Multimodal large language models (MLLMs) increasingly support high-stakes decision making by combining complementary information from images and text. While existing explainability methods identify influential image regions or text tokens, they cannot answer a fundamental question: which modality drives a prediction? Consequently, a model may produce the correct output while relying on the wrong source of evidence, masking shortcut learning and unsafe reasoning. We formulate modality attribution as a complementary explainability objective for multimodal foundation models and propose Counterfactual Modality Attribution (CMA), the first framework for quantifying modality-level contributions in MLLMs. CMA generates image-only, text-only, and joint multimodal counterfactuals using coupled diffusion priors and converts them into principled modality attribution scores through a cooperative game-theoretic formulation based on Shapley values. We evaluate CMA on controlled synthetic benchmarks with known ground-truth modality reliance and on a real-world multimodal clinical dataset. CMA correctly identifies the decision-driving modality in 98% of controlled cases and consistently outperforms baselines, revealing failures of cross-modal reasoning that remain invisible to predictive accuracy alone. Our results establish modality attribution as a complementary dimension of explainability beyond feature attribution, providing a principled framework for auditing multimodal foundation models in safety-critical applications.

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