Orthopedic Medical Billing Services
Orthopedic medical billing services are specialty billing and revenue cycle services built for orthopedic surgery practices where one misapplied global period modifier, one bundled arthroscopy code, or one unbilled implant turns a completed surgery into unpaid work. EverCure Billing manages the full revenue cycle for orthopedic practices across the United States: prior authorizations for arthroplasty and spinal procedures, surgical and fracture care coding, in-office imaging and DME billing, workers' compensation claims, denial appeals, and aged A/R recovery. Your surgeons operate. We make sure every part of that episode of care actually gets paid.
What Are Orthopedic Medical Billing Services?
Orthopedic medical billing services cover every financial step in an orthopedic episode of care from the first consult through surgery, hardware, therapy, and the last follow-up visit inside the global period.
For an orthopedic practice specifically, that means verifying benefits and obtaining authorization before surgery, coding the procedure with the correct CPT, ICD-10, HCPCS, and modifier set, billing the implant and casting supplies, handling in-office X-ray and physical therapy claims, submitting to commercial, Medicare, workers' comp, and auto carriers, appealing denials, and working the balance until it clears.
Orthopedics is one of the hardest specialties to bill correctly because a single patient generates several different claim types a surgical claim, an imaging claim, a DME claim, a therapy claim, and sometimes a workers' comp claim each with different rules, different payers, and different documentation requirements.
Why Do Orthopedic Practices Lose Revenue on Work They Already Performed?
The denials in orthopedics aren't random. They cluster around a handful of specific rules that general billing teams consistently get wrong:
The global surgical package
Most orthopedic procedures carry a 10-day or 90-day global period. Every visit, injection, and minor procedure inside that window has to be evaluated: is it included in the global fee, or separately billable with modifier 24, 58, 78, or 79? Bill it wrong in one direction and the claim denies. Bill it wrong in the other direction and you never charge for work you actually did.
Multiple procedure and bundling rules
Arthroscopic procedures bundle aggressively. A knee scope with a meniscectomy and a chondroplasty in the same compartment isn't three payable codes. NCCI edits, modifier 51 reductions, and modifier 59/XS logic decide what actually gets reimbursed and payers apply them differently.
Assistant surgeon and co-surgeon claims
Modifiers 80, 82, AS, and 62 have payer-specific eligibility rules by procedure code. Submitted without checking whether that CPT allows an assistant, the claim denies and often never gets reworked.
Implants, hardware, and casting supplies
Implant costs, C-codes in the ASC setting, and casting and splinting supplies are separately billable in many contracts and routinely left unbilled. On a high-volume practice this is one of the largest silent leaks we find.
DME and orthotic billing
Braces, walking boots, and orthotics are billed on L-codes under different rules than surgical claims, often requiring a supplier number, written orders, and ABN handling. Practices dispensing DME without a proper billing workflow give the revenue away.
Workers' compensation and personal injury claims
Different fee schedules, different forms, different filing deadlines, state-by-state variation, and slow adjuster follow-up. These claims are high-dollar and high-effort, which is exactly why they end up sitting in aged A/R.
Prior authorization on high-cost procedures
Total joint replacement, spinal fusion, and advanced imaging almost always require authorization, and payers increasingly require documented conservative treatment first. No auth, no payment and it can't be fixed after surgery.
We build the billing workflow around these seven pressure points, because that's where orthopedic revenue is actually being lost.
What Orthopedic Billing Services Does
EverCure Billing Provide?
Insurance eligibility and benefits verification
Coverage, plan type, deductible status, coinsurance, DME benefits, therapy visit limits, and surgical benefits confirmed before the date of service including whether the case is commercial, Medicare, workers' comp, or auto.
Prior authorization and pre-certification
Authorization requests prepared and submitted for joint replacement, spinal procedures, arthroscopy, advanced imaging, and DME, with conservative treatment documentation attached and approval expiry tracked against the scheduled surgery date.
Orthopedic surgical coding
CPT, ICD-10-CM, and HCPCS assignment for musculoskeletal procedures with correct laterality, approach, compartment, and modifier set reviewed against operative reports rather than scheduled procedure names.
