TL;DR: The Centers for Medicare & Medicaid Services modified NCD 315 governing infrared therapy devices, with a policy review date of January 9, 2026. The national non-coverage determination remains in effect. Here's what billing teams need to know.
The CMS infrared therapy device coverage policy has been on the books since October 2006, and this 2026 administrative update doesn't reverse it. Infrared therapy devices — including monochromatic infrared energy (MIRE) devices — remain nationally non-covered under Medicare for every listed indication. This policy does not list specific CPT or HCPCS codes, but the clinical scope is broad. If your DME billing operation touches wound care, diabetic neuropathy, or peripheral sensory neuropathy treatments, this NCD 315 Medicare determination directly affects your reimbursement picture.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | CMS (Centers for Medicare & Medicaid Services) |
| Policy | Infrared Therapy Devices — NCD 315 |
| Policy Code | NCD 315 |
| Change Type | Modified (administrative review) |
| Effective Date | 2026-01-09 |
| Impact Level | High — blanket national non-coverage across multiple conditions |
| Specialties Affected | Podiatry, wound care, neurology, physical therapy, DME suppliers |
| Key Action | Audit any infrared therapy device claims billed to Medicare — these will deny across all indications listed in the policy |
CMS Infrared Therapy Device Coverage Criteria and Medical Necessity Requirements 2026
The short answer: there are no covered indications under this policy.
NCD 315 in the CMS Medicare system is a National Coverage Determination. That means it overrides any local coverage determination (LCD) a Medicare Administrative Contractor (MAC) might otherwise apply. A MAC cannot create a covered indication where a national non-coverage determination exists.
The Centers for Medicare & Medicaid Services determined in October 2006 that infrared therapy devices fail the medical necessity standard under Section 1862(a)(1)(A) of the Social Security Act. That's the "reasonable and necessary" test. CMS concluded there was sufficient evidence to say these devices do not meet it — for any of the proposed indications.
The 2026 review date does not change the coverage policy. CMS reviewed NCD 315 and left the non-coverage determination intact. If your team was watching for a reversal or a newly covered indication, it didn't happen.
Prior authorization doesn't apply here in the typical sense. You can't get prior auth approval to override a national non-coverage determination. The denial is categorical. Submitting a prior auth request won't unlock reimbursement for these services under Medicare.
CMS Infrared Therapy Device Exclusions and Non-Covered Indications
This section isn't a list of a few carve-outs from an otherwise covered policy. The entire policy is a non-coverage determination.
CMS explicitly excludes the use of infrared and/or near-infrared light and/or heat — including monochromatic infrared energy — for the following:
| # | Excluded Procedure |
|---|---|
| 1 | Diabetic peripheral sensory neuropathy — including pain symptoms arising from this condition |
| 2 | Non-diabetic peripheral sensory neuropathy — including pain symptoms arising from this condition |
| 3 | Wounds of the skin and/or subcutaneous tissues |
| 4 | Ulcers of the skin and/or subcutaneous tissues |
The language is deliberately broad. CMS covers both the device use itself and any related accessories. "Related accessories" means the flexible pads, infrared diode arrays, and any add-on components sold with the device.
The real issue here is scope creep in clinical documentation. Some practices attempt to frame infrared therapy as incidental warming or as a secondary element of a covered wound care visit. The policy language closes that door. The warming effect is explicitly acknowledged as a possible secondary effect of the device — and the non-coverage determination covers it anyway.
Don't try to bill around this through a different clinical framing. The claim denial will follow.
