Specialized billing for orthopedic practices — surgical coding, fracture care, joint replacement, and workers compensation claims by orthopedic billing experts. Serving practices nationwide across the United States.
Get Free Practice Audit Contact UsComprehensive billing coverage for your specialty
Accurate CPT coding for joint replacements, arthroscopies, fracture repairs, spinal surgeries, and all orthopedic procedures.
Specialized workers comp billing with state-specific fee schedules, narrative reports, and employer coordination.
Personal injury and auto accident billing with lien management and coordination with attorneys.
Orthopedic denials often involve medical necessity. We appeal every denial with full supporting documentation.
Managing auth requirements for elective surgeries, MRIs, and physical therapy referrals to prevent denials.
Financial reporting for your orthopedic practice with payer performance analysis and collection benchmarks.
Orthopedics combines big-ticket surgery, 90-day global periods, casting and DME, imaging, and therapy — more moving revenue parts than nearly any specialty. The claims are large, which means the denials are large: one unauthorized joint replacement or one misbilled fracture care episode is a five-figure problem. Orthopedic billing rewards operational discipline more than any cleverness.
Closed fracture treatment can bill as a global fracture-care package (covering the restorative treatment plus 90 days of follow-up) or as itemized E/M visits — and the right answer depends on the payer, the fracture, and who's providing follow-up. Choosing wrong either leaves money on the table or double-bills the follow-up. We make the package-versus-itemized decision case by case and make sure casting supplies and applications bill correctly alongside.
Most orthopedic surgery carries a 90-day global period, and everything that happens inside it needs the right modifier or it doesn't pay: staged procedures (58), returns to the OR for complications (78), unrelated procedures (79), unrelated E/M (24), and the decision-for-surgery visit (57). Hardware removal, manipulation under anesthesia, and second-side joint work all live inside this modifier system. Global-period leakage — care delivered free inside the window because nobody appended the modifier — is one of the biggest invisible losses in orthopedic practices, and one of the first things our audits quantify.
Joint replacements, spine procedures, arthroscopy, and MRI/CT all sit behind prior authorization at most commercial payers — often with conservative-therapy prerequisites (documented PT, injections, imaging) that must appear in the record before approval. A missing auth on orthopedic surgery isn't a paperwork nuisance; it's the largest single denial dollar amount a practice can take. Our auth team clears every case before it's scheduled and tracks the CO-197 patterns by payer so requirements never surprise us.
Implants and hardware need invoice-backed billing in facility settings; braces, boots, and slings dispensed in-office are DME with their own HCPCS codes, modifiers (RT/LT, NU), and payer documentation rules — and in-office DME denials are chronic when the paperwork discipline slips. We bill the supply stream as seriously as the surgical one, because across a year it's serious money.
Few specialties see more workers' compensation and auto/liability claims. These follow state fee schedules, paper-heavy processes, adjuster relationships, and their own timely filing rules — and they age into write-offs when treated like commercial claims. Our team runs comp and auto claims on their own workflows, with the state-specific forms and follow-up cadence they demand.
These are 2026 national Medicare rates from the CMS fee schedule. Your local rate is a little higher or lower, and many commercial contracts are priced as a percentage of Medicare, so this is a useful baseline when you review your own payments.
| Code | Service | Office | Facility or reading only |
|---|---|---|---|
| 27447 | Total knee replacement | Not paid in office | $1,159.35 |
| 27130 | Total hip replacement | Not paid in office | $1,162.02 |
| 29881 | Knee arthroscopy with partial meniscus removal | Not paid in office | $515.71 |
| 29827 | Arthroscopic rotator cuff repair | Not paid in office | $976.31 |
| 20610 | Large joint injection | $68.81 | $39.75 |
| 73562 | Knee X-ray, 3 views | $42.42 | $9.35 (reading only, -26) |
| 99214 | Established patient visit, moderate | $135.61 | $84.50 |
Joint replacements carry a 90-day global period, so related follow-up visits in that window are included. Check any code in the global period lookup.
Free one-week audit. We review a week of your claims, denials and open prior authorizations, and show you where money is being lost.
Free one-week trial. We work your orthopedic claims for a week, so you can see the process before you sign anything.
Simple pricing. Most practices pay a percentage of what we actually collect, typically 4–7% of net collections. Flat-rate pricing is also available.
Specialties that sit either side of an orthopedic episode, from imaging through rehabilitation.
Post-operative therapy sits inside the surgical episode, where global period rules decide what is separately billable.
Conservative management before and after surgery is co-managed, with overlapping injection coding.
Imaging drives orthopedic decision-making, and in-office imaging changes the billing entirely.
Inflammatory joint disease is co-managed, and the referral direction changes the coding.
Foot and ankle work overlaps directly, with scope-of-practice affecting which codes each side may bill.
We bill all of these in house. If your group spans several of them, multi-specialty billing keeps one team across every line — or see the full list of services.
Reference: global period in medical billing — the 90-day surgical package, and the difference between modifier 58 and modifier 78 when a patient returns to theatre.
Get a free billing audit and see how much more your orthopedic practice can collect.
Get Free Practice AuditFree resources: Denial Code Lookup | RVU Calculator | AR Days Calculator | CO-97 — global surgery bundling