Infrared therapy
CPT code 97026 is used when a healthcare provider applies infrared light therapy to a patient's body to help reduce pain and increase circulation in injured or painful areas. This is a passive treatment that uses heat energy from infrared light waves.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
Billing tips
Always bill 97026 in conjunction with active therapy codes (97110, 97112, 97116) to demonstrate it is part of a comprehensive treatment plan, not standalone
Impact: Standalone infrared therapy billing faces 60-80% higher denial rates; bundling with active interventions demonstrates medical necessity
Document the specific body area treated, duration of application (typically 15-20 minutes), and patient response to treatment in the daily note
Impact: Specific documentation reduces audit risk and supports medical necessity; vague notes are the #1 reason for retroactive denials
Do not bill 97026 on the same day as hot pack application (97010) to the same body region, as payers consider these duplicative
Impact: Billing both codes together results in automatic denial of one service, typically the lower-paying code (97010 at $5.57)
Apply modifier GP, GO, or GN on every claim based on the therapy discipline providing the service to ensure proper therapy cap tracking
Impact: Missing therapy modifiers can result in claim denials or incorrect application toward therapy thresholds, affecting all subsequent claims
Bill 97026 only once per session regardless of the number of body areas treated, as it is considered an untimed service
Impact: Billing multiple units per session will result in denial of additional units; this is a one-unit-per-day maximum code
Ensure the treatment plan specifically identifies infrared therapy as a medically necessary modality with measurable goals, not just patient comfort
Impact: Plans that list infrared therapy for 'pain relief' without functional goals face 40-50% higher audit selection rates
Common denials
Medical necessity not established - infrared therapy billed as standalone treatment without active interventions
How to appeal: Submit appeal with comprehensive treatment plan showing infrared therapy as preparatory modality before active exercise/manual therapy. Include evidence-based literature supporting thermal preparation for tissue mobilization. Provide progress notes showing functional improvement.
Duplicate service - billed on same date as hot packs (97010) or other superficial heat modality to the same area
How to appeal: If treating different body regions, resubmit with modifier 59 and documentation clearly indicating distinct anatomical areas. If same region, accept denial as services are considered duplicative per Medicare policy and most commercial payer guidelines.
Exceeds frequency limitations - infrared therapy provided too many times per week without documented justification
How to appeal: Provide detailed clinical notes explaining why increased frequency is medically necessary, patient's complex condition, and functional deficits requiring this treatment intensity. Include physician orders supporting frequency and anticipated duration.
Missing or incorrect therapy modifier (GP, GO, GN) causing claim to deny or process incorrectly
How to appeal: Resubmit as corrected claim with appropriate therapy discipline modifier. Include attestation that service was provided under qualified therapist supervision and is part of documented plan of care. Most payers allow correction within filing limits.
Frequently asked questions
How much does Medicare pay for CPT code 97026 in 2025?
Medicare pays $6.79 for CPT code 97026 (infrared therapy) in 2025, based on the national average non-facility rate. This rate is the same for both facility and non-facility settings. The reimbursement is calculated from 0.21 total RVUs multiplied by the 2025 conversion factor of 32.3465.
Can you bill CPT 97026 and 97010 on the same day?
No, you should not bill CPT 97026 (infrared therapy) and 97010 (hot packs) on the same day for the same body region, as payers consider these duplicate superficial heating modalities. If treating distinctly different anatomical areas, you may bill both with modifier 59 and clear documentation, but this rarely meets medical necessity standards and faces high denial rates.
Is CPT 97026 a timed or untimed code?
CPT 97026 is an untimed code, meaning you bill only one unit per session regardless of how long the infrared therapy is applied. You cannot bill multiple units even if treatment exceeds 15 minutes or if multiple body areas are treated. This is different from timed codes like 97110 or 97140 where units are based on time intervals.
What modifiers are required for CPT code 97026?
CPT 97026 requires a therapy discipline modifier: GP (physical therapy), GO (occupational therapy), or GN (speech-language pathology, rarely applicable). You may also need modifier KX when exceeding Medicare therapy thresholds, or modifier 59 when billing with potentially bundled services on different body regions. The therapy discipline modifier is mandatory for Medicare and most commercial payers.
Does infrared therapy CPT 97026 require a physician order?
Yes, CPT 97026 requires a physician's order or referral as part of a comprehensive plan of care for physical or occupational therapy. The order should specify the type of therapy services needed, though it doesn't need to detail every specific modality. The treating therapist determines appropriate modalities, including infrared therapy, based on clinical evaluation and treatment planning.
What are the RVUs for CPT code 97026 in 2025?
For 2025, CPT 97026 has 0.06 work RVUs, 0.14 practice expense RVUs (both facility and non-facility), and 0.01 malpractice RVUs, totaling 0.21 total RVUs. This is one of the lowest RVU values in physical medicine, reflecting the minimal work effort and resources required for this passive modality.
How do you document medical necessity for CPT 97026?
Document medical necessity for CPT 97026 by explaining how infrared therapy addresses specific functional limitations in the treatment plan, serves as preparation for active interventions, and contributes to measurable functional goals. Include the clinical rationale for choosing infrared over alternatives, patient response showing benefit, and how it integrates with skilled therapeutic interventions. Avoid documentation that suggests use only for comfort or relaxation, as this does not meet medical necessity standards.