The application of infrared therapy is considered medically necessary for patients requiring the application of superficial heat in conjunction with other procedures or modalities, to reduce or decrease pain/produce analgesia, reduce stiffness/tension, myalgia, spasm, or swelling.
Coverage For CPT Code 97026
Effective for services performed on or after October 24, 2006, the Centers for Medicare and Medicaid Services announce a NCS stating the use of infrared and/or near-infrared light and/or heat, including monochromatic infrared energy, is non-covered for the treatment, including symptoms such as pain arising from these conditions, of diabetic and/or non-diabetic peripheral sensory neuropathy, wounds and/or ulcers of the skin and/or subcutaneous tissues in Medicare beneficiaries. Further coverage guidelines can be found in the National Coverage Determination (Pub. 100-03), Section 270.6.
Medical Necessity Of CPT Code 97026
Infrared application applied in the absence of associated procedures or modalities, or used alone to reduce discomfort, are considered not medically necessary and therefore, are not covered.