CPT 97026: Infrared Light Therapy for Pain and Mobility
Medicare pays $7 and commercial payers pay $13 on average nationally for this procedure.
CPT code 97026 describes the application of infrared light therapy as a therapeutic modality to targeted body areas to reduce pain, increase joint mobility, promote circulation, and support tissue healing; the service is typically delivered by clinicians such as physicians, physical therapists, or massage therapists in outpatient physical therapy clinics, rehabilitation centers, or physician offices.
For related coverage guidance, see recent payer policy updates: Hip Arthroplasty (partial and total hip replacement), Shoulder Arthroplasty (Total, Partial, Reverse, Revision and Resurfacing), Artificial Lumbar Intervertebral Disc (Lumbar Total Disc Arthroplasty).
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National Reimbursement Benchmarks
Medicare’s national mean for CPT 97026 sits at $6.9, while BUCA’s mean for commercial plans is notably higher at $12.9, indicating commercial averages near double the Medicare level. This gap highlights material differences between government reimbursement and average commercial payments for this modality.
Examining dispersion (P75 minus P25) shows Blue Cross Blue Shield with a range of $6.6 (P75 $19.5 minus P25 $12.9) and BUCA with a range of $5.0 (P75 $14.7 minus P25 $9.5) as the widest and among the wider spreads; Aetna and Cigna exhibit tighter spreads of $3.1 (Aetna $7.1−$4.0) and $4.7 (Cigna $9.6−$4.9) respectively, while UnitedHealth Group’s spread is $2.4 (P75 $7.9−P25 $5.5), the tightest of the set. These dispersion differences reflect variable commercial contracting dynamics across payers.