CCSD code 64302 – Transoesophageal echocardiography as sole procedure

Key takeaways

CCSD code 64302 covers a transoesophageal echocardiogram and its written report, charged as the only cardiac procedure that session.

Reporting already sits inside the fee, so a separate reporting code counts as unbundling and gets rejected.

The probe route picks the code, since 64301 describes a surface study that includes bubble contrast.

No CCSD code covers TOE performed alongside a cardiac intervention, so unbundling rules absorb the study instead.

Most insurers want pre-authorisation, a documented indication and a written report before they release payment.

What CCSD code 64302 covers

CCSD code 64302 pays for a transoesophageal echocardiogram and the written report that follows it. The code applies only when TOE is the single cardiac procedure charged for that session.

Its official descriptor reads Transoesophageal echocardiography (including reporting) (as sole procedure), and three phrases inside that line carry all the billing consequences.

The descriptor comes from the Clinical Coding and Schedule Development Group, the board that maintains the schedule for Bupa, AXA Health, Aviva and Vitality. Read each phrase as an instruction rather than a description.

• Transoesophageal echocardiography: the probe goes into the oesophagus. A surface study or a stress echo belongs on a different code.
• Including reporting: the written report is already paid for. Adding a separate reporting code is unbundling.
• As sole procedure: TOE has to be the only cardiac procedure charged that session. Nothing else in the schedule covers TOE performed alongside an intervention.

The CCSD technical guide sets out the business rules that govern how codes interact. Read it next to the schedule itself, because a descriptor alone will not tell you how two codes behave together. Those rules start with what the fee already buys.

What the 64302 fee includes, and what it leaves out

The fee buys the imaging, the probe and the report. Sedation, anaesthesia and any concurrent cardiac procedure sit outside it. Most unbundling errors start on this line, so the table below splits the two sides.

How a TOE study runs, step by step

A TOE passes a flexible probe down the oesophagus, which sits directly behind the heart. From there it produces sharper pictures of posterior cardiac structures than a surface echo can.

Two of the five steps below generate their own billing questions, so the sequence is worth knowing.

1. Preparation: the patient fasts for at least four hours. Consent is taken, baseline observations are recorded, and IV access goes in.
2. Sedation or throat spray: conscious sedation or topical anaesthesia makes the probe tolerable. Sedation is a co-procedure and sits outside 64302.
3. Probe insertion and imaging: the cardiologist advances the probe and acquires the views the indication calls for.
4. Recovery: the patient stays in a monitored area until sedation wears off and observations settle.
5. Reporting: the cardiologist writes up the findings. That report is paid for inside 64302 and never billed on its own.

The indications insurers expect to see

Insurers authorise 64302 against a named clinical indication, recorded before the procedure. The British Society of Echocardiography and the British Heart Rhythm Society both publish guidance on when TOE is appropriate.

These six come up most often in private cardiology:

• Valvular heart disease: detailed assessment of the mitral, aortic, tricuspid or pulmonary valves, including prosthetic valve function.
• Cardioversion for atrial fibrillation: excluding left atrial thrombus beforehand. Check the combination rules where the cardioversion follows in the same session.
• Infective endocarditis: looking for vegetations, abscesses or fistulae when a surface echo is inconclusive.
• Aortic pathology: assessment of the thoracic aorta for dissection, aneurysm or intramural haematoma.
• Source of embolism: investigation of the left atrial appendage or interatrial septum after an embolic stroke.
• Intraoperative monitoring: continuous TOE during cardiac surgery. Insurers usually treat this as part of the surgical episode.

Write the indication into the notes before the study rather than afterwards. A retrospective entry is the first thing an auditor questions, and it weakens an otherwise sound claim.

64302 or 64301: The probe route decides

These two codes get mixed up because the numbers sit next to each other, but they describe different studies. 64302 is the transoesophageal code. 64301 is a transthoracic study that includes bubble contrast. Neither descriptor mentions whether a second procedure took place.

Check the procedure record before coding. A probe passed into the oesophagus means 64302. A probe held on the chest wall means 64300 or 64301, depending on whether bubble contrast was given. The whole decision fits into three questions.

When another procedure happens in the same session

Neither code has a “with another procedure” variant, and nothing else in the schedule covers TOE alongside a cardiac intervention. Concurrency is handled by the combination and unbundling rules attached to 64302 itself.