Global period management
Every post-operative encounter evaluated against the applicable global period, with modifiers 24, 25, 57, 58, 78, and 79 applied where documentation supports separate billing.
Fracture care and casting billing
Initial versus subsequent fracture care coding, cast and splint application codes, and separately billable supply codes captured on every applicable encounter.
Implant, hardware, and supply billing
Implant and hardware charges captured per contract terms, including ASC C-code reporting where applicable, so device costs aren't absorbed by the practice.
DME and orthotics billing
L-code billing for braces, boots, and orthotics with written order verification, ABN workflow for non-covered items, and supplier compliance requirements handled.
In-office imaging and physical therapy billing
X-ray billing with correct professional and technical component split, plus therapy billing under the 8-minute rule, modifier GP, and the KX threshold requirement.
Workers' compensation and personal injury billing
State fee schedule application, required forms and reports, adjuster follow-up, and lien handling where applicable with the persistent follow-up these claims demand.
Claim scrubbing and submission
Pre-submission checks for NCCI bundling pairs, MUE unit limits, modifier logic, diagnosis linkage, and place-of-service accuracy across office, ASC, and hospital claims.
Payment posting and underpayment review
ERA and manual EOB posting with contractual allowance verification against your negotiated rates because orthopedic contracts are complex and underpayments hide easily.
Denial management and appeals
Every denial categorized by root cause, corrected, and appealed with operative reports and supporting documentation attached, then fed back upstream so the same error stops recurring.
Accounts receivable follow-up and recovery
Structured aging-bucket follow-up with priority on high-dollar surgical claims, workers' comp balances, and anything approaching timely filing.
Provider credentialing and payer enrollment
New surgeon enrollment, re-credentialing, CAQH maintenance, Medicare enrollment through PECOS, and ASC facility enrollment where needed.
Reporting and analytics
Monthly reporting on collections, clean claim rate, denial rate by reason, days in A/R, surgical versus office revenue split, and payer-level performance.
Which Orthopedic Procedures
Do You Bill?
Joint replacement total and partial knee, hip, shoulder, wrist, and ankle arthroplasty, including revision procedures and implant reporting.
Arthroscopy knee, shoulder, hip, ankle, wrist, and elbow scopes with correct compartment coding and bundling logic across combined procedures.
Fracture care closed, open, and percutaneous treatment across upper and lower extremity, with initial versus subsequent care distinction and casting supply capture.
Spine procedures discectomy, laminectomy, spinal fusion, and instrumentation, including levels, approach, and bone graft coding.
Soft tissue and tendon procedures rotator cuff repair, ACL and other ligament reconstruction, tendon repair and transfer, meniscectomy and meniscal repair.
Hand, wrist, and nerve procedures carpal tunnel release, cubital tunnel release, trigger finger release, and nerve decompression.
Foot and ankle procedures bunionectomy, hammertoe correction, ankle fusion, heel spur removal, and Achilles repair.
Corrective and reconstructive procedures osteotomy, bone grafting, hardware removal, and limb realignment.
Sports medicine and pediatric orthopedics including procedures performed under specialized payer and school or athletic coverage arrangements.
Non-surgical orthopedic services joint and trigger point injections, viscosupplementation, durable medical equipment, in-office imaging, and physical therapy.
Which Orthopedic CPT and ICD-10 Codes
Do You Work With?
