Coding for Clarity: Echocardiography Gains Two New CPT Add-On Codes

The approval of two new Current Procedural Terminology (CPT) codes acknowledges echocardiographic myocardial strain imaging and myocardial contrast perfusion echocardiography as emerging technologies, often a necessary step before a code is promoted to payable status.

New technologies need new codes 

CPT codes describe medical, surgical and diagnostic services and procedures. These codes communicate uniform information about medical services and procedures to healthcare providers, payers, administrators and accrediting bodies. They are also vital as financial and analytical tools.

New codes are necessary when novel technologies enter clinical practice, as was the case for myocardial strain imaging and myocardial contrast perfusion echocardiography. The American Society of Echocardiography (ASE) developed codes for these new technologies and submitted them to the American Medical Association (AMA) and the CPT panel in an effort to ensure that these emerging medical services would be distinctly identified and to facilitate utilization tracking and claims processing.

Myocardial strain imaging

Myocardial strain imaging is used for the quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics. The new CPT code for this service is +0399T. It should only be reported in conjunction with the base codes listed in the chart on page 39, and may only be reported once per imaging session. ASE has discussed this new services with both private payers and Medicare administrative contractors (MACs).

ASE and the American College of Cardiology also are seeking limited coverage for myocardial strain imaging when it is performed to aid in detection of cardiotoxicity in patients who are receiving potentially cardiotoxic chemotherapy or radiation therapy. There are several roles for cardiovascular ultrasound during potentially cardiotoxic cancer treatment regimens. First, prior to potentially cardiotoxic chemotherapy, echocardiography can ensure that patients do not already have impaired cardiac function. Second, during chemotherapy, cardiovascular ultrasound can monitor ventricular function to exclude chemotherapy-induced dysfunction. Last, during follow-up treatment, cardiovascular ultrasound can determine if new symptoms are potentially due to cardiac disease.

Early detection of decreased ventricular function allows modification in the chemotherapy regimen, either by increasing the interval between doses or by reducing the total cumulative dose of a potentially toxic agent. In addition to routine monitoring of left ventricular systolic function (including use of advanced techniques such as contrast enhanced imaging and 3D imaging for more accurate and reproducible measurements of left ventricular systolic function), myocardial strain imaging allows detection of subclinical left ventricular systolic dysfunction before it manifests as heart failure symptoms or a reduction in left ventricular ejection fraction.

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Myocardial contrast perfusion echocardiography

Myocardial contrast perfusion echo- cardiography aids in detection of myocardial ischemia and myocardial viability and is well-tolerated and safe in both ambulatory and critically ill patients. The newly established code for myocardial contrast perfusion echocardiography is +0439T. This code should be submitted whenever myocardial contrast perfusion echocardiography is performed but may be used only in conjunction with specific base CPT codes, as detailed in the chart above. As for myocardial strain imaging, this new add-on code may be submitted only once per imaging session. ASE is working with private payers and MACs to seek appropriate reimbursement for this service.

Use or lose

The new codes are category III codes—also known as “tracking codes”—which are used to describe new and emerging technologies. While the Centers for Medicare and Medicaid Services (CMS) does not always decide to cover category III codes, these codes often pave the way for the development of permanent category I codes, which are necessary for national Medicare reimbursement.  

Before a category III code is promoted to category I status, CMS collects and analyzes national utilization tracking data. If clinicians do not submit the new category III codes with their claims, or Medicare determines that the codes are not necessary, then the codes may “sunset” after five years, thereby closing the door for reimbursement and limiting patients’ access to the technology. This is why ASE is encouraging the cardiovascular community to share information about the new codes with their lab staff and business departments. Submitting these codes whenever myocardial strain imaging or myocardial perfusion echocardiography is performed will allow national utilization tracking, which is a critical next step toward establishing reimbursement for these services. 


Michael Main, MD, is the medical director of the cardiovascular ultrasound imaging laboratory at Saint Luke’s Mid America Heart Institute in Kansas City, Mo. He serves as chair of the ASE Advocacy Committee. Denise Garris is principal with The Korris Group and an ASE consultant.