Summary & Overview
CPT 97026: Infrared Modalities for Therapeutic Management
CPT 97026 represents the application of an infrared therapeutic modality used in physical medicine and rehabilitation to relieve pain and support soft-tissue healing. Nationally, this modality is a common adjunct to physical therapy care plans and is billed when infrared energy is applied to one or more treatment areas. The code is relevant across outpatient office settings where modality-based therapy is delivered.
Key payers discussed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of reimbursement and coverage considerations, typical clinical contexts where infrared therapy is applied, and operational details relevant to billing and documentation. The content outlines common associated clinical diagnoses and related CPT codes for modality services to help situate CPT 97026 within therapy workflows.
This publication provides benchmarks for how the code is used in practice, identifies policy and coverage themes affecting modality reimbursement, and summarizes clinical scenarios that commonly justify use of the service. Data limitations: Service line metadata is not provided. Data not available in the input where noted.
CPT Code Overview
CPT 97026 denotes the application of an infrared modality to one or more areas. This procedure falls within Physical Medicine and Rehabilitation Modalities and is commonly provided in an office setting (POS 11). The code represents use of infrared energy for therapeutic purposes, typically aimed at pain relief and promoting soft tissue healing.
Clinical & Coding Specifications
Clinical Context
A patient presents to a physical therapy clinic with localized musculoskeletal pain affecting one or more regions (for example, low back pain or unilateral knee pain). The physical therapist performs an evaluation, documents objective findings, and applies an infrared modality (97026) to the affected area(s) as part of a therapeutic session to reduce pain, increase local circulation, and prepare tissues for therapeutic exercise or manual therapy. Treatment is provided in an outpatient office setting (POS 11) by providers under the Physical Therapist taxonomy, with billing tracked using the required Medicare therapy modifier.
Coding Specifications
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Modifiers
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GP: Physical therapy modifier required by Medicare to track therapy services. Use when the service is furnished by a physical therapist or facility providing physical therapy and must be reported for Medicare claims tracking. -
Provider Taxonomies
| Taxonomy Code | Specialty |
|---|---|
225100000X | Physical Therapist |
261QP2000X | Physical Therapy Clinic/Center |
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Notes
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Billers should append the listed modifier where payer policy or Medicare tracking requires it. If additional modifier guidance is needed for professional or technical components, that information is not provided in the input.
Related Diagnoses
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M54.5— Low back painLow back pain is a common indication for applying an infrared modality (
97026) to reduce pain and improve local circulation prior to active therapy. -
M25.561— Pain in right kneeRight knee pain may be treated with localized infrared application to decrease discomfort and facilitate subsequent therapeutic exercise.
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M25.562— Pain in left kneeLeft knee pain is clinically relevant for localized modality application to manage pain and improve function before activity-based interventions.
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M79.1— MyalgiaGeneralized or regional myalgia can prompt use of infrared therapy to address muscle pain and promote relaxation of affected musculature.
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M54.2— CervicalgiaNeck pain (cervicalgia) is an indication for targeted infrared application to reduce pain and support range-of-motion and strengthening treatments.
Related CPT Codes
| CPT Code | Description |
|---|---|
97028 | Application of a modality to one or more areas; ultraviolet |
Clinical relationship: 97028 is another single-modality application similar in billing structure to 97026 but represents ultraviolet therapy rather than infrared. In a clinical workflow, 97028 may be used as an alternative modality choice when ultraviolet therapy is clinically indicated instead of infrared. These codes are commonly used alternatively based on the selected physical modality; they are not additive for the same modality application to the same area during the same visit.
National Reimbursement Benchmarks
National Medicare mean rates for 97026 ($6.92) are lower than the BUCA (average commercial) mean ($8.87), with Medicare clustered tightly around its median. Commercial payers show higher mean levels overall, led by Blue Cross Blue Shield at $12.48 and followed by Cigna and the BUCA composite.
Rate dispersion (P75 − P25) is widest for Blue Cross Blue Shield (4.50) and Cigna (5.50), indicating greater variability in commercial contracting; the tightest distributions are Medicare (1.00) and UnitedHealth Group (2.00). The table and chart below present the full breakdown.
State Benchmarks
State: AK1 / 50
Alaska Benchmarks
Alaska exhibits a wide spread in reimbursement rates for CPT code 97026, with Blue Cross Blue Shield showing the largest range between the 25th and 75th percentiles ($23.67 - $11.17 = $12.50), indicating substantial variability in payments. Cigna also demonstrates a notable spread ($18.00 - $6.50 = $11.50), while UnitedHealth Group's rates are tightly clustered at $16.00 across all percentiles, suggesting uniformity in their reimbursement approach.
Compared to national averages, Alaska's commercial payers consistently offer higher mean rates, often more than double the national benchmarks. The table and chart below present the full breakdown of payer-specific rates, highlighting the state's elevated reimbursement environment for this code.
Key Insights for Alaska
- Blue Cross Blue Shield is the highest paying payer for CPT 97026 in Alaska, with a mean rate of $18.56.
- Medicare is the lowest paying payer in Alaska, with a mean rate of $6.70.
- All commercial payers in Alaska reimburse at rates significantly above their respective national averages, with the state mean rates often more than double the national benchmarks.
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