Last Updated on January 25, 2026 by Judith Buckland, MBA, RDCS, FASE
Effective January 1, 2026, CMS finalized policy changes allowing certain transesophageal echocardiography (TEE) services to be billed when performed in the Ambulatory Surgical Center (ASC) setting. The update, highlighted by the American Society of Echocardiography (ASE), reflects the continued shift of structural and interventional cardiac procedures into ambulatory sites of care.
While the change expands flexibility, it also introduces important operational and reimbursement considerations for both physicians and ASC facilities.
What Changed: Newly Allowed TEE Codes in ASCs
CMS approved the following TEE codes for use in ASCs when performed as part of a structural or interventional procedure (not as standalone studies):
- 93312 – TEE probe placement, image acquisition, interpretation
- 93318 – TEE for intra-procedural monitoring
- C8925–C8927 – TEE with contrast (including congenital and monitoring indications)
What Did Not Change for Physicians
Physician payment remains unchanged:
- The professional component of 93312 and 93318
- Paid under the Medicare Physician Fee Schedule (MPFS)
- Not site-of-service dependent
- Billed with modifier -26 by the interpreting physician
Example: A cardiologist interpreting TEE performed in an ASC bills 93312-26.
Documentation Still Matters—More Than Ever
When TEE is performed in an ASC, documentation must clearly support:
- Medical necessity and indication
- Probe placement and image acquisition
- Interpretation and reporting
- For 93318, continuous intra-procedural monitoring
Reports should also show how TEE directly informed procedural decision-making, such as device positioning, assessment of residual regurgitation, or identification of complications.
Clear documentation is critical to avoid denials.
What Changes for Facilities
Unlike physician payment, facility reimbursement does change in ASCs:
- ASC payment methodology applies (not OPPS)
- Technical component payments may be lower than hospital outpatient rates
- New C-codes support CMS data tracking for TEE with contrast
Facilities should assess equipment availability, staffing, probe reprocessing workflows, and payer-specific ASC rates as TEE-supported procedures move into ambulatory settings.
Key Takeaway
As TEE-guided procedures migrate into ASCs, success depends on coordination between physicians, facilities, and revenue cycle teams. Proper coding, modifiers, documentation, and awareness of ASC payment rules will be essential.
For full details and official guidance, ASE strongly encourages members to review the complete CMS and ASE resources.
👉 Read the full ASE article and CMS references
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