CPT 97026Physical Therapy

Infrared therapy

CPT code 97026 covers infrared therapy, a treatment using infrared light to warm tissues and improve blood flow to affected areas. This is commonly used as part of physical therapy to reduce pain and stiffness in muscles and joints.

Showing rates for

National Average

Base Medicare rate

$6.79

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.06

PE RVU (NF)

0.14

MP RVU

0.01

Total RVU

0.21

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Bill 97026 only once per day regardless of multiple applications, as Medicare considers this a daily maximum code
Impact: Prevents automatic denials and recoupment; attempting to bill twice on same day results in 100% denial of second unit
Always pair with active treatment codes (97110, 97112, 97140) to demonstrate infrared therapy is preparatory to skilled intervention
Impact: Increases likelihood of payment; standalone 97026 has 60-80% higher denial rate compared to when billed with active therapy
Document specific body part treated, temperature settings, duration, and patient response to support medical necessity
Impact: Reduces audit risk and supports appeals; vague documentation is cited in 45% of post-payment audit denials for this code
Verify payer coverage policy before treatment as many commercial payers classify 97026 as non-covered or bundled
Impact: Prevents bad debt; approximately 30% of commercial payers exclude passive modalities from coverage as of 2025
Include the total timed therapy minutes calculation for the entire treatment session, not just the infrared application time
Impact: Ensures proper unit billing for all services; affects overall reimbursement which may range $100-300 per therapy session
Consider using infrared therapy strategically for higher-paying patients or cash-pay scenarios rather than for Medicare-only patients
Impact: At $6.79 reimbursement with high documentation burden, ROI is negative for many practices when overhead exceeds $8-12 per modality

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Frequently asked questions

How much does Medicare pay for CPT code 97026 in 2025?

Medicare pays $6.79 for CPT code 97026 in 2025 (national average for both facility and non-facility settings). This rate is based on 0.21 total RVUs multiplied by the 2025 conversion factor of 32.3465.

Can you bill CPT 97026 more than once per day?

No, CPT 97026 should only be billed once per day regardless of how many times infrared therapy is applied during the treatment session. Medicare and most payers consider this a daily maximum code, and billing multiple units on the same date will result in denial of additional units.

Is infrared therapy CPT 97026 covered by Medicare?

Yes, Medicare covers CPT 97026 when medically necessary and part of a skilled therapy plan of care, but coverage is increasingly scrutinized. The service must be provided as part of an overall treatment plan that includes active therapeutic interventions, not as a standalone passive modality. Documentation must support medical necessity.

What modifier is required for CPT 97026 on Medicare claims?

Medicare requires therapy discipline modifiers GP (physical therapy), GO (occupational therapy), or GN (speech-language pathology) on CPT 97026 claims to indicate which therapy plan of care the service falls under. Claims without these modifiers will be rejected. Modifier KX is also required when therapy services exceed the therapy cap threshold.

Can CPT 97026 be billed with other physical therapy codes?

Yes, CPT 97026 can and should be billed with other physical therapy codes such as 97110 (therapeutic exercise), 97112 (neuromuscular reeducation), or 97140 (manual therapy). However, infrared therapy alone is rarely considered skilled service, so documentation must show it supports active therapeutic interventions. Some payer policies bundle or exclude passive modalities.

What is the RVU value for CPT code 97026?

CPT code 97026 has a total RVU of 0.21 for 2025, consisting of 0.06 work RVU, 0.14 practice expense RVU (both facility and non-facility), and 0.01 malpractice RVU. This is one of the lowest RVU values in physical therapy, reflecting the limited skill and time required for infrared therapy application.

Why do insurance companies deny CPT 97026 claims?

Insurance companies commonly deny CPT 97026 for lack of medical necessity, classification as a non-covered passive modality, bundling with other therapy services, or determination that treatment constitutes maintenance rather than skilled therapy. Many commercial payers have policies excluding or limiting reimbursement for passive modalities like infrared therapy, requiring prior authorization, or paying only when specific criteria are met.