A transthoracic echocardiogram (TTE) is a critical tool for evaluating cardiac function, structure, and hemodynamics. While complete echo codes such as 93306 and 93307 are widely understood, CPT 93308—the limited or follow-up echocardiogram—is frequently misunderstood and commonly denied due to documentation issues.
Billing 93308 correctly requires a clear understanding of what qualifies as limited, which structures must be documented, how payers define medical necessity, and when Doppler add-on codes may be used. Ensure clean claims for non-Doppler echo studies using our CPT 93307 Transthoracic Echocardiogram Billing Guide fully updated for 2024–2025.
This guide provides a comprehensive breakdown of CPT 93308 for cardiologists, internal medicine providers, hospital systems, and billing teams.
What Is CPT Code 93308?
CPT 93308 is officially defined as:
“Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed; follow-up or limited study.”
In simple terms:
93308 = Limited transthoracic echo (TTE) OR follow-up echo, without complete evaluation.
This means:
- Fewer structures are evaluated
- The exam is focused on one or a few specific clinical questions
- It does not represent a full comprehensive echo
Examples of limited or follow-up studies include:
- Assessing pericardial effusion
- Evaluating LV function after treatment
- Checking valve status after a suspected change
- Follow-up of pulmonary pressures
- Re-evaluation after heart failure therapy
93306 vs 93307 vs 93308 (Key Differences)
Understanding the difference between complete and limited exams is essential:
| CPT Code | Description | Includes Doppler? | Scope |
| 93306 | Complete echo with spectral & color Doppler | Yes | Comprehensive |
| 93307 | Complete echo without Doppler | No | Comprehensive |
| 93308 | Limited or follow-up echo | Only if add-on Doppler codes used | Not comprehensive |
A quick rule:
- If the exam does not evaluate all major cardiac structures → 93308
- If Doppler is performed → add 93321 (Doppler limited) or 93325 (color Doppler). Strengthen documentation and avoid denials with our expert CPT 93306 Complete Echocardiogram Billing Guide written specifically for cardiology practices.
This is what many billing teams miss:
93308 by itself NEVER includes Doppler.
You must add-on codes if Doppler is used.
When Should CPT 93308 Be Used?
Use 93308 when:
1. The exam is focused or limited
Common examples:
✔ Assess pericardial effusion
✔ Evaluate LV systolic function
✔ Follow-up of known cardiomyopathy
✔ Reassess RV strain
✔ Recheck valve regurgitation progression
✔ Evaluate structural abnormalities seen on a prior study
✔ Post-procedure follow-up
2. The medical record clearly states this is a follow-up or limited exam
Payers require documentation of:
- What specific structure(s) are evaluated
- The reason the exam is limited
- Why a full echo is not necessary
3. Doppler is NOT performed unless add-on codes are added
If Doppler is used without billing 93321 or 93325, payers frequently deny or downcode the study.
Examples of Limited Echo Scenarios
Appropriate use cases:
- Re-checking LVEF after CHF management
- Checking for new or worsening pericardial effusion
- Assessing valvular regurgitation progression
- Evaluating segmental wall motion abnormalities after MI
- Follow-up of pulmonary hypertension measurement
- Assessing IVC collapse to guide volume status
- Avoid stress-test denials and understand payer variations with our CPT 93015 Cardiac Stress Test Billing Guide covering supervision, NCCI edits, and interpretation rules.
Not appropriate:
- Attempting to bill a limited echo for what is actually a full exam
- Screening
- Administrative evaluations
- “Routine follow-up” without symptoms
Documentation Requirements for CPT 93308
Your documentation must clearly support that the exam is limited in scope AND medically necessary. Get complete clarity on supervision and split-billing requirements from our CPT 93016 Stress Test Supervision Billing Guide optimized for cardiology practices.
