CPT code 93318 – Intraoperative TEE billing guide (2026)

Key takeaways

CPT Code 93318 reports TEE used to monitor cardiac pumping function and steer immediate treatment, mainly during cardiac surgery or in critically ill patients.

TEE that guides a transcatheter structural intervention such as TAVR or left atrial appendage occlusion is reported with 93355, a standalone code, not 93318.

93355 is not reported with 93312-93318, so the two codes do not appear together for the same TEE service.

The physician’s professional component, 93318-26, carries 3.05 national RVUs in 2026, while the global and technical codes are contractor-priced.

The report must show ongoing monitoring that informed treatment decisions in real time, not a single diagnostic look.

CPT Code 93318: official descriptor and what it means

CPT Code 93318 is the code for transesophageal echocardiography (TEE) performed for monitoring purposes. The physician places the probe, acquires real-time 2D images, and interprets them continuously. That ongoing assessment of the heart’s pumping function drives therapeutic decisions on an immediate time basis.

The American Medical Association (AMA) descriptor breaks into three parts. Read together, they describe hemodynamic monitoring rather than a diagnostic study or procedural guidance.

The key phrase is “for monitoring purposes.” It separates 93318 from 93312, a complete diagnostic TEE. It also separates 93318 from 93355, which covers TEE guidance of transcatheter structural heart interventions.

What CPT Code 93318 covers: scope and clinical scenarios

93318 covers TEE used to watch how the heart is pumping while the care team acts on what it sees. The images answer questions about filling, contractility and volume status. The answers change fluid, drug or ventilator management in the moment.

Clinical scenarios where 93318 typically applies include:

• Cardiac surgery: monitoring ventricular function and volume status during coronary bypass or open valve surgery.
• Weaning from cardiopulmonary bypass: assessing ventricular function as the patient comes off bypass, guiding inotrope and fluid decisions.
• High-risk noncardiac surgery: watching cardiac performance during major procedures where hemodynamic instability is expected, such as liver transplantation.
• Critically ill patients: ongoing assessment of an unstable patient in the intensive care unit, such as shock of unclear cause.
• Hemodynamic monitoring during a transcatheter procedure: 93318 can be reported for monitoring here, but only as monitoring, never as guidance of the intervention.

The supporting diagnosis should reflect why the patient’s cardiac function needed continuous watching. Examples include R57.0 (cardiogenic shock) and R65.21 (severe sepsis with septic shock). In cardiac surgery, coronary artery disease coded as I25.10 and aortic valve stenosis coded as I35.0 are common. The examples are illustrative rather than a coverage list, so check your contractor’s policy for accepted diagnoses.

What CPT Code 93318 does not cover

93318 is narrow on purpose. Several common TEE services belong to other codes, and reporting them as 93318 is a frequent source of denials.

• Guidance of a structural intervention: TEE that guides TAVR, left atrial appendage occlusion or transcatheter mitral repair is 93355. The same applies to atrial septal defect or patent foramen ovale closure.
• A complete diagnostic TEE: a stand-alone study to evaluate cardiac anatomy is 93312, or 93315 when congenital anomalies are present.
• A one-time intraoperative look: a single diagnostic examination with no ongoing monitoring does not meet the descriptor’s continuous assessment requirement.
• Transthoracic echocardiography: TTE uses a chest-wall probe and is reported with codes such as 93306, never with 93318.

Each of those services has its own descriptor and documentation rules. Our procedure codes library carries billing guides across the CPT range, so check the neighboring code’s guide before you switch codes.

CPT 93318 vs 93355: monitoring versus structural guidance

Both codes can involve TEE in a procedure room, but they describe different jobs. 93318 tracks how the heart is pumping so the team can treat the patient. 93355 guides the hands of the interventionalist placing a device or valve.

One caveat from the American Society of Anesthesiologists statement on TEE: 93318 can still be reported during a transcatheter procedure. It must describe hemodynamic monitoring of the patient, documented as monitoring. If the TEE’s job was to guide the device, the correct code is 93355.

The purpose of the TEE decides the code, and NCCI then decides which codes can share a claim. The diagram sets out both for the three TEE services above.

Documentation requirements for CPT Code 93318

The report has to prove that monitoring happened over time and changed care. Payers look for the same few elements on every 93318 claim.

• Indication: why the patient’s cardiac function needed continuous watching, linked to a specific ICD-10-CM code.
• Probe placement: a statement that the TEE probe was placed and by whom.
• Ongoing imaging: evidence that images were acquired and interpreted repeatedly during the case, with time points where possible.
• Findings and actions: what the images showed and the therapeutic measures that followed, such as fluid, inotrope or surgical changes.
• A separate signed report: a TEE report authored by the interpreting physician, distinct from the anesthesia or operative record.

Who can report 93318

Anesthesiologists and cardiologists with TEE training most often perform and report 93318. Credentialing rules come from the hospital and each payer, so confirm local requirements before billing. Only one physician reports the interpretation for a given monitoring service.

