Are you making the most of the CPT code 97026 in your acupuncture, chiropractic, or massage therapy practice? If you're offering infrared therapy, understanding this code is essential for accurate billing and maximizing reimbursements. Proper coding ensures compliance with insurance regulations, allowing you to focus on patient care while optimizing your revenue.
The CPT code 97026 is specifically designated for infrared therapy and is widely used by holistic practitioners to help relieve muscle and joint pain. If your practice integrates infrared therapy alongside acupuncture, chiropractic, or massage therapy treatments, knowing how to bill correctly is crucial to getting reimbursed.
Reimbursement for CPT Code 97026: What Holistic Practitioners Need to Know
Unlike other therapeutic modalities, infrared therapy (97026) is not covered by Medicare as it is considered an experimental or investigational treatment. However, private insurers may provide coverage, depending on the patient’s diagnosis and the insurer’s policies. It’s crucial to check with each insurance provider regarding their specific coverage guidelines before billing.
Understanding the 8-Minute Rule
For private insurers that cover infrared therapy, the 8-minute rule applies, meaning you must provide at least 8 minutes of treatment to bill for one unit of 97026. If the session lasts 23 minutes or longer, you may be eligible to bill for two units.
97026 CPT Code in Acupuncture, Chiropractic, and Massage Therapy
Many acupuncturists, chiropractors, and massage therapists integrate infrared therapy into their treatment plans to promote healing. Here’s how different holistic practitioners can use and bill for the CPT code 97026:
- Acupuncturists: Infrared heat therapy can be used before or after acupuncture to enhance circulation and muscle relaxation. Ensure the therapy is medically necessary and properly documented.
- Chiropractors: Infrared therapy is often paired with spinal adjustments to alleviate inflammation and pain. Check with insurance providers for any modifier requirements.
- Massage Therapists: Some states allow infrared therapy billing under insurance when paired with therapeutic massage. Proper documentation and ICD-10 codes are crucial for reimbursement.
Billing and Insurance Guidelines for 97026
Proper billing practices help holistic practitioners receive reimbursement without unnecessary claim denials. Here’s what you need to know:
Common Modifiers for 97026
Using the right modifier codes ensures that your claims are processed correctly. Common modifiers include:
- -22: Increased procedural services (for extended therapy sessions)
- GY: Indicates a non-covered service under Medicare
- KX: Used when services exceed therapy caps, proving medical necessity
- 59: Distinguishes infrared therapy as a separate and distinct service when billed with other procedures
Medicare vs. Private Insurance for 97026
| Insurance Type | Coverage for 97026 | Billing Considerations |
|---|---|---|
| Medicare | Not Covered | Infrared therapy is considered investigational by CMS |
| Private Insurance | Varies by provider | May require pre-authorization or specific modifiers |
Best Practices for Documentation and Compliance
Accurate documentation is essential for insurance approval and to avoid billing errors. Ensure your records include:
- Detailed treatment plans with therapy goals
- Session start and end times to support the 8-minute rule
- Specific application areas and any changes in treatment
- Clear medical necessity statements that justify the use of infrared therapy
- Regular progress notes to track patient improvement
By following these best practices, you can enhance medical billing compliance, avoid denials, and ensure a smoother reimbursement process.
Optimize Your Infrared Therapy Billing with Holbie
As a holistic practitioner, ensuring proper CPT coding and documentation for 97026 is crucial for getting paid correctly while staying compliant with insurance guidelines. While Medicare does not cover infrared therapy, private insurers may under specific conditions.
Holbie specializes in medical billing for acupuncturists, chiropractors, and massage therapists, helping you navigate complex billing rules, reduce denials, and increase revenue.
👉 Need expert billing assistance? Contact Holbie today for customized support on infrared therapy billing and insurance claims!
