Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 97026 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Application Of A Modality To O, Application Of A Modality To One Or More Areas Infraredapplication Of A Modality To One Or More Areas Infrared
| Key Fact | Detail |
|---|---|
| Service Type | Medicine Services and Procedures Physical Medicine and Rehabilitation Evaluations |
| Common Place of Service | 11 - Office 50 - Federally Qualified Health Center |
| Common Modifiers | GP - Services delivered under an outpatient physical therapy plan of care 59 - Distinct Procedural Service |
| Complexity Level | Low |
| Medicare Fee Schedule | $6.68 national non-facility rate (2026) · View Medicare rates for 97026 |
| Medicaid Fee Schedule | $5.52 median of the 7 states in the free preview · View Medicaid rates for 97026 |
National average reimbursement for CPT 97026 by major payers:
$14.78
$6.31
$8.31
$6.76
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 97026.
CPT 97026
5 of 25 sample ratesHigher to lower in this preview
Sonam Verma
$17.00Published rateJada Johnson
Advocate Health And Hospitals Corporation
$11.38Published rateCynthia Gordon
Illinois Professionals Health Progr
$6.98Published rateJoseph Pepitone
Northshore University Healthsystem Faculty Practice Associates
$5.92Published rateStacey Occomy
Franciscan Physician Network
$4.40Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 97026 vs. Other Physical Medicine and Rehabilitation Evaluations Codes
The CPT 97026 code is part of the Medicine Services and Procedures services used for Physical Medicine and Rehabilitation Evaluations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 97026 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 97024-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Diathermyapplication Of A Modality To One Or More Areas Diathermy |
| 97026-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Infraredapplication Of A Modality To One Or More Areas Infrared |
| 97028-CPT | Low | Application Of A Modality To O, Application Of A Modality To One Or More Areas Ultraviolet Application Of A Modality To One Or Moreareas Ultraviolet |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 97026. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 97026 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 97026) and we'll show you how you compare in 15 minutes or less.