Summary & Overview
HCPCS C8926: Transesophageal Echocardiography (TEE) with Contrast for Congenital Anomalies
HCPCS Level II code C8926 designates a transesophageal echocardiography (TEE) procedure using contrast — or performed without contrast and then with contrast — specifically for evaluation of congenital cardiac anomalies. The code bundles probe placement, image acquisition, interpretation, and reporting into a single diagnostic service. This procedure is clinically important for detailed anatomic and functional assessment of congenital heart defects that are not adequately visualized by transthoracic echocardiography.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of how C8926 is defined and used, clinical context for when contrast-enhanced TEE is indicated in congenital heart disease, and the typical settings where the service is delivered. The publication summarizes billing considerations, common modifiers (listed separately), and practical notes on service components included in the code.
This resource is intended to help billing, clinical, and administrative audiences understand the scope of the service represented by C8926, the clinical scenarios that typically warrant contrast-enhanced TEE for congenital anomalies, and the payer landscape relevant to coverage and claims processing. Data not available in the input will be identified in the detailed sections.
Billing Code Overview
HCPCS Level II code C8926 describes a transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies. The code includes probe placement, image acquisition, interpretation, and report, reflecting a comprehensive TEE exam tailored to evaluate congenital heart defects.
Service type: Diagnostic imaging — transesophageal echocardiography with contrast for congenital cardiac anomalies
Typical site of service: Hospital or outpatient cardiac imaging center where TEE procedures are performed under appropriate monitoring and anesthesia support
Clinical & Coding Specifications
Clinical Context
A 6-year-old child with known congenital heart disease (suspected atrial septal defect with intermittent right-to-left shunt on prior transthoracic echo) is scheduled for a transesophageal echocardiography with contrast to better define intracardiac anatomy. The patient arrives to the echocardiography laboratory pre-procedure after fasting per anesthesia instructions. The procedure team includes a pediatric cardiologist or cardiac sonographer, an anesthesiologist or sedation nurse, and support staff. After consent and timeout, sedation or general anesthesia is induced for airway protection. A transesophageal echocardiography (TEE) probe is placed orally into the esophagus; baseline images are acquired. If initial imaging is nondiagnostic for suspected intracardiac shunt or structural anomaly, an agitated saline or other contrast agent is administered intravenously and repeat imaging is performed to evaluate for right-to-left or left-to-right shunting and to better delineate congenital defects. The interpreting physician documents probe placement, image acquisition, findings, interpretation and produces a formal report. Post-procedure, the patient is recovered in PACU or the pediatric recovery area and discharged per standard monitoring criteria or admitted if intervention is planned.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier; standard reporting | Use when no special circumstances apply. |