Professional Medical Billing for Echocardiograms
Cardiologists who interpret echocardiograms performed in the hospital setting must be careful to apply modifier 26 (Professional component) to the echocardiogram code in their medical billing. For example, the physician should report 93307-26 for a complete transthoracic echocardiogram performed on a hospital inpatient or outpatient. Modifier 26 tells the payor that the physician did not provide the technical component (TC) of the exam. The TC consists of the facility expenses related to the exam, including the costs of personnel, equipment, overhead, etc.
The following CPT® echocardiogram codes require modifier 26 for the professional component: 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93318, 93320, 93321, 93325, and 93350. The codes for placement of an esophageal probe for TEE (93313 and 93316) do not require modifier 26.
Modifier 26 is not used when the exam is performed in the office setting, where the physician owns the equipment and employs the personnel.
The Office of Inspector General has stated that during 2007 it will review Medicare payments for echocardiograms to determine whether physicians billed appropriately for the professional and technical components of this service. Failure to apply modifier 26 on claims for hospital exams could result in overpayments and compliance risks.
