Echocardiography Services Now Billable in the ASC Setting: What ASE Members Need to Know

Effective January 1, 2026, CMS has finalized policy changes permitting certain echocardiography services to be billed when performed in the Ambulatory Surgical Center (ASC) setting, reflecting the continued migration of structural and interventional cardiac procedures to ambulatory sites of care.

Newly Allowed CPT®/HCPCS Codes in ASCs

93312	Transesophageal echocardiography; probe placement, image acquisition, interpretation
93318	Transesophageal echocardiography for monitoring during percutaneous procedures
C8925	Transesophageal echocardiography with contrast (or without contrast followed by with contrast), real-time 2D imaging
C8926	Transesophageal echocardiography with contrast for congenital cardiac anomalies
C8927	Transesophageal echocardiography with contrast for monitoring purposes (continuous assessment)

 

Why This Matters for Physicians

For ASE members, this policy change expands flexibility in where TEE services may be performed and billed, however, is important to note that TEE services are considered ancillary to the underlying structural and/or interventional procedure, rather than standalone services. At the same time, this shift introduces important operational, documentation, and payment considerations—most notably for the technical component—requiring close coordination among physicians, facilities, and billing teams.

 

Physician Payment: What Does Not Change

• The professional component of 93312 and 93318:
  • Continues to be paid under the Medicare Physician Fee Schedule (MPFS)
  • Is not site-of-service dependent
  • Is billed by the interpreting physician

 

Modifier -26 (Professional Component)

• Use when: The physician performs interpretation and reporting
• Who bills: Interpreting physician
• Payment: MPFS professional RVUs
• Example: Cardiologist bills 93312-26 for interpreting a TEE performed in an ASC

 

Documentation Expectations for Physicians

For physicians practicing in the ASC setting, documentation must fully support clinical, coding, and regulatory requirements.

Documentation should clearly reflect:

• Medical necessity and indication for TEE
• Probe placement and image acquisition
• Interpretation and reporting
• For 93318, continuous intra-procedural monitoring and guidance

Reports should also document how TEE directly informed clinical decision-making, such as:

• Confirming device positioning
• Assessing residual shunt or regurgitation
• Identifying real-time procedural complications

Clear documentation is critical to support appropriate billing and reduce payer denials.

Why This Matters for Facilities

 

Technical Component: What Does Change in ASCs

While physician payment remains unchanged, facility payment does change when TEE is performed in an ASC.

ASC facility payment:

• Follows the ASC payment methodology, not OPPS
• Is often lower than hospital outpatient payment for the same service
• Reflects different cost baselines, packaging policies, and budget neutrality adjustments

 

Estimated CY 2026 ASC (Technical Component)

HCPCS Code	Descriptor	Payment Indicator	CY2026 Rate*
93312-TC	TEE	Z3	$133.93
93318-TC	Interoperative TEE	Z2	$297.30

*Rates are estimates and may vary by site.

• Z2: Paid separately when integral to a surgical procedure; OPPS-based
• Z3: Paid separately; MPFS non-facility PE-based

 

Technical Component – TC

• Use when: Billing for equipment, supplies, and technical staff
• Who bills: ASC facility
• Payment: ASC fee schedule
• Example: ASC bills 93318-TC for providing equipment and sonographer support during a structural intervention

 

TEE With Contrast: C-Codes in the ASC

CMS also added three C-codes to the ASC setting to track TEE with contrast. These HCPCS Level II codes support CMS data collection and payment calibration.

HCPCS Code	Descriptor	Payment Indicator	CY 2026 Rate
C8925	2D TEE w/ or w/o contrast	Z2	$437.12
C8926	TEE w/ contrast, congenital	Z2	$437.12
C8927	TEE w/ contrast, monitoring	Z2	$437.12

 

How Facilities Should Prepare

Facilities expanding TEE services into ASCs should ensure:

• Availability of TEE-capable equipment
• Trained echocardiography and anesthesia staff
• Robust probe reprocessing workflows that meet regulatory and infection-control standards
• Close review of payer-specific ASC allowable rates

Facility margins may differ from hospital outpatient settings, even when the clinical service is identical.

Key Takeaway

As TEE-supported procedures transition into ambulatory settings, close coordination between physicians, facilities, and revenue cycle teams is essential. Proper code selection, modifier use, documentation, and monitoring of payer-specific rules will be critical to ensure accurate payment and minimize denials.

ASE will continue to support members with ASC-specific guidance and practical tools as these site-of-service changes unfold and clinical practice continues to evolve.

 

Additional Resources

• ASE Webpage on CY 2026 OPPS / ASC Final Rule
• ASE’s Webpage on CMS Payment Models and Rules
• CY 2026 OPPS/ASC Final Rule
• ASC Covered Procedures List (Addendum AA)
• CMS ASC Payment System Overview