Coverage Indications at a Glance
| Indication | Coverage Status | Relevant Codes | Notes |
|---|---|---|---|
| Diabetic peripheral sensory neuropathy | Not Covered | Not specified in policy | Includes pain symptoms arising from condition |
| Non-diabetic peripheral sensory neuropathy | Not Covered | Not specified in policy | Includes pain symptoms arising from condition |
| Skin wounds and ulcers | Not Covered | Not specified in policy | Covers skin and subcutaneous tissue wounds |
| Infrared therapy device accessories | Not Covered | Not specified in policy | Accessories covered under same non-coverage determination |
| Local warming (secondary effect) | Not Covered | Not specified in policy | CMS acknowledged warming effect — non-coverage applies regardless |
CMS Infrared Therapy Billing Guidelines and Action Items 2026
| # | Action Item |
|---|---|
| 1 | Audit your active charge capture for infrared therapy device services billed to Medicare. Pull claims from the last 12 months. If your team has been billing infrared therapy under any indication listed in NCD 315, flag those for review immediately. The effective date of the current non-coverage determination is October 24, 2006 — not January 9, 2026. That means any claims billed after 2006 were already subject to denial. |
| 2 | Confirm your billing team knows the scope of "related accessories." The non-coverage determination covers the device and all related accessories. A claim for the pad array, the diode replacement, or any component billed separately still falls under this policy. Train your coders not to split-bill accessory lines to avoid the denial. |
| 3 | Remove infrared therapy devices from any DME supplier catalog or order set that auto-generates Medicare claims. If your durable medical equipment ordering workflow includes these devices, the system should flag Medicare patients at order entry — before a claim is generated. |
| 4 | Do not submit appeals based on medical necessity documentation alone. The denial basis here is not insufficient documentation — it's a national non-coverage determination under Section 1862(a)(1)(A). Medical necessity letters from treating physicians will not overturn this. Understand the distinction between a denial you can fight and one you can't. This one falls in the second category. |
| 5 | Evaluate your ABN (Advance Beneficiary Notice) process for these services. If you provide infrared therapy services to Medicare beneficiaries and collect out-of-pocket, the patient must sign a valid ABN before the service. The ABN should clearly state that Medicare will not cover infrared therapy for their condition. If your practice delivers these services without a signed ABN, you may not be able to bill the patient. Talk to your compliance officer about your current ABN workflow for non-covered DME services. |
| 6 | Check whether any commercial payer contracts follow CMS non-coverage determinations by reference. Some commercial plans adopt Medicare billing guidelines and NCDs for their own DME benefit administration. If your commercial payers incorporate CMS coverage policies by reference, this non-coverage may extend beyond Medicare. Pull your payer contracts and review the DME benefit language. |
| 7 | If your practice was recently approached by an infrared therapy device vendor with claims about Medicare reimbursement — escalate that conversation to your compliance officer now. Vendors sometimes market these devices with outdated or misleading coverage information. Any arrangement where a vendor implies Medicare will pay for these services after 2006 is a red flag. Your compliance officer needs to know about it. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Infrared Therapy Devices Under NCD 315
A Note on Codes
The CMS NCD 315 policy document does not list specific CPT or HCPCS codes. This is a meaningful gap for infrared therapy billing. The non-coverage determination describes the devices and indications in clinical terms rather than code-level specificity.
That means your billing team cannot rely on a clean "deny this code" list. The policy applies based on the service being billed — not a single billable code. MACs process these claims against the policy's clinical description, and denials may come through utilization review rather than automated code-level edits.
What This Means for Claim-Level Auditing
Because NCD 315 doesn't specify codes, infrared therapy billing can slip through charge capture controls that rely on code-level flags. Your auditors need to review claims by device type and clinical indication — not just by procedure code.
If your MAC has issued a related LCD that does reference specific HCPCS codes for infrared devices, that LCD will operate within the ceiling set by NCD 315. An LCD cannot cover what a national NCD prohibits. Check with your regional MAC to identify any HCPCS-level coding guidance they've published that aligns with NCD 315 restrictions.
The transmittals referenced in the policy — TN 1127 and TN 1183 (Medicare Claims Processing) — contain the original claims processing instructions issued when the non-coverage determination took effect in 2006. Those transmittals may contain code-level guidance. Pull them directly from CMS if you need claims processing specifics.
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