Transthoracic echocardiography (TTE) is one of the most important non-invasive tools in cardiology. It provides real-time visualization of cardiac structure and motion, allowing clinicians to diagnose heart failure, valvular disease, cardiomyopathies, congenital anomalies, and many other cardiovascular conditions.
CPT 93307 describes a complete TTE performed without Doppler or color flow mapping. While this code is less commonly billed than 93306, it remains essential in situations where Doppler is not medically indicated or not performed due to study limitations.
This comprehensive guide covers what CPT 93307 includes, when to use it, common payer policies, documentation requirements, prior authorization rules, and how to avoid denials. Improve accuracy and reduce payer denials with our expert CPT 93018 Stress Test Interpretation Billing Guide
covering documentation, medical necessity, and interpretation rules.
What Is CPT 93307?
Official CPT definition:
“Echocardiography, transthoracic, real-time with image documentation (2D), with or without M-mode recording; complete, without spectral or color Doppler echocardiography.”
In practical terms:
CPT 93307 = Complete TTE (2D + M-mode), but no Doppler and no color flow mapping.
It is used when the study is complete structurally, but does not include:
- Spectral Doppler
- Color flow Doppler
If Doppler is performed, you must bill 93306 instead.
What CPT 93307 Includes
To use CPT 93307, the exam must be anatomic and complete, meaning multiple cardiac structures are evaluated. Strengthen compliance for TTE procedures using our detailed CPT 93306 Transthoracic Echocardiogram Billing Guide featuring documentation tips, supervision rules, and NCCI guidance.
93307 includes:
- 2D imaging
- M-mode (if performed)
- Full structural evaluation
Typical structures examined:
- Left ventricle
- Right ventricle
- Atria (LA/RA)
- Mitral valve
- Aortic valve
- Tricuspid valve
- Pulmonic valve
- Aortic root
- Pericardium
- IVC/SVC
- Wall motion
- Overall cardiac morphology
What 93307 does NOT include:
- Doppler measurements (inflow/outflow patterns)
- Regurgitation or stenosis gradients
- RVSP estimation
- Regurgitant jets
- Shunt assessments
If Doppler is used—even briefly—the correct code is 93306.
When to Use CPT 93307
Use CPT 93307 when:
✔ A complete structural echocardiogram is performed
Meaningful anatomic evaluation is documented.
✔ Doppler is not performed
Either because it wasn’t required or wasn’t feasible.
✔ Doppler is clinically unnecessary
Examples:
- Follow-up to check chamber size only
- Pre-op structural evaluation without valvular symptoms
- Surveillance of cardiomyopathies
- Ejection fraction assessment without valvular concern
✔ Doppler could not be obtained due to poor windows
Examples:
- Severe obesity
- COPD
- Post-surgical patients
- Body habitus limitations
Document the reason if Doppler could not be obtained.
✔ There is no clinical need for valvular hemodynamic measurements
If there’s no suspicion of valvular abnormalities, providers may choose 93307. Avoid common ECG billing errors by reviewing our comprehensive CPT 93000 12-Lead ECG Billing Guide built to support cardiology practices seeking cleaner claims.
When NOT to Use CPT 93307
Avoid billing 93307 if:
❌ Doppler OR color flow mapping was performed
Even minimal Doppler use → 93306.
❌ The exam is limited
Instead, use 93308.
❌ Evaluation of valvular abnormalities is needed
Doppler is required for assessing:
- Stenosis
- Regurgitation
- Gradients
- RVSP
Use 93306 in these cases.
❌ A pre-existing valvular disease is being followed
Doppler is always required here.
Clinical Indications for CPT 93307
Appropriate ICD-10 diagnoses include:
- I42.0 – Dilated cardiomyopathy
- I42.1 – Hypertrophic cardiomyopathy
- I50.9 – Heart failure
- R06.02 – Shortness of breath
- I10 – Hypertension
- I48.91 – Atrial fibrillation
- I25.10 – Coronary artery disease
- Q24.9 – Congenital heart anomaly
- R94.31 – Abnormal ECG
- R01.1 – Heart murmur (only if NOT evaluating valve gradients)
If valve pathology is suspected → must use 93306. Improve accuracy for 24-hour cardiac monitoring with our CPT 93224 Holter Monitor Billing Guide including documentation, hooks, interpretation rules, and NCCI edits.