2026 Medicare payment for CPT Code 93318

Medicare pays the professional component of 93318 at a national rate. In the 2026 Medicare Physician Fee Schedule, 93318-26 has status A and 3.05 facility RVUs. The global code and the technical component have status C, so your Medicare Administrative Contractor (MAC) prices those.

The two 2026 conversion factors apply to different clinicians. Qualifying APM participants are paid at $33.5675, and everyone else at $33.4009. Your locality’s geographic adjustment then moves the figure, so reconcile each payment against your electronic remittance advice (ERA).

Medicare and payer coverage policies for CPT Code 93318

No national coverage determination is specific to 93318. Coverage is set contractor by contractor, and many policies restrict TEE monitoring to defined indications.

• Check your MAC’s local coverage determinations and billing articles for TEE before scheduling cases.
• Expect payers to ask why ongoing monitoring was needed, not just why TEE was used.
• Commercial and Medicare Advantage plans may require prior authorization for planned cases.
• Some policies treat routine intraoperative TEE as not medically necessary without a stated indication.

Cardiac surgery and critical care groups should audit 93318 claims against their contractor’s policy each year. Coverage drift is easier to catch in an audit than in a stack of denials.

Common denial reasons for CPT Code 93318 and how to avoid them

TEE monitoring claims fail for a handful of predictable reasons. Each one has a fix that belongs before submission.

1. Guidance billed as monitoring. The report describes guiding a TAVR or closure device. Fix: Report 93355 for guidance, and 93318 only for documented hemodynamic monitoring.
2. No evidence of ongoing assessment. The report reads like a single diagnostic exam. Fix: Document repeated assessments and the treatment decisions they drove.
3. Diagnosis does not support monitoring. A vague code such as I51.9 does not explain the need. Fix: Code the condition that made continuous monitoring necessary.
4. Conflicting TEE codes on one claim. 93318 appears with 93312 or 93355 for the same service. Fix: Choose the one code that matches what was done. NCCI blocks 93318 beside 93312 or 93315 outright, with no modifier override.
5. Wrong place of service. The POS does not match the hospital setting. Fix: Use POS 21 for inpatient or 22 for on-campus outpatient hospital as appropriate.

A clear denial management workflow turns these patterns into checklist items. Track each denial reason so you can see which fix your team needs most.

Billing CPT Code 93318 with modifiers

Most 93318 services happen in a hospital, where the facility owns the equipment. The physician then bills 93318-26, the one 93318 line Medicare prices nationally.

How to bill CPT Code 93318: step by step

1. Confirm the purpose of the TEE. Monitoring of cardiac function points to 93318. Guidance of a structural intervention points to 93355.
2. Check the report. It should show probe placement, repeated assessments and the treatment decisions that followed.
3. Select the diagnosis. Code the condition that required continuous monitoring, as specifically as the record supports.
4. Review the other echo codes on the claim. Remove any diagnostic TEE or guidance code that describes the same service.
5. Apply modifiers and POS. Add 26 where the facility owns the equipment, and match POS to the hospital setting.
6. Submit and reconcile. Send a clean claim, then compare the MAC’s payment with what it paid on earlier claims.

How Pabau supports documentation and claims for CPT Code 93318

Most 93318 denials start in the record. The monitoring report, the diagnosis and the charge often live in separate systems, so mismatches slip through before anyone builds the claim. Pabau, our practice management and billing platform, keeps all three on one patient record.

Pabau’s clinical forms capture the TEE indication, findings and treatment changes in a consistent structure. Pabau’s claims management software then submits the claim through Claim.MD and tracks its status. ERA remittances come back into Pabau and are matched to the claims they settle. Your team can see what each payer paid and spot underpaid claims.

Coding decisions still sit with your coders. Pabau gives them a complete report to code from and a clear view of what each payer paid.

Keep TEE reports and claims in one place

Pabau’s clinical forms and claims management keep the monitoring report, the diagnosis and the claim on one patient record. Claims go out through Claim.MD, and ERA remittances come back matched to each claim.

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Conclusion

CPT Code 93318 pays for watching the heart and acting on what the images show. Guiding a valve or closure device belongs to 93355. Get that line right in the report, and most of the coding follows.

Write each report so a reviewer can see the ongoing assessments and the decisions they drove. Then bill the professional component with modifier 26, and keep 93312 and 93315 off the same claim.

Book a demo to see how Pabau keeps TEE documentation and claim tracking on one record.

Continue your research

Need a clearinghouse connection for cardiac procedure claims? Pabau’s Claim.MD integration submits claims and tracks their status and ERA remittances from inside Pabau.

Confused by denial codes on a 93318 remit? Denial codes in medical billing explains the most common CARC codes and how to map them back to corrective actions.

Looking for a broader reference on TEE billing compliance? Medical billing compliance covers payer audit triggers and documentation standards that apply across cardiology procedures.

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