Summary & Overview
CPT 93351: Transthoracic Stress Echocardiography (2D) with ECG Monitoring
CPT 93351 is the code for transthoracic stress echocardiography performed in real time with image documentation (2D) during rest and exercise or pharmacologic stress, including continuous electrocardiographic monitoring and a formal interpretation and report. This procedure is an important diagnostic tool for assessing ischemia, wall motion abnormalities, and cardiovascular function under stress, and is commonly performed in outpatient, non‑facility settings. Nationally, stress echocardiography supports clinical decision making for patients with suspected or known coronary artery disease and other stress‑provoked cardiac conditions.
Major commercial and government payers covered in this review include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the procedure, how it fits within cardiovascular diagnostic pathways, and comparisons to related services. The publication outlines typical billing relationships with associated technical and professional components, highlights common clinical indications and coding relationships, and identifies adjacent CPT codes used for resting echocardiography, contrast use, and standalone cardiovascular stress testing.
This summary equips billing managers, clinicians, and policy analysts with a clear reference for the clinical role of CPT 93351, payer relevance, and the scope of content provided in the full publication. Data not available in the input is noted where applicable.
CPT Code Overview
CPT 93351 describes a transthoracic stress echocardiogram performed in real time with image documentation (2D) and includes M‑mode recording when performed. The procedure is performed during rest and a cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, and includes interpretation and report. The service includes performance of continuous electrocardiographic monitoring and is provided under the supervision of a physician or other qualified health care professional.
Service type: Cardiovascular – Echocardiography Stress Testing
Typical site of service: Non‑facility setting (e.g., office, clinic, diagnostic testing center)
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with known ischemic heart disease presents to a non-facility outpatient diagnostic testing center for evaluation of exertional chest pain and suspected ischemia. The patient undergoes a transthoracic stress echocardiogram performed with treadmill exercise under continuous electrocardiographic monitoring, with real-time 2D imaging and M-mode as indicated. A supervising physician interprets the images and provides a written report. Typical workflow: patient check-in and pretest assessment, baseline resting echocardiographic images, instrumenting for ECG monitoring, exercise or pharmacologic stress protocol, acquisition of stress images, post-test monitoring, and physician interpretation and documentation.
Coding Specifications
-
26— Professional component: used when billing only the interpretation and report by the physician or other qualified health care professional; the provider bills for professional work separate from the performing facility or technical staff. -
TC— Technical component: used when billing only the technical services including equipment, sonographer time, and image acquisition; the facility or entity that supplies the technical resources bills with this modifier.
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|