CPT Codes
Relevant Category I CPT codes, Category III CPT codes, and HCPCS codes cover echocardiography procedures and specific AI-enabled coded indications such as HFpEF detection.
Medicare Coverage
CMS has established payment mechanisms for specific AI-enabled echocardiography indications with assigned codes, across outpatient and inpatient methodologies.
Multiple Settings
Reimbursement pathways are available across hospital outpatient, hospital inpatient, and physician office settings.
Relevant Coding
CPT and HCPCS codes relevant to echocardiography procedures and specific AI-enabled coded indications.
Transthoracic Echocardiography (Complete)
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography.
The primary billing code for a complete TTE. When billed with Modifier 26, it represents the professional component (physician interpretation and report), which is the workflow most directly augmented by AI-assisted analysis software.
Stress Echocardiography
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report.
Covers transthoracic echocardiographic imaging during stress testing. Typically billed alongside stress test codes (93015–93018), with component billing varying depending on site of service (hospital outpatient vs. physician office). AI-assisted analysis may enhance interpretation efficiency and diagnostic accuracy during stress echo procedures.
TTE with Contrast (Hospital Outpatient)
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography.
An HCPCS Level II code used exclusively for hospital outpatient facility billing under OPPS when contrast is performed. This code replaces the CPT technical component for contrast echocardiography in this setting; physicians still bill CPT codes (e.g., 93306-26) for the professional component separately.
AI-Assisted Heart Failure Detection
Noninvasive detection of heart failure derived from augmentative analysis of an echocardiogram that demonstrated preserved ejection fraction, with interpretation and report by a physician or other qualified health care professional.
This Category III code is specific to AI-derived detection of heart failure with preserved ejection fraction (HFpEF) from echocardiographic data. It replaced prior HCPCS code C9786 and has an assigned outpatient APC as well as an inpatient New Technology Add-on Payment (NTAP) pathway. Category III codes are temporary tracking codes used to collect data on emerging technologies.
Myocardial Strain Imaging
Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to primary procedure).
This add-on code is reported in conjunction with a primary echocardiography procedure. It covers the additional analysis involved in speckle tracking-based strain assessment.
CPT codes are maintained by the American Medical Association. HCPCS Level II codes are maintained by CMS. The applicability of specific codes should be verified with your billing and compliance team. Coding practices may vary by institution and payer.
Reimbursement by Care Setting
Payment mechanisms and methodologies differ depending on where the service is performed.
Hospital Outpatient
Under the Outpatient Prospective Payment System (OPPS), echocardiography and AI-enabled coded services are assigned to an Ambulatory Payment Classification (APC) for qualifying indications.
Payment rates under OPPS are adjusted based on geographic wage indices. Actual payment may vary by facility location.
Hospital Inpatient
Inpatient services are generally paid under the IPPS Diagnosis-Related Group (DRG) methodology. Certain qualifying AI-based technologies may receive additional New Technology Add-on Payments (NTAP).
Diagnostic services are generally bundled within the DRG payment for the overall admission. However, specific FDA-cleared AI technologies with assigned codes may qualify for additional payment through the New Technology Add-on Payment (NTAP) pathway.
Physician Office
In the physician office setting, professional interpretation services may be reported under applicable CPT codes. Payment for certain Category III codes may be carrier-priced.
Carrier-priced codes do not have a nationally established payment rate. Reimbursement is determined by individual Medicare Administrative Contractors (MACs) and may vary significantly by region.
Commercial Payer Coverage
Coverage and reimbursement from commercial health plans continues to evolve as AI-assisted cardiac imaging becomes more widely adopted.
Evolving Landscape
Commercial payer policies for AI-assisted echocardiography are actively developing. Coverage determinations may vary by health plan and region.
Provider Engagement
Healthcare organizations are encouraged to work directly with their payer representatives to understand coverage policies and prior authorization requirements for emerging technologies.
Clinical Evidence
Clinical validation and published evidence may support coverage discussions with commercial health plans. Peer-reviewed data can be a valuable resource in these conversations.
Frequently Asked Questions
Common questions about coding and reimbursement for echocardiography and AI-enabled coded indications.
Important Information
The information provided on this page is intended for general informational purposes only and is not a guarantee of coverage or reimbursement. Reimbursement policies, coding requirements, and payment rates are subject to change and may vary by payer, geography, and care setting. This information does not constitute legal, financial, or billing advice. Healthcare providers should consult with qualified billing and compliance professionals, as well as the applicable payer, to determine coverage and reimbursement for specific services. CPT is a registered trademark of the American Medical Association.
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