Who reviews prior authorization requests for Follow-up ultrasound imaging of the heart for congenital defects (CPT 93304)?

Most commercial payers hand imaging reviews to a radiology benefit manager. For the payers tracked here, requests are reviewed using guidelines from eviCore, Carelon, CMS, UnitedHealthcare / eviCore. The request is submitted through that organization's portal rather than the health plan's general line.

What should be in the clinical notes before requesting Follow-up ultrasound imaging of the heart for congenital defects (CPT 93304)?

Reviewers look for a recent office visit that documents the symptoms and how long they have lasted, exam findings, results of any earlier imaging, treatments already tried and how the patient responded, and the specific question the study is expected to answer. The diagnosis code on the request should match what the notes describe.

CPT 93304: Follow-up ultrasound imaging of the heart for congenital defects - Prior Authorization and Price

Home › CPT Codes › Follow-up ultrasound imaging of the heart for congenital defects

CPT 93304

Follow-up ultrasound imaging of the heart for congenital defects.

Cardiac & Vascular Testing

Build a submission checklist for this study

Payer guidelines that apply

Payer	Reviewed using	Guideline	Sections
Aetna	eviCore	Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac Imaging Guidelines effective Feb 3, 2026	9 that name this code
Anthem BCBS	Carelon	Imaging of the heart effective Nov 15, 2025	19 that name this code
Cigna	eviCore	Cardiac Imaging Guidelines 2.0.2026, effective Sep 1, 2026 Pediatric Cardiac Imaging Guidelines 1.0.2026, effective Feb 3, 2026	9 that name this code
Medicare	CMS	—	None found
Original Medicare does not run a prior authorization program for outpatient imaging; claims are judged against the coverage policies above. Medicare Advantage plans set their own prior authorization rules.
UnitedHealthcare	UnitedHealthcare / eviCore	Commercial and Exchange Cardiovascular and Radiology Imaging Guidelines 09.2026, effective Sep 1, 2026	9 that name this code

Guidelines collected from the payers' published documents on September 29, 2026. Payers revise these documents during the year. Open the guideline link to confirm the current version before you submit.

Conditions the guidelines address for this study

These are the clinical situations where payer guidelines discuss Follow-up ultrasound imaging of the heart for congenital defects. Each has its own criteria for when the study is considered appropriate.

Established bicuspid aortic valve Anthem BCBS
Established mitral valve prolapse Anthem BCBS
Established native valvular regurgitation Anthem BCBS
Established native valvular stenosis (does not apply to congenital valvular stenosis) Anthem BCBS
Established valvular heart disease – patients who have undergone valve intervention (replacement or repair) Anthem BCBS
Evaluation of aortic disease Anthem BCBS
Evaluation of cardiac masses or cardiac source of embolus Anthem BCBS
Evaluation of infective endocarditis (native or prosthetic valves) Anthem BCBS
Evaluation of patients with cardiac arrhythmias Anthem BCBS
Evaluation of patients with congenital heart disease Anthem BCBS
Evaluation of patients with known CAD Anthem BCBS
Evaluation of patients with pulmonary embolus Anthem BCBS
Evaluation of patients with pulmonary hypertension Anthem BCBS
Evaluation of patients with suspected CAD Anthem BCBS
Evaluation of pericardial diseases Anthem BCBS
Evaluation of signs, symptoms, or abnormal testing Anthem BCBS
Evaluation of suspected or established Kawasaki disease Anthem BCBS
Evaluation of ventricular function Anthem BCBS
Suspected valvular heart disease Anthem BCBS

Typical price

Commercial insurance, median

$677

Middle half of rates: $485 to $981

Medicare, hospital outpatient

$558

Facility payment

Medicare, physician fee schedule

$154

National, non-facility

Commercial figures come from negotiated rates published by 704 hospitals; Medicare figures from CMS fee schedules. Rates vary widely by hospital and plan. Pricing data from CenterIQ.

Get notified when the rules for this study change

Payers update imaging guidelines several times a year. We will email you when the criteria for Follow-up ultrasound imaging of the heart for congenital defects change.

CPT 93304: Follow-up ultrasound imaging of the heart for congenital defects - Prior Authorization and Price

Payer guidelines that apply

Conditions the guidelines address for this study

Typical price

Get notified when the rules for this study change

Frequently asked questions

Imaging CPT Code Coverage Lookup

Quick Access - Common Imaging CPT Codes

CT

MRI

MRA

PET