Application of infrared light or heat to one or more body areas as a supervised therapy modality.
- Medicare
- $6.68
- Work RVU
- 0.06
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Area treated and device used
- Clinical reason for infrared over other heat
- Diagnosis supporting coverage
- Skilled services performed in the same session
- Patient response
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
97026 is infrared therapy, a supervised untimed modality used to warm tissue before exercise or to address pain. It is billed once per session.
Medicare lists it as restricted coverage (status R). Coverage depends on the condition and local contractor policy. Medicare has a national coverage determination that does not cover infrared therapy devices for treating diabetic peripheral neuropathy and related conditions, so a podiatry or foot and ankle clinic billing it for neuropathy will get denied.
In ortho PT, it is uncommon and usually a minor add-on to a session. Most of the problem is medical necessity. Payers want a clear reason heat via infrared is needed instead of a hot pack, which pays nothing under Medicare. Document the area, the device, the reason, and the skilled care it supports. Several commercial plans treat it as investigational or bundle it with other modalities.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (0.06) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (0.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 0.06 |
| Practice expense RVU | 0.13 |
| Malpractice RVU | 0.01 |
| Total RVU | 0.2 |
| Medicare national rate | $6.68 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $6.68 |
Common denial reasons
The recurring reasons claims for CPT 97026 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Billed for diabetic neuropathy, non-covered under Medicare NCD
- Restricted coverage and diagnosis not on the local policy
- Commercial payer considers it investigational
- Missing therapy modifier
- No skilled service accompanying the modality
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01Does Medicare cover 97026?
02Is 97026 timed?
03Can 97026 be billed with 97010?
Sources & references
Editorial content was developed using the following public sources.
- 01CMS Physician Fee Schedule 2026
- 02cms.govhttps://www.cms.gov/medicare/payment/fee-schedules/physician
- 03Medicare NCD 270.6 Infrared Therapy Devices
Mira Scribe
Mira Scribe records the area, device, and clinical reason in the note, which gives a reviewer something to approve when coverage is restricted.
See how Mira captures CPT 97026 documentation