US Reimbursement for AI Echocardiography
Coding and reimbursement pathways in the United States for echocardiography procedures and AI-enabled coded indications: CPT/HCPCS codes, Medicare payment methodologies, NTAP, OPPS, and coverage by care setting.
Is Us2.ai reimbursed in the United States?
In the United States, reimbursement for Us2.ai follows the underlying echocardiography service rather than a separate AI-specific code. Us2.ai automates measurements and structured reporting inside the standard transthoracic echo workflow, so the study is billed under its established CPT code, most commonly CPT 93306 for a complete TTE, with the physician interpretation reported under the professional component (Modifier 26) that Us2.ai augments. There is currently no Us2.ai-specific AI add-on code in the US. The value of Us2.ai lies in faster reporting, higher throughput, and complete structured reports that strengthen the economics of every reimbursed echo. Whether any AI-specific add-on code applies depends on the indication, site of care, and payer, so confirm with your billing and compliance team.
Reimbursement Landscape
Echocardiography procedures and specific AI-enabled coded indications may be eligible for reimbursement through established Medicare payment pathways across multiple care settings.
Established CPT Codes
Us2.ai is billed through the established Category I CPT codes for the echocardiogram it supports, most commonly 93306 (complete TTE), under the professional component that Us2.ai augments. Separate Category III and HCPCS codes exist in the market for specific AI cardiac indications.
Medicare Coverage
Medicare reimburses the underlying echocardiography across outpatient (OPPS), inpatient (IPPS / DRG), and physician-office (MPFS) settings. CMS has also begun assigning procedure-level codes to specific AI cardiac indications.
Multiple Settings
Reimbursement pathways are available across hospital outpatient, hospital inpatient, and physician office settings.
Relevant Coding
CPT and HCPCS codes relevant to echocardiography procedures and specific AI-enabled coded indications.
Transthoracic Echocardiography (Complete)
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography.
The primary billing code for a complete TTE. When billed with Modifier 26, it represents the professional component (physician interpretation and report), which is the workflow most directly augmented by AI-assisted analysis software.
Stress Echocardiography
Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation and report.
Covers transthoracic echocardiographic imaging during stress testing. Typically billed alongside stress test codes (93015–93018), with component billing varying depending on site of service (hospital outpatient vs. physician office). AI-assisted analysis may enhance interpretation efficiency and diagnostic accuracy during stress echo procedures.
TTE with Contrast (Hospital Outpatient)
Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2D), includes M-mode recording, when performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography.
An HCPCS Level II code used exclusively for hospital outpatient facility billing under OPPS when contrast is performed. This code replaces the CPT technical component for contrast echocardiography in this setting; physicians still bill CPT codes (e.g., 93306-26) for the professional component separately.
AI HFpEF Detection (Market Add-on Code)
Noninvasive detection of heart failure derived from augmentative analysis of an echocardiogram that demonstrated preserved ejection fraction, with interpretation and report by a physician or other qualified health care professional.
Included here as market context. This Category III code covers AI-derived detection of heart failure with preserved ejection fraction (HFpEF) from echocardiographic data, and is specific to one AI HFpEF detection pathway. It is <strong>not a general code for AI-assisted echocardiography</strong>, and it is <strong>not a Us2.ai code</strong>: Us2.ai is reimbursed through the underlying echocardiography service (see the answer above), not through 0932T. We list it because it shows CMS has begun assigning procedure-level codes to specific AI cardiac indications. Released by the AMA on 1 July 2024 and effective for CMS reimbursement on 1 January 2025 (replacing prior HCPCS code C9786), CMS assigned 0932T to <strong>APC 5743</strong> with a national outpatient rate of <strong>$299.91</strong>; the inpatient pathway is the New Technology Add-on Payment (NTAP) under ICD-10-PCS <strong>XXE2X19</strong>. Category III codes are temporary tracking codes for emerging technologies.
Myocardial Strain Imaging
Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to primary procedure).
This add-on code is reported in conjunction with a primary echocardiography procedure. It covers the additional analysis involved in speckle tracking-based strain assessment.
CPT codes are maintained by the American Medical Association. HCPCS Level II codes are maintained by CMS. The applicability of specific codes should be verified with your billing and compliance team. Coding practices may vary by institution and payer.
Model the impact on your service
Plug in your annual echo volume and reimbursement rates to model net new year-one revenue from the additional capacity Us2.AI adds.
Reimbursement by Care Setting
Payment mechanisms and methodologies differ depending on where the service is performed.
Hospital Outpatient
Under the Outpatient Prospective Payment System (OPPS), echocardiography and AI-enabled coded services are assigned to an Ambulatory Payment Classification (APC) for qualifying indications.
Payment rates under OPPS are adjusted based on geographic wage indices. Actual payment may vary by facility location.
Hospital Inpatient
Inpatient services are generally paid under the IPPS Diagnosis-Related Group (DRG) methodology. Certain qualifying AI-based technologies may receive additional New Technology Add-on Payments (NTAP).
Diagnostic services are generally bundled within the DRG payment for the overall admission. However, specific FDA-cleared AI technologies with assigned codes may qualify for additional payment through the New Technology Add-on Payment (NTAP) pathway.
Physician Office
In the physician office setting, professional interpretation services may be reported under applicable CPT codes. Payment for certain Category III codes may be carrier-priced.
Carrier-priced codes do not have a nationally established payment rate. Reimbursement is determined by individual Medicare Administrative Contractors (MACs) and may vary significantly by region.
Commercial Payer Coverage
Coverage and reimbursement from commercial health plans continues to evolve as AI-assisted cardiac imaging becomes more widely adopted.
Evolving Landscape
Commercial payer policies for AI-assisted echocardiography are actively developing. Coverage determinations may vary by health plan and region.
Provider Engagement
Healthcare organizations are encouraged to work directly with their payer representatives to understand coverage policies and prior authorization requirements for emerging technologies.
Clinical Evidence
Clinical validation and published evidence may support coverage discussions with commercial health plans. Peer-reviewed data can be a valuable resource in these conversations.
Frequently Asked Questions
Common questions about echocardiography coding and reimbursement in United States.
What CPT code is used for Us2.ai?
Does Us2.ai have a Category III CPT code?
Can AI-assisted echocardiography be billed under CPT 93306?
Is Us2.ai reimbursed for HFpEF?
Does Medicare reimburse AI echocardiography?
What is the difference between Category I and Category III CPT codes?
What is Modifier 26 and why is it important?
What is the difference between CPT codes and HCPCS codes?
What does "carrier-priced" mean?
How does OPPS reimbursement work for outpatient settings?
Are commercial payers covering AI-enabled echocardiography indications?
Where can I get more information?
Important Information
The information provided on this page is intended for general informational purposes only and is not a guarantee of coverage or reimbursement. Reimbursement policies, coding requirements, and payment rates are subject to change and may vary by payer, geography, and care setting. This information does not constitute legal, financial, or billing advice. Healthcare providers should consult with qualified billing and compliance professionals, as well as the applicable payer, to determine coverage and reimbursement for specific services. CPT is a registered trademark of the American Medical Association.
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