CPT Code 97026: Application of a Modality to One or More Areas; Infrared
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In this quick-reference guide to CPT code 97026, we answer frequently asked questions from our community of chiropractors. Follow us for other articles in our ongoing series, courtesy of ChiroTouch, the cloud-based EHR designed specifically for chiropractors. 

NOTE: CPT codes and guidelines can be revised over time. To avoid billing issues, be sure to stay current with annual coding updates and changes to payer guidelines.

About CPT Code 97026: Infrared Light Therapy

CPT code 97026 pertains to attended infrared light therapy, a modality utilized in chiropractic care for various therapeutic purposes. This non-invasive treatment involves the application of infrared radiation to target specific areas of the body, offering pain relief and promoting healing.

Category or Type of Service

CPT code 97026 falls under the category of Physical Medicine and Rehabilitation. It is commonly used by chiropractors as part of a comprehensive treatment plan to address musculoskeletal issues and promote patient wellness.

Billing Interval

Code 97026 is typically billed per session. However, some payers may have specific requirements for billing in 15-minute intervals. Always consult your payer guidelines for accurate billing practices for laser therapies.

When Should Chiropractors Use This Code?

Chiropractors should use CPT code 97026 in the following scenarios:

  • Musculoskeletal pain management. Infrared therapy can be employed to alleviate pain associated with various musculoskeletal conditions, such as arthritis, strains, and sprains.
  • Promoting healing. Light therapy is often utilized to stimulate circulation, reduce inflammation, and facilitate the body’s natural healing processes.
  • Adjunct to chiropractic care. Infrared therapy can complement chiropractic adjustments by preparing the muscles and tissues for manipulation and enhancing treatment outcomes.

When incorporating code 97026 into treatment plans, ensure that the therapy is medically necessary and aligns with the patient’s diagnosis and overall care objectives.

When Should Chiropractors Not Use This Code?

Chiropractors should refrain from using CPT code 97026 in certain situations:

  • Lack of medical necessity. If infrared therapy isn’t cleared as medically necessary for the patient or does not contribute to the patient’s treatment goals, it should not be billed. Some providers may not view infrared light therapy as a valid medical treatment; check their guidelines before billing.
  • Unsupervised use. Don’t bill this code if the patient uses infrared therapy, or if their therapy use isn’t supervised by a medical professional.
  • Unsubstantiated claims. Avoid billing for sessions that lack documented evidence of the therapeutic benefit of infrared therapy or its relevance to the patient’s condition.

Which Modifiers Can Be Used With CPT Code 97026?

Modifiers can provide additional information regarding the circumstances of the service rendered. Common modifiers used with CPT code 97026 include:

  • Modifier 25: Use this if on the same day as an Evaluation and Management (E/M) service, the infrared therapy session is distinct and goes above and beyond what’s normally expected for the E/M visit.
  • Modifier 59. This modifier may be applied to indicate that the infrared therapy session was distinct or independent from other services provided during the same encounter.
  • Modifier GP. Modifier GP may be applicable if the infrared treatment is directly provided by a physical therapist as part of a physical therapy plan of care.

What Are the Billing Guidelines and Documentation Requirements Specific to This Code?

Adhering to proper billing guidelines and documentation requirements is essential for accurate reimbursement and compliance. For CPT code 97026, check for the following:

  • Session duration. Document the duration of each light therapy session to support billing accuracy.
  • Medical necessity. Clearly outline the medical necessity of the therapy in the patient’s treatment plan, including relevant diagnoses and treatment objectives.
  • Detailed session documentation. Maintain detailed treatment notes that outline the rationale for employing infrared therapy, the specific areas targeted, and the patient’s response to treatment.

What Are Common Mistakes Made Specific to CPT code 97026?

Avoiding common pitfalls associated with CPT code 97026 can help ensure proper billing and compliance. Some common mistakes include:

  • Overutilization. Employing infrared therapy excessively or without adequate justification can lead to inappropriate billing and potential audit scrutiny.
  • Insufficient documentation. Failing to document the medical necessity and specifics of each therapy session may result in claim denials or audit findings.
  • Inaccurate coding. Verify the appropriateness of using CPT code 97026 for each patient encounter and confirm adherence to payer guidelines.

What Are Potential Audit Triggers Specific to CPT Code 97026?

Certain factors may trigger audits or scrutiny related to the use infrared light treatment’s CPT code, such as:

  • Unusual billing patterns. An unusually high frequency of infrared therapy sessions or inconsistencies in billing practices may attract audit attention.
  • Documentation discrepancies. Discrepancies between documented treatment notes and billed services can raise red flags during audits.
  • Lack of medical necessity. Inadequate documentation supporting the medical necessity of infrared therapy sessions may prompt further review by auditors.

What Can I Do to Improve the Accuracy and Efficiency of My Practice’s Billing and Coding Processes?

Chiropractors can enhance the accuracy and efficiency of their billing and coding processes by:

  • Conducting routine audits of their practice’s billing and coding practices to identify and address discrepancies or errors.
  • Staying informed about updates and changes to coding regulations and payer policies through ongoing education and training.
  • Using modern electronic health record (EHR) and practice management software to streamline coding workflows and ensure compliance with documentation requirements.

By implementing these strategies, chiropractors can optimize their billing and coding practices, minimize errors, and maintain compliance with regulatory standards.

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