Transthoracic Echocardiography (TTE) CPT codes and indication

2011 Transthoracic Echo CPT® Codes:



§ CPT®93303 TTE for congenital cardiac anomalies, complete

§ CPT®93304 TTE for congenital cardiac anomalies, follow-up or limited

§ CPT®93306 TTE with 2-D, M-mode, Doppler and color flow, complete

§ CPT®93307 TTE with 2-D, M-mode, without Doppler or color flow

§ CPT®93308 TTE with 2-D, M-mode, follow-up or limited



The following are indications for which transthoracic echocardiography (TTE) can be performed at least once:

Ø Valve function and structure including:

§ Mitral valve prolapse

§ Mitral regurgitation

§ Mitral stenosis

§ Aortic regurgitation

§ Aortic stenosis

§ Bicuspid aortic valve

§ Tricuspid valve regurgitation

§ Pulmonary valve regurgitation

Ø If valve surgery is being considered, TTE to assess aortic, pulmonary or mitral stenosis or regurgitation can be performed once or twice a year.

§ TTE can accurately assess the severity of valve stenosis but is sometimes less accurate in assessing valve regurgitation.



Ø Ventricular function including global and segmental wall motion for evaluating ejection fraction (EF) and coronary artery disease.

§ Echo can be performed to evaluate cardiomyopathy due to etiologies such as ischemia, alcohol, viral myocarditis, or idiopathic.

§ Echo can be performed before and after chemotherapy known to affect heart function.

Ø Ventricular structure including:

§ Infiltrative diseases (e.g. sarcoid, amyloid)

§ Aneurysm with/without thrombus

§ Ventricular septal defect (VSD)

§ Papillary muscle rupture/dysfunction

§ Hypertrophy (including asymmetric septal hypertrophy, spade heart, hypertensive concentric hypertrophy, infiltrative hypertrophy)

Ø Evaluate atrial or ventricular chamber size (e.g. patients with atrial fibrillation, tachyarrhythmias, or left ventricular dilatation).

§ Yearly TTE may be indicated depending on the clinical circumstance.

Ø Detection of embolic source in patients with recent Transient Ischemic
Attack (TIA), stroke, or peripheral vascular emboli.


§ Although transesophageal Echo (TEE) is more accurate in visualizing thrombus in the cardiac chambers and in visualizing the cardiac valves for vegetations (or classic mitral valve fibrinous excrescences), TTE is non-invasive and is indicated as the initial study.

§ Intravenous injected sterile saline contrast can be performed for shunt detection in cases of known or suspected atrial and/or ventricular septal defect and/or patent foramen ovale.

v This is best assessed using TEE, especially in patients with decompression illness, although TTE is still useful in this setting.

Ø Evaluation of ASD repair or VSD repair; within the first year of surgery, if stable clinically, routine imaging is not supported.

§ If patients become newly symptomatic more than one year after successful repair of congenital heart disease, TTE is appropriate

Ø Tumor evaluation including myxomas

Ø Clot detection

Ø Evaluation of right ventricular systolic pressure and pulmonary
hypertension

Ø Evaluation of pericardial effusion/pericardial disease including pericardial cysts
 (cysts are usually benign, most frequently at the right cardiophrenic border, treated by observation [chest CT, cardiac MRI, or TTE] or drainage  prcutaneously or by open surgery), particularly suspected cardiac tamponade

Ø Evaluation of congenital heart disease

Ø Evaluation of endocarditis

§ TTE or TEE is appropriate when there is fever, positive blood cultures indicating bacteremia, or a new murmur.

v Note: lack of visible vegetations does not eliminate the diagnosis.

v TEE remains a more sensitive technique for identification of small vegetations.

Ø Complications of pacemaker insertion should be monitored by TTE

Ø Coarctation of the Aorta

§ Follow-up (surveillance) imaging after repair of coarctation.

v Infants and children: echo every month for several months, then echo every 6 months to one year thereafter until age 18, then follow surveillance imaging frequency for adults—chest MRA (CPT®71555) every 2 to 3 years and before  and after any intervention for re-coarctation.

o Screening for first-degree relatives of patients with hypertrophic
cardiomyopathy (HCM)

Ø First-degree relatives who are 12 to 18 years old should be screened yearly for HCM by 2D- echocardiography and ECG .

Ø First-degree relatives who are older than age 18 should have 2D-echo and
ECG every five years to screen for delayed adult-onset LVH.

Ø Systematic screening is usually not indicated for first-degree relatives who
are younger than age 12 unless there is a high-risk family history or the child is involved in particularly intense competitive sports.

Ø Affected individuals identified through family screening or otherwise should be evaluated every 12 to18 months with 2D-echo, Holter monitor, and blood pressure response during maximal upright exercise.