| Code Range | What It Covers |
|---|---|
| 20100–29999 | Musculoskeletal system surgery the core orthopedic surgical range |
| 20600–20615 | Joint and bursa aspiration and injection, with and without ultrasound guidance |
| 22510–22899 | Spine procedures including fusion, instrumentation, and vertebral augmentation |
| 23000–24999 | Shoulder and humerus procedures including rotator cuff repair |
| 25000–26989 | Forearm, wrist, and hand procedures |
| 27000–27899 | Pelvis, hip, femur, knee, and lower leg procedures including arthroplasty |
| 28001–28899 | Foot and toe procedures |
| 29000–29799 | Casts, splints, and strapping application |
| 29800–29999 | Arthroscopic procedures across all joints |
| 64702–64726 | Peripheral nerve decompression, including carpal tunnel release |
| 70010–73725 | Diagnostic radiology across head, neck, chest, spine, pelvis, and extremities |
| 97110–97530, 97760–97763 | Physical therapy, orthotic and prosthetic management |
| 98925–98943 | Osteopathic and chiropractic manipulative treatment |
| 99202–99215, 99024 | Office E/M visits and post-operative follow-up reporting |
| L-codes, Q4001–Q4051, A4570 | Orthotics, braces, casting supplies, and splints |
| M16.–, M17.–, M19.– | Osteoarthritis of hip, knee, and other joints |
| M23.–, M75.– | Meniscal and cruciate derangement, shoulder lesions including rotator cuff tears |
| M25.5–, M54.– | Joint pain by site, and dorsalgia including low back and neck pain |
| S42.–, S52.–, S72.–, S82.– | Fractures of shoulder/humerus, forearm, femur, and lower leg |
| G56.0– | Carpal tunnel syndrome by laterality |
| M48.06–, M51.– | Spinal stenosis and intervertebral disc disorders |
Code sets update annually and payer bundling policy updates more often than that. Keeping current on both is part of the service, not an add-on.
Which Modifiers Decide Whether
an Orthopedic Claim Gets Paid?
Unrelated E/M by the same physician during a post-operative global period.
Significant, separately identifiable E/M on the same day as a minor procedure.
The E/M visit at which the decision for major surgery was made.
Staged or planned related procedure during the global period.
Unplanned return to the operating room for a related procedure.
Unrelated procedure by the same physician during the global period.
Bilateral versus unilateral, formatted the way each payer accepts it.
Multiple procedures, and the payment reduction sequence that follows.
Distinct procedural service across separate sites, sessions, or compartments.
Reduced or discontinued services.
Increased procedural services, supported by documented additional work.
Assistant surgeon, resident-unavailable assistant, non-physician assistant, and co-surgeon.
Professional and technical component split on in-office imaging.
Therapy plan of care and threshold-exception reporting.
Advance beneficiary notice and non-covered service indicators for DME.
Modifier accuracy is not a detail in orthopedic billing. It is most of the revenue.
How Does Compliance Work in Orthopedic Billing?
Operative report to code alignment
Codes are assigned from the dictated operative report, not the scheduled procedure. If the surgeon performed less or more than planned, the claim reflects what was actually documented.
Global period integrity
Post-operative visits inside a global period are reported correctly, including 99024 where payers require post-op visit tracking. Misreporting global visits is a common audit trigger.
NCCI and MUE compliance
Every code combination is checked against active edit pairs and unit limits before submission, with modifiers applied only where the documentation genuinely supports unbundling.
Medical necessity and coverage policy
Joint replacement, spinal fusion, and advanced imaging are reviewed against Medicare LCDs and commercial medical policy, including documented conservative treatment, before the claim goes out.
DME supplier compliance
Written orders, delivery documentation, and ABN issuance for non-covered items are handled as standard workflow, not as an exception.
HIPAA and data security
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI on personal devices or unsecured channels.
How Does
Onboarding Work?
Free billing audit
We review a sample of recent surgical claims, denials, and your aged A/R to identify where revenue is being lost and how much is still recoverable.
Findings and scope
You receive a written summary of what we found and a clear proposal covering services, pricing, and timeline. No obligation to continue.
System access and setup
We work inside your existing EHR and practice management system. No migration, no software purchase, no disruption to your clinical or surgical scheduling team.
Workflow mapping
We document your procedure mix, surgical volume, ASC versus hospital split, DME and therapy lines, top payers, workers' comp exposure, and current denial patterns.
Go live
New claims begin flowing through our process while we work your existing aged A/R in parallel starting with high-dollar surgical balances and anything nearing timely filing.
Ongoing reporting and review
Monthly financial reporting, a dedicated account manager, and a scheduled review call covering what's working and what needs to change.
Typical onboarding runs two to four weeks depending on system access and practice size.
Which EHR and Practice Management Systems
Do You Work In?
We work directly inside your current system rather than asking you to change platforms. Our team has worked across eClinicalWorks, AdvancedMD, NextGen, athenahealth, Kareo/Tebra, DrChrono, CareCloud, Epic, and Cerner, along with orthopedic-specific and ASC-based platforms.
