Orthopedics Billing Cheat Sheet (2026)
Orthopedics loses the most revenue inside the 90-day global. Post-op visits get written off when they were separately billable, injections get coded without the guidance that was performed, and X-rays go out without the professional component.
Quick reference for orthopedics billers. Last updated .
Top Orthopedics CPT Codes & 2026 Medicare Allowables
| Code | Description | Non-Facility | Facility | Total RVU |
|---|---|---|---|---|
| 20610 | Major joint or bursa aspiration or injection | $68.81 | $39.75 | 2.06 |
| 20611 | Major joint injection with ultrasound guidance | $104.21 | $50.10 | 3.12 |
| 27130 | Total hip arthroplasty | $1,162.02 | $1,162.02 | 34.79 |
| 27447 | Total knee arthroplasty | $1,159.35 | $1,159.35 | 34.71 |
| 29826 | Shoulder arthroscopy with subacromial decompression | $147.63 | $147.63 | 4.42 |
| 29881 | Knee arthroscopy with meniscectomy | $515.71 | $515.71 | 15.44 |
| 73721 | MRI lower extremity joint without contrast | $204.41 | $204.41 | 6.12 |
| 73030 | X-ray shoulder, complete, two or more views | $35.74 | $35.74 | 1.07 |
| 73562 | X-ray knee, three views | $42.42 | $42.42 | 1.27 |
| 99213 | Established patient office visit, low MDM | $95.19 | $57.45 | 2.85 |
National 2026 Medicare Physician Fee Schedule estimates (total RVU multiplied by the conversion factor). These are adjusted by state locality. See the per-state table on the Orthopedics billing services page.
Modifiers That Prevent Orthopedics Denials
A significant, separately identifiable E/M on the same day as a joint injection (20610) or other minor procedure.
The E/M that resulted in the decision for major surgery with a 90-day global, such as a total knee or hip arthroplasty.
A staged or planned related procedure during the global, such as planned hardware removal.
An unplanned return to the operating room for a related complication during the global period.
An unrelated procedure by the same surgeon during a global period, which resets the global for the new procedure.
Splitting the professional read from the technical component on in-office X-rays such as 73030 or 73562 when the practice does not own both.
Top Orthopedics Denials → Quick Fix
Routine post-op is in the 90-day global. Use modifier 24 for an unrelated E/M, or 78 and 79 for related and unrelated returns, with documentation.
20611 already includes ultrasound guidance. Do not also bill a separate guidance code; bill 20610 only when no imaging guidance was used.
Append modifier 25 to the E/M and document an evaluation distinct from the decision to inject.
Append modifier 57 to the E/M that led to the decision for major surgery, so it is not bundled into the surgical global.
Bill the professional component with modifier 26 when the practice reads but does not own the equipment, so the read is not lost.
NCCI Bundling Watch-Outs
Code pairs from this specialty's set that carry NCCI edits. Billing both without a justified modifier triggers a bundling denial.
| Code | Bundles With | Rationale |
|---|---|---|
| 20610 | 00400 | Anesthesia service included in surgical procedure |
| 20610 | 01380 | Anesthesia service included in surgical procedure |
| 20611 | 00400 | Anesthesia service included in surgical procedure |
| 20611 | 01380 | Anesthesia service included in surgical procedure |
| 27130 | 0213T | Misuse of Column Two code with Column One code |
| 27130 | 0216T | Misuse of Column Two code with Column One code |
| 27447 | 01250 | Anesthesia service included in surgical procedure |
| 27447 | 01320 | Anesthesia service included in surgical procedure |
Documentation That Holds Up on Appeal
Whether ultrasound guidance was used and recorded. 20611 includes guidance; 20610 does not.
The procedure and the 90-day global start, so post-op visits are billed with the correct modifier instead of written off.
Each compartment and procedure performed, since multi-compartment work changes the codes and bundling.
Whether the visit is related or unrelated to the surgery, to support modifier 24, 78, or 79.
Whether the practice owns the equipment and read the study, to support the global, technical, or professional split.
Revenue Orthopedics Practices Leave on the Table
Writing off post-op visits inside the global that qualified for modifier 24 or 79.
Billing 20610 plus a separate guidance code when 20611 already includes ultrasound guidance, or the reverse, leaving guidance unbilled.
Losing the X-ray professional component on in-office imaging.
Not billing the injectable drug (J-code) units alongside the injection procedure.
Orthopedics Billing FAQ
How do I bill post-op visits in the 90-day global?
Routine post-op is included and not separately billable. An unrelated problem uses modifier 24, a related return to the OR uses 78, and an unrelated procedure uses 79. The documentation has to support related versus unrelated.
20610 or 20611 for a joint injection?
20611 when ultrasound guidance was used and recorded; it includes the guidance. 20610 when no imaging guidance was used. Billing a separate guidance code on top of 20611 is a bundling denial.
When do I use modifier 57 versus 25?
57 for the E/M that decides on major surgery with a 90-day global. 25 for a significant separate E/M on the same day as a minor procedure. Using the wrong one bundles the visit into the surgery.
How do we keep the X-ray professional fee?
Bill the professional component with modifier 26 when your physician reads a study performed on equipment the practice does not own. Otherwise the read is absorbed and lost.
Stop Losing Orthopedics Revenue to Preventable Denials
Our AAPC-certified orthopedics coders apply every rule on this sheet to your claims. Call 888-701-6090 for a free billing assessment.