Documentation Requirements for CPT 93307
To ensure clean claims, the documentation must include:
✔ 1. Medical necessity
Why was the echo ordered?
Examples:
- Heart failure assessment
- Structural evaluation
- Cardiomyopathy follow-up
- Abnormal chest X-ray
- Post-MI follow-up
✔ 2. Indications for not using Doppler
Examples:
- “Doppler not clinically indicated.”
- “Doppler images limited by poor acoustic windows.”
✔ 3. Complete structural examination
Document evaluation of:
- LV/RV
- Atria
- All four valves
- Pericardium
- Aortic root / ascending aorta
✔ 4. Findings and measurements
Such as:
- LV wall motion
- EF estimate
- Structural abnormalities
- Chamber sizes
✔ 5. Final interpretation
A diagnostic conclusion must be included.
✔ 6. Signed report
Unsigned = automatic denial.
Prior Authorization Requirements for CPT 93307
The requirements usually mirror those for CPT 93306.
Medicare
- No prior authorization
- The study must be medically necessary
Medicaid
Varies by state; some require PA for initial imaging or repeat studies.
Commercial Insurance
Most commercial payers do NOT require PA for a routine TTE if medically necessary.
PA may be required if:
- Patient is in an HMO
- The echo is repeated too soon
- The plan has cardiac imaging restrictions
Patients most likely to require PA:
- HealthNet
- Ambetter
- Kaiser
- UHC (certain plans)
- Aetna (depends on policy)
Common Denials for CPT 93307
❌ 1. Doppler was performed but not documented
If Doppler was used, even once → must bill 93306.
❌ 2. Documentation does not support a “complete” study
Missing structures = denial.
❌ 3. Limited evaluation billed incorrectly
If it is a limited study, use 93308, not 93307.
❌ 4. Medical necessity insufficient
Echo should not be coded for vague or routine reasons.
❌ 5. Missing saved images
Medicare requires image archiving.
❌ 6. ICD-10 not supported
Use cardiac-related diagnoses when applicable.
❌ 7. Missing final report
The interpretation must be included.
Correct Billing Scenarios
Scenario 1 — Cardiomyopathy Evaluation
Evaluation of LV and RV structure without Doppler needs.
→ Code: 93307
Scenario 2 — Post-MI Follow-Up (Structural Only)
Checking LV function & wall motion.
→ Code: 93307
Scenario 3 — Pre-Operative Echo
Surgeon wants to rule out structural abnormalities; Doppler not required.
→ Code: 93307
Scenario 4 — Poor Acoustic Windows
Doppler is not feasible due to body habitus.
→ Code: 93307
Document the reason.
Final Thoughts
CPT 93307 remains an important billing code for transthoracic echocardiography, especially when Doppler assessment is not clinically required or not possible. Proper code selection, complete structural documentation, and accurate reporting are key to avoiding denials and ensuring compliance. Strengthen remote monitoring workflows using our CPT 93228 Mobile Cardiac Telemetry Billing Guide covering setup, technician involvement, interpretation, and billing requirements.
If your cardiology or internal medicine practice wants help improving echo billing accuracy, choosing the correct echo CPT codes, or reducing denials, Global Tech Billing LLC provides specialized cardiology billing support.
Frequently Asked Questions (FAQ)
1. What is the difference between 93306 and 93307?
- 93306: Complete TTE with Doppler + color
- 93307: Complete TTE without Doppler
2. When should I use 93308 instead?
When the study is limited, it is not complete.
3. Can I bill 93307 if Doppler was attempted but failed?
Yes — document the reason Doppler was unattainable.
4. Does 93307 need prior authorization?
Most commercial plans: No
Some HMOs: Yes
Medicare: No
5. Does 93307 require stored images?
Yes — archiving is mandatory.
6. Can 93307 be billed with an E/M visit?
Yes — if the visit is separately identifiable (use modifier 25).
7. Can you bill 93307 twice on the same day?
No — unless medically justified (extremely rare).
