Transesophageal Echocardiography (TEE)

Transesophageal echocardiography (TEE) is covered when transthoracic echocardiography (TTE) is technically inadequate or non-diagnostic and additional information from TEE would materially affect patient management, and for certain initial indications (e.g., suspected aortic dissection, procedural guidance, endocarditis with moderate/high pre-test probability, exclusion of left atrial thrombus prior to valvuloplasty, critical illness, congenital anomalies, and select intraoperative uses). Significant esophageal pathology is a relative contraindication, routine or indiscriminate use (including routine searches for embolic sources or routine intraoperative application) is not covered, and daily billing for TEE used solely for ongoing hemodynamic monitoring in ICU/operative settings is not appropriate because such monitoring is bundled into E/M services. Providers must document clinical justification, TTE adequacy (or reason TTE was not done), maintain training/certification records, store images and provide written interpretations for intraoperative studies to support separate payment.