97026 CPT Code (2023) | Description & Billing Guidelines
Infrared therapy can be billed with CPT code 97026. The description of CPT 97026 and the billing guidelines can be found below.
97026 CPT Code Description
Description Of CPT 97026: CPT code 97026 can be billed to apply an infrared modality to one or more areas. The official description of this code can be found below.
Billing Guidelines For CPT Code 97026
The Centers for Medicare and Medicaid Services announced an 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 are in the National Coverage Determination (Pub. 100-03), Section 270.6.
Medical Necessity Of CPT Code 97026
Infrared applications 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.
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.
