CPT code 93304: Transthoracic echo, congenital, limited or follow-up2026 Medicare rate & RVUs in Illinois
Reports a focused or follow-up transthoracic echocardiogram for congenital heart disease when the study does not require a complete congenital examination.
Medicare pays $143.27–$158.30 for 93304 in the office in Illinois, from Rest of Illinois to Suburban Chicago, IL. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What 93304 covers
This service uses ultrasound from the chest wall to assess a focused question or follow-up finding in a patient with congenital heart disease. Cardiologists and other qualified imaging professionals commonly perform it in an echocardiography lab, hospital, or outpatient setting. It may support surveillance of a known congenital defect or assessment after an intervention when a limited examination is appropriate; it is not the complete congenital study.
Select 93304 when the documented examination is limited or a follow-up study for congenital cardiac anatomy, rather than a complete congenital study or a limited study for a noncongenital indication. The report should identify the clinical question and the structures or findings assessed. Bill the global service without a component modifier, or use modifier 26 for interpretation or TC for equipment and staff when billing a component. CMS applies the cardiovascular diagnostic multiple-procedure reduction to the technical component, not the professional interpretation.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 93304 pays more and less in Illinois
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
4 payment localities
$143.27 to $158.30
| Payment locality | Office | Facility |
|---|---|---|
| Chicago, IL | $156.18 | Unavailable |
| East St. Louis, IL | $144.76 | Unavailable |
| Rest of Illinois | $143.27 | Unavailable |
| Suburban Chicago, IL | $158.30 | Unavailable |
How the 93304 rate is calculated
Each of 93304’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 93304
RVUs × geographic indexes × conversion factor
Work0.73
0.73 RVUs× 1.000 GPCI
Practice expense3.83
3.83 RVUs× 1.000 GPCI
Malpractice0.04
0.04 RVUs× 1.000 GPCI
Adjusted RVUs
4.6000
Conversion factor
$33.4009
Medicare rate
$153.64
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 93304
The CMS indicators that decide how 93304 is paid alongside other services.
CMS payment indicators · 93304
Transthoracic echo, congenital, limited or follow-up
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 6 | Diagnostic cardiovascular reduction applies to the technical component. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 1 | Diagnostic test with separate professional (26) and technical (TC) components. |
What modifiers do to the payment
Modifier 26 · payment effect
With and without the modifier
93304 without 26 · national office
$153.64
Transthoracic echo, congenital, limited or follow-up
93304-26 · Professional component
$34.74
Pays only the interpretation and report.
93304 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 93303Congenital echoComplete transthoracic study
- Both address congenital cardiac anomalies by transthoracic imaging. Choose 93303 for a complete examination and 93304 for a limited or follow-up study.
- 93308EchocardiogramFollow-up or limited study
- Both describe limited or follow-up transthoracic imaging, but 93304 is for congenital cardiac anomalies; 93308 belongs to the general series.
- 93306Echocardiogram (TTE)Complete, with spectral and color Doppler
- 93306 is a complete transthoracic study with Doppler. 93304 is selected for a limited or follow-up congenital study.
93304 billing questions
When should 93304 be chosen over 93303?
Use 93304 for a limited or follow-up transthoracic study addressing congenital heart disease. Use 93303 when the congenital examination is complete.
How does 93304 differ from 93308?
93304 identifies a limited or follow-up study for congenital cardiac anomalies. 93308 is the corresponding limited or follow-up transthoracic study in the general, noncongenital series.
Can the professional and technical portions be billed separately?
Yes. Report modifier 26 for the interpretation and report, or modifier TC for the equipment and staff. Billing without either modifier represents the global service.
Does the multiple-procedure reduction affect both components?
CMS applies the cardiovascular diagnostic multiple-procedure reduction to the technical component. It does not apply to the professional interpretation.
What documentation supports reporting 93304?
Document the congenital heart condition, the reason for the focused or follow-up examination, and the findings or structures evaluated. The record should support a limited study rather than a complete congenital examination.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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