CPT Code 93356: Myocardial Strain Imaging Using Speckle Tracking

CPT code 93356 covers myocardial strain imaging using speckle tracking to assess heart muscle function and support clinical decision-making.

Use Code

What is the CPT code 93356?

CPT code 93356 refers to myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics. This advanced, non-invasive echocardiography imaging technique evaluates the deformation (strain) of heart muscle to gain deeper insights into cardiac function. Unlike standard echocardiography, strain imaging using speckle can detect subclinical myocardial strain dysfunction, even when the ejection fraction appears normal.

This technique tracks natural acoustic markers, or “speckles,” within the myocardium throughout the cardiac cycle. By analyzing the movement of these speckles, clinicians can assess myocardial strain—longitudinal, radial, and circumferential—providing detailed insights into myocardial mechanics and cardiac structure.

CPT code 93356 is an add-on code, meaning it must be reported in conjunction with a base echocardiography imaging procedure. Accepted base codes include:

93303, 93304 (Congenital echo)
93306, 93307, 93308 (TTE)
93350, 93351 (Stress echo)

It's important to note that Medicare does not reimburse CPT 93356 separately in outpatient hospital settings, as it is bundled under the Outpatient Prospective Payment System (OPPS). However, other insurers may offer separate reimbursement, depending on medical necessity and documentation.

CPT code 93356 documentation requirements

To appropriately report CPT code 93356 (myocardial strain imaging using speckle tracking), the following documentation elements must be included:

Base echocardiography code: CPT 93356 must be reported in conjunction with an appropriate base echocardiography code, such as 93306.
Medical necessity: The documentation must clearly establish that myocardial strain imaging was medically necessary based on the patient's condition, such as in cases of heart failure, pulmonary hypertension, and valvular heart disease. It should also confirm that the procedure was performed in accordance with payer or insurer-specific guidelines.
Use of speckle tracking: The report must specify that speckle tracking technology was used to obtain myocardial strain imaging, as CPT code 93356 is tied explicitly to this modality.
Global longitudinal strain (GLS): The report should include the GLS value, typically expressed as a percentage. This key measurement may also be described qualitatively (e.g., normal or abnormal) and is critical in evaluating left ventricular function.
Strain analysis type and findings: Clearly document the type(s) of strain analysis performed (e.g., longitudinal, circumferential, radial) and include a quantitative interpretation of findings derived from the speckle tracking data. Both static and real-time image data should be referenced or included.
Comparison to prior studies: If available, incorporate a comparison of current strain measurements to previous echocardiographic studies to evaluate for changes or trends in myocardial function.
Summary of indications: The report must specify that speckle tracking technology was used to obtain myocardial strain imaging, as CPT code 93356 is specifically tied to this modality.

CPT code 93356 billing guidelines

Add-on code: CPT 93356 is reported in addition to standard echocardiography codes since it represents an advanced imaging component.
Document the medical necessity of the myocardial strain imaging.
Include clinical indications such as cardiomyopathies (infiltrative, hypertrophic, dilated) or patients at risk for these conditions.
Detail the review of the request, clinical questions to be answered, analysis of strain data (regional/global longitudinal, radial, circumferential strain/strain rates), comparison to prior studies if available, and a detailed report with findings reviewed with the referring physician.

The following modifiers can also be used:

Modifier 26 for professional component (interpretation only).
Modifier TC for technical component (equipment and supplies only).
Modifier 59 for distinct procedural service if performed with other imaging on the same day.
Modifiers 76, 77, 91 for repeat procedures or tests.
Modifiers 52, 53 for reduced or discontinued services.