AXA Health’s June 2018 notification of schedule changes added eight cardiac codes to the unbundling list for 64302:

• K5760, K5780 and K5790: catheter ablation procedures, including pulmonary vein isolation for atrial fibrillation.
• K6030 and K6060: pacemaker or ICD generator replacement, and lead replacement.
• K6511: adult cardiac catheterisation by femoral access.
• K6180: short-term circulatory support with a left ventricular assist device.
• X5020: external cardioversion.

Where one of those procedures happens in the same session, 64302 is not separately chargeable. Freedom Health Insurance’s Chapter 8 schedule states the wider principle plainly. Transoesophageal echocardiography “should not be charged in addition to any valve-related procedures”.

Each insurer keeps its own combination rules, and those lists get revised. So before adding 64302 to a claim that already carries an intervention, check the current rules for the insurer you are billing.

Related echocardiography codes worth knowing

CCSD does not keep the echo codes in one block. Three sit together in the 643xx range, while stress echo sits with the investigations codes. A coder scanning only the neighbouring numbers will miss it.

Descriptors and rules change between editions, so confirm anything borderline against the current schedule. Our full CCSD code list covers the other codes a cardiology practice bills regularly.

How a 64302 claim moves from booking to payment

A 64302 claim passes through five stages, and four of them happen before the invoice leaves the practice. Most rejections trace back to one of those four.

1. Pre-authorisation: the practice requests cover before the procedure date. The authorisation names the code, the clinical indication and the treating consultant.
2. Procedure and note: the cardiologist records the probe route, the indication and the findings. An auditor reads that note before anything else.
3. Invoice build: the invoice carries 64302, the date of service, the consultant’s name and GMC number, the facility, and the ICD-10 diagnosis code.
4. Submission: most UK practices file electronically through Healthcode rather than by post or email.
5. Adjudication and payment: the insurer pays its own published benefit. Any difference between that benefit and the practice fee becomes a patient shortfall.

Consultant recognition sits underneath all five stages. An unrecognised consultant gets declined whatever the code says, so review recognition with each insurer at least once a year. Bupa CCSD codes sets out how one insurer applies the schedule, and individual codes can be checked through the Bupa code search portal.

Before you submit: The five-line check

Run these five lines before the invoice goes out. Each one maps to a denial reason further down this page.

• Does the note say the probe went into the oesophagus?
• Is the pre-authorisation number on the invoice, and still in date?
• Was any other cardiac procedure carried out in the same session?
• Is the written echo report filed against the patient record?
• Is the consultant recognised by this insurer today?

Documentation that holds up in an audit

A correct code still fails when the record behind it is thin. The British Society of Echocardiography sets the reporting standard, which asks for structured findings, measurements and a clear clinical conclusion. Insurers then add their own requirements on top.

• Pre-authorisation reference: it belongs on the invoice. Claims without it get rejected at the administrative stage, before anyone reads the clinical detail.
• Indication in the notes: the record states why the TOE was needed, dated before the procedure.
• Signed consent: written consent for the study, and separately for sedation where it was given.
• Written report: the cardiologist’s echo report sits in the record. Since 64302 pays for reporting, a missing report undermines the whole claim.
• Archived images: loops and stills stay in the imaging system. Some insurers request them during post-payment audits.
• Consultant letter: a summary to the referrer covering findings and the management plan supports medical necessity.

Digital, time-stamped forms make this easier than paper ever did. When an insurer audits an episode, the date a consent was signed matters as much as the signature on it.

Where 64302 claims go wrong most often

Denials cluster around six errors, and a short pre-submission check catches most of them. Roughly in order of how often they turn up:

• The wrong modality: 64302 billed for a transthoracic study, or 64300 and 64301 billed for a TOE. Insurers cross-reference the note against the code, and the probe route gives it away immediately.
• 64302 added to an intervention: an ablation, cardioversion, pacing procedure or catheterisation in the same session absorbs the imaging. A separate 64302 line reads as unbundling.
• Missing or expired pre-authorisation: authorisations are procedure-specific and date-limited. Performing the study before one is confirmed leads to automatic denial at most insurers.
• A separate reporting code: the descriptor already includes reporting, so code-edit checks reject the second line.
• Thin clinical documentation: a brief report, or an indication missing from the pre-procedure notes. Both are common audit findings.
• Recognition and duplicates: an unrecognised consultant, the same claim sent twice, or 64302 billed next to 64300 or 64301 for one episode.

