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Orthopedics Billing Services

Surgical procedures, fracture care global periods, modifier stacking, implant billing. Orthopedic billing demands specialty expertise.

AAPC Certified
HIPAA Compliant
All 50 States
Starting at 2.49%
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HIPAA Compliant
AAPC Certified
4.9/5 Rating
300+ Practices
27447TKA
29881Arthroscopy
20610Injection
Mod 59Distinct

Why Orthopedics Billing Requires Specialty Expertise

Orthopedics spans office visits, injections, imaging, casting, surgical procedures, and post-op care. A single knee arthroscopy can involve multiple codes with modifier 59/XE. Global periods affect follow-up billing.

Common Orthopedics CPT Codes

Our coders handle these orthopedics codes daily. This is not an exhaustive list.

Code
Description
27447
TKA
29881
Arthroscopy
20610
Injection
Mod 59
Distinct

Orthopedics Billing Challenges We Solve

Common billing problems in orthopedics and how our team handles them.

Surgical Bundling

Multiple procedure codes per surgery with correct modifier usage.

Global Period Management

10- and 90-day globals affect follow-up billing.

Implant Billing

Device cost recovery requires payer-specific knowledge.

Workers Comp

Separate fee schedules and documentation requirements.

Common Orthopedics Denial Reasons

We prevent these before submission and appeal aggressively when they occur.

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Multiple procedure codes per surgery with correct modifier usage
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10- and 90-day globals affect follow-up billing
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Device cost recovery requires payer-specific knowledge
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Separate fee schedules and documentation requirements

Revenue Opportunities Most Orthopedics Practices Miss

Orthopedic practices leave significant revenue on the table in three areas. First, global period follow-up visits. The 90-day global after joint replacement includes routine follow-up, but complications (wound infections, DVT, hardware issues) are separately billable with modifier 78 or 24. Second, implant billing — many ASC-based orthopedic practices don't adequately pursue separate implant reimbursement. Third, office-based procedures like joint injections, fracture care, and DME fitting are frequently under-captured in busy orthopedic practices. Proper charge capture for every office procedure adds $150,000 to $300,000 annually for a typical orthopedic group.

Payer-Specific Orthopedics Billing Tips

Medicare bundles total joint replacement (27447 TKA, 27130 THA) into Comprehensive Joint Replacement (CJR) bundles in certain markets, affecting how post-acute care is managed and billed. Commercial payers vary widely on implant reimbursement — some pay a separate device fee above the facility fee, others include the device in the facility payment. Workers compensation pays orthopedic procedures at state fee schedules that can be 20% to 50% above commercial rates. Always bill WC claims directly to the WC carrier, never to the patient's health insurance.

Orthopedics Billing Best Practices

Practical tips from our coding team to maximize reimbursement and minimize denials.

1
For multiple procedure surgeries, sequence the highest-RVU procedure first. Second and subsequent