Can you bill CPT 93306 and 93356 together?

Yes, CPT code 93306 and CPT code 93356 can be billed together.

Billing Guidelines for 93306 and 93356

• Parent and Add-On Relationship: CPT 93306 is a primary code for a complete transthoracic echocardiogram (TTE) with spectral and color Doppler. CPT +93356 is an add-on code for myocardial strain imaging using speckle tracking.
• Documentation Requirements: You must document the quantification, measurements, and clinical interpretation of the strain analysis in the report, not just the image acquisition.
• Frequency Limits: Report code 93356 only once per imaging session regardless of the number of qualifying primary echo codes performed.
• Modifiers: Code 93356 does not split into professional or technical components and does not require a -26 modifier.

Yes, CPT code 93356 can be billed directly with CPT code 93306.

✅ Billing Guidelines for 93356 and 93306

• Add-on Status: CPT +93356 is an add-on code for myocardial strain imaging and must always be paired with a primary echocardiography code like 93306.
• No NCCI Edits: There are no National Correct Coding Initiative (NCCI) edit restrictions preventing them from being billed together.
• Frequency: Report 93356 only once per imaging session regardless of the primary code.

💡 Documentation Requirements

• Quantification: Must document numerical measurements (e.g., global longitudinal strain values).
• Interpretation: Requires a formal physician clinical interpretation, not just image capture.

⚠️ Payer Specifics & Facility Rules

• Medicare Outpatient (OPPS): Code 93356 is packaged into the base echo payment and not separately reimbursed on the facility side, though it must still be reported.
• Professional/Commercial: Generally allowed and separately reimbursed by professional billing and commercial payers, subject to individual policy rules.

No, CPT code 93306 and add-on code 93325 cannot be billed together for the same transthoracic echocardiogram.

Why They Cannot Be Billed Together

• Bundled Services: CPT code 93306 covers a complete transthoracic echocardiogram that automatically includes both spectral Doppler and color flow Doppler.
• Add-On Status: Code 93325 (color flow velocity mapping) is an add-on code meant for other baseline studies that do not include color Doppler (such as 93307 or 93308), not for 93306.
• Unbundling Edits: The National Correct Coding Initiative (NCCI) considers billing 93325 with 93306 to be unbundling, and payers will reject or deny the additional code. Modifiers like Modifier 59 cannot override this bundling rule for the same study.

CPT code 93356 is an add-on code used to report myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics.

Core Billing Guidelines & Rules

• Add-On Status: It is a + add-on code and must always be billed in addition to a primary echocardiography imaging code. It cannot be reported by itself.
• Allowed Parent Codes: It can only be reported alongside specific transthoracic or stress echocardiography codes:
  • Transthoracic: 93303, 93304, 93306, 93308 (Note: also referenced with 93307 in general guidance)
  • Stress Echo: 93350, 93351
• Frequency: Limit reporting to once per imaging session, regardless of how many views or quantitative metrics are analyzed.
• Modifiers: The code does not split cleanly into professional and technical components for separate fractional billing in a hospital setting; it is typically reported by the interpreting physician as a single charge without modifier -26 when performed in facility environments where the equipment is hospital-owned.

Documentation Requirements

To ensure compliant reimbursement and avoid claim denials, the final medical record and echo report must explicitly include:

• Statement that speckle tracking strain imaging was performed.
• Quantitative strain values (such as Global Longitudinal Strain or GLS percentage).
• Identification of the specialized software algorithm utilized for the calculation.
• The cardiologist's clinical interpretation and evaluation of the strain data.
• Clear documentation of medical necessity or covered clinical indications (such as monitoring for chemotherapy cardiotoxicity, heart failure, or specific cardiomyopathies) rather than routine or general screening.

CPT 93306 does not require a modifier if you are billing for the global service (both technical and professional components) performed entirely within your own office or facility.

When Modifiers Are Required

You only need to add a modifier when splitting the service or reporting specific clinical circumstances:

• Modifier 26 (Professional Component): Use this if the physician only interpreted the echocardiogram and wrote the report, while an outside facility or hospital provided the equipment and technician.
• Modifier TC (Technical Component): Use this if you are billing strictly for the equipment, room, and technologist, and another provider is handling the professional interpretation. (Note: Do not append modifier TC if the service is performed in a hospital setting, as the hospital's claim inherently covers the technical portion.)
• Modifier 59 or X{EPSU} (Distinct Procedural Service): Use this if a separate, distinct echocardiography or diagnostic service is performed on the same date of service that would otherwise be bundled.
• Modifiers 76 / 77 (Repeat Procedure): Use modifier 76 for a repeat procedure by the same physician, or modifier 77 for a repeat procedure by a different physician on the same day.