Billing sedation alongside 64302

Sedation sits outside the 64302 fee, so it can be billed separately when it is handled correctly. Who gave it, and which insurer is being billed, decide how.

• Cardiologist-administered sedation: where the consultant gives conscious sedation without an anaesthetist, bill the relevant CCSD sedation code alongside 64302. Confirm the code against the current schedule, because sedation codes get updated.
• A separate anaesthetist: the anaesthetist bills their own CCSD anaesthetic code. The cardiologist bills 64302 for the study.
• Insurer-specific rules: some policies cover conscious sedation inside the procedure benefit, and others want a separate authorisation.
• Topical anaesthesia only: throat spray without sedation is part of the procedure setup and is not billed separately.

Sedation cover does not transfer between insurers. A Bupa patient and a Vitality patient on the same list can sit under different rules on the same day.

What 64302 pays across UK schedules

CCSD places 64302 in the Intermediate complexity band, and that banding drives the anaesthetist benefit on most schedules. The amounts still differ by insurer, because each one sets its own benefit on top of the shared code.

Across UK schedules published in 2025 and 2026, the procedure benefit for 64302 sits between roughly £290 and £350. The anaesthetist benefit runs from about £150 to £215. Freedom Health Insurance’s Chapter 8 schedule lists £320 for the specialist and £213 for the anaesthetist. Allianz Care’s UK recognition schedule lists the same £320 with a £150 anaesthetist fee.

• Treat published figures as guide rates. A rate contracted with an insurer can sit below the published amount.
• Check the current edition. Schedules are revised, so confirm the version before quoting a fee or submitting a claim.
• The anaesthetist benefit is not yours. It is paid against the anaesthetist’s own claim, not added to the cardiologist’s fee.
• Self-paying patients sit outside all of this. No insurer schedule applies, and the practice sets its own fee.

Quote a fee to an insured patient only after confirming the benefit with their insurer. Where the benefit falls short of the practice fee, tell the patient about the shortfall in writing before the procedure is booked.

How Pabau keeps CCSD billing consistent

Cardiology teams billing several insurers keep the same details in three places. The patient record holds one copy, the invoice a second, and the insurer’s portal a third. Every rekeying step is a chance for a date, a policy number or a code to drift.

Practice management software like Pabau closes that loop. Insurer and policy details live on the patient record, so whoever raises a 64302 invoice can see who is being billed before they start. That is what makes claims management without rekeying workable for a small billing team.

For a private cardiology practice, these are the parts that save the most administrative time:

• Insurer details on the record: the patient’s insurer, policy number and authorisation reference sit with their clinical notes instead of a separate spreadsheet.
• One claims dashboard: claims across every insurer appear in a single list, so none of them waits unnoticed after the procedure.
• Electronic submission: UK claims go to Healthcode without leaving Pabau, and they can be emailed direct where an insurer prefers that.
• Missing-detail checks: Pabau flags incomplete claim information before submission, which removes a common administrative rejection.
• Billing and claims in step: the invoice and the claim carry the same figures, so a part-paid benefit and a patient shortfall stay visible together.
• Signed digital forms: consent is captured and time-stamped against the patient record, which is what an insurer asks for at audit.

None of this replaces a coder’s judgment on the probe route. It removes the retyping around that judgment, which is where the administrative denials come from.

Send every cardiology claim from one place

Pabau keeps insurer details on the patient record, checks claims for missing information, and files them to Healthcode without leaving the system. Your billing team stops retyping and starts chasing fewer rejections.

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Conclusion

64302 turns on one line in the procedure note. If the probe went into the oesophagus, and nothing else cardiac happened that session, the code is right. Read that line first and the rest of the claim follows from it.

The claims that fail rarely fail on the code. They fail on an authorisation that expired, a report nobody filed, or a second line added to an intervention that already covered the study. A five-line check before submission removes most of them.

Build those checks into the billing workflow rather than into one person’s memory. Book a demo to see how Pabau handles CCSD claims for cardiology and other private practice specialties.

Continue your research

Want to see how one insurer applies the CCSD schedule? Bupa CCSD procedure codes covers recognition requirements and the coding issues that come up most.

Need the published benefit behind a code? Bupa procedure fee schedules shows how a benefit schedule maps onto CCSD codes for private consultants.

Chasing a rejection you cannot explain? Denial codes in medical billing decodes the reason codes insurers return and what to do about each one.

Frequently asked questions