1. Indication / Reason for the exam
Examples:
- “Follow-up evaluation of moderate pericardial effusion”
- “Limited echo to reassess LV systolic function post-therapy”
- “Limited study to evaluate RV enlargement in suspected pulmonary hypertension”
2. Structures evaluated
List the exact structures assessed:
- Pericardium
- LV function
- Right heart
- Valves involved
- Great vessels (as indicated)
- IVC evaluation
3. Statement identifying this is a LIMITED study
Include this explicitly:
“This is a limited/follow-up transthoracic echocardiogram focused on…”
4. If Doppler is used, document the specific Doppler elements
Spectral Doppler examples:
- Mitral inflow
- TR jet velocity
- Aortic outflow
Color Doppler examples:
- MR jet
- AI flow
- TR regurgitation
And bill:
- 93321 (spectral Doppler add-on)
- 93325 (color Doppler add-on)
5. Final interpretation & physician signature
Medicare requires a:
- Detailed impression
- Comparison to prior echo
- Signed report
Payer Rules for CPT 93308
Medicare
Medicare covers 93308 only when:
- Documentation supports a limited study
- Medical necessity is clear
- Only a limited structure evaluation is performed
Common Medicare denials include:
- “Downcoded to 93306/93307” when documentation appears complete
- “Insufficient medical necessity”
- “Limited echo not justified; full study required.”
- Doppler used, but no add-on Doppler codes billed
Medicaid
Medicaid frequently denies 93308 for:
- No documented clinical change
- Insufficient reason for a limited study
- Repeating a follow-up too soon
Commercial Payers
Private payers often:
- Require prior echo comparison
- Deny if “complete” terminology appears in the report
- Deny Doppler elements without add-on codes
Modifier Rules for CPT 93308
As with other echo codes:
- 93308-26 → professional component only (interpretation)
- 93308-TC → technical component only
- 93308 → global billing (when practice performs + interprets the echo)
Use modifier 59 when billing:
- 93321
- 93325
…to avoid bundling denials.
Common Denials for CPT 93308 (and How to Prevent Them)
❌ 1. Documentation appears “complete” instead of “limited.”
Avoid language like:
- “Comprehensive evaluation”
- “Complete assessment”
❌ 2. Doppler was performed but not billed
Bill add-on codes or remove Doppler documentation.
Ensure clean claims for non-Doppler echo studies using our CPT 93307 Transthoracic Echocardiogram Billing Guide fully updated for 2024–2025.
❌ 3. No clear reason for the limited study
Must document:
- Why limited
- What is being rechecked
❌ 4. Missing physician interpretation
Payers require a formal, signed report.
❌ 5. Too frequent repeat studies
Justify the timing with:
- New symptoms
- Clinical changes
- Guideline-supported follow-up
Correct Billing Scenarios
Correct Example
Limited echo evaluating pericardial effusion only.
→ 93308
Correct Example With Doppler
Limited echo evaluating MR regurgitation severity.
→ 93308 + 93325 (color Doppler)
→ Possibly 93321 if spectral Doppler is used
Incorrect Example
Full echo performed but coded as 93308 to save time.
→ Should be 93306 or 93307
Incorrect Example
Limited follow-up echo, but Doppler documented with no add-on codes.
→ Denial likely
Final Thoughts
CPT 93308 plays a vital role in follow-up and focused cardiac evaluations, but is one of the most commonly denied echo codes due to documentation errors and misunderstanding of what qualifies as a limited study. Clear documentation, correct add-on coding, and accurate identification of exam scope are essential for compliance and reimbursement.
If your practice needs help optimizing cardiology echo billing, reducing denials, or configuring accurate documentation templates, Global Tech Billing LLC offers dedicated expertise in cardiovascular billing and payer policy management.
FAQ: CPT 93308 Common Questions
1. What qualifies as a limited echo?
Any echo that does not evaluate all major cardiac structures.
2. Can 93308 be billed with Doppler?
Yes — but ONLY using add-on codes 93321 or 93325.
3. Is 93308 reimbursed less than 93306/93307?
Yes — significantly lower than complete studies.
4. Can NPs or PAs perform and bill 93308?
Yes, depending on state regulations and payer policies.
5. How often can 93308 be repeated?
As medically necessary, documentation must justify frequency.
Reduce audit risk by reviewing our practical CPT 93308 Limited Echocardiogram Billing Guide
designed for real-world cardiology documentation needs.
6. Can 93308 be billed with an E/M visit?
Yes — some payers require modifier 25 on E/M.
7. What if Doppler is used unintentionally?
Bill 93321 or 93325 OR remove Doppler documentation.
