CPT code 97026: Infrared therapy2026 Medicare rate & RVUs in Guam
Reports application of infrared heat to a selected body area when the service is medically necessary and meets Medicare's limited coverage circumstances.
Medicare pays $7.13 for 97026 in the office in Guam (Hawaii, Guam, HI). Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
Your location
On this page 9 sections
What 97026 covers
Code 97026 represents therapeutic application of infrared heat, typically from an infrared lamp, to one or more body areas. Physical and occupational therapists may use it for localized pain or stiffness, including as a preparatory modality before movement or other skilled treatment. It is an untimed modality used in outpatient rehabilitation and clinician office settings.
Report the service only when infrared treatment is medically necessary and the case falls within Medicare's restricted coverage circumstances; a therapy diagnosis alone does not establish coverage. Document the treated area, clinical rationale, modality provided, and its relationship to the therapy plan. A professional-component modifier does not apply. CMS reduces practice expense for the second and later therapy units furnished on the same day. Because 97026 is untimed, do not count 15-minute increments.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
97026 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | $7.13 | Unavailable |
How the 97026 rate is calculated
Each of 97026’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 97026
RVUs × geographic indexes × conversion factor
Work0.06
0.06 RVUs× 1.000 GPCI
Practice expense0.13
0.13 RVUs× 1.000 GPCI
Malpractice0.01
0.01 RVUs× 1.000 GPCI
Adjusted RVUs
0.2000
Conversion factor
$33.4009
Medicare rate
$6.68
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 97026
The CMS indicators that decide how 97026 is paid alongside other services.
CMS payment indicators · 97026
Infrared therapy
| Rule | CMS value | What it means |
|---|---|---|
| Global period | XXX | The global surgery concept doesn’t apply. |
| Multiple procedures | 5 | Therapy reduction: practice expense of the second and later units is reduced. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 7 | Therapy service: the split doesn’t apply. |
What modifiers do to the payment
Modifier CQ · payment effect
With and without the modifier
97026 without CQ · national office
$6.68
Infrared therapy
97026-CQ · Allowed amount unchanged
$6.68
Medicare cuts its own payment by 15% after the patient’s 20% coinsurance; the allowed amount stays the same. On $100 allowed: $20 coinsurance, then Medicare pays $68 instead of $80.
97026 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 97010Pack therapyHot or cold
- Use 97026 for infrared heat application. Code 97010 represents hot or cold pack therapy.
- 97024DiathermyMicrowave or other diathermy
- Use 97026 for infrared treatment; 97024 identifies diathermy, a different method of delivering therapeutic heat.
- 97028Light therapyUltraviolet application
- 97028 is ultraviolet therapy. It is not the code for infrared heat delivered by an infrared lamp.
97026 billing questions
How does 97026 differ from diathermy?
97026 reports infrared heat, commonly delivered by an infrared lamp. Diathermy is a different modality and is reported with 97024.
Is 97026 a timed service?
No. It is an untimed modality, so units are not counted in 15-minute increments.
Can modifier 26 be appended?
No. CMS identifies 97026 as a therapy service for which the professional-component modifier does not apply.
What documentation supports reporting 97026?
Record the body area treated, the clinical reason for infrared therapy, the modality provided, and how it relates to the therapy plan. Medicare payment is restricted to specific circumstances.
Can 97026 be reported with exercise or another modality?
97026 identifies the infrared application itself, not exercise or another treatment. Report another service only when it was separately furnished and its own reporting requirements are met.
How does the therapy multiple procedure reduction affect 97026?
CMS reduces practice expense for the second and later therapy units furnished on the same day. The reduction applies to practice expense.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 97026 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Build my fee sheet