If your system isn't listed, tell us which one you use in most cases we can be trained and productive in it within days.
Who Do We Work With?
We serve practices nationwide, with a growing footprint in Indiana and New Jersey.
What Does Orthopedic Billing Cost?
Our orthopedic medical billing services are priced as a percentage of monthly collections our revenue only grows when yours does. Your exact rate depends on surgical volume, procedure mix, payer mix, workers' comp share, and which parts of the cycle you want us to handle.
There are no setup fees and no long-term lock-in contracts. The free audit is the fastest way to get a number that's accurate rather than generic.
Why Choose EverCure Billing for Orthopedic Billing?
We code from the operative report.
Not from the schedule, not from a superbill checkbox. That single discipline prevents a large share of orthopedic denials and undercoding.
Global periods are managed, not guessed.
Every post-op encounter is evaluated against the correct global window, so you neither lose billable visits nor trigger audit exposure.
Nothing gets left unbilled.
Implants, casting supplies, DME, in-office imaging, and therapy are all captured these lines are where most practices quietly give revenue away.
Workers' comp gets worked, not parked.
These claims are slow and manual, which is exactly why they age. We follow up on them with the same discipline as commercial claims.
Denial data goes back into coding.
Every denial reason is tracked so the same error stops repeating instead of being resubmitted forever.
A named account manager.
One person who knows your surgeons, payers, and case mix reachable directly, with a scheduled monthly review.
No long-term contracts.
We keep your business by performing, not by locking you in.
Is Your Orthopedic Practice Leaving Money on the Table?
Most orthopedic practices don't know their true denial rate by reason, how much of their aged A/R is still collectible, how many implants and supplies went unbilled last quarter, or how much they're being underpaid against contracted rates until someone actually looks.
That's what the free audit is for. We review your recent claims, denials, and A/R and give you a written breakdown of what's recoverable and what's causing the leak. No cost, no obligation.
Frequently Asked Questions
About Orthopedic Medical Billing
Our team works at the level orthopedic billing requires coding from operative reports, managing 10-day and 90-day global periods, applying arthroscopy bundling logic, and handling implant, DME, imaging, and therapy lines alongside the surgical claim. General billing knowledge doesn't cover any of that.
Every post-operative encounter is checked against the applicable global window before it's billed. Where documentation supports separate billing, modifiers 24, 58, 78, or 79 are applied. Where it doesn't, the visit is reported correctly rather than billed and later recouped.
Yes. Implant and hardware charges are captured per your contract terms, casting and splinting supplies are billed on every applicable encounter, and DME is billed on L-codes with written order verification and ABN handling for non-covered items.
Yes. We apply the correct state fee schedule, submit required forms and reports, follow up with adjusters, and handle lien documentation where applicable. These claims need persistent follow-up, which is exactly why they age when nobody owns them.
Yes. Therapy is billed under the 8-minute rule with modifier GP and KX threshold reporting where required, and in-office imaging is billed with the correct professional and technical component split.
Yes. We log into your current system and work in it. There's no software to buy and no data migration required.
Both. Aged A/R is usually where the fastest recovery is available, so we begin working it in parallel with new claim submission, prioritizing high-dollar surgical balances and anything nearing timely filing.
Our standard is submission within one business day of receiving the complete operative report and supporting documentation. When documentation is missing, we tell you the same day rather than letting the claim sit.
We maintain audit-ready documentation linking every code to its supporting operative report and clinical note, and we respond to payer record requests with the documentation package the payer is actually asking for.
Yes. New surgeon enrollment, re-credentialing, CAQH maintenance, Medicare enrollment through PECOS, and ASC facility enrollment are available bundled or standalone.
All work is performed under signed HIPAA agreements with role-based PHI access, secure transfer methods, and no PHI stored on personal devices.
Start with the free billing audit. You'll get a written picture of where your revenue is leaking before you commit to anything.
Ready to Fix Your Orthopedic Revenue Cycle?
Every unbilled implant, every denied arthroscopy claim, and every workers' comp balance sitting past 120 days is money your practice already earned. Let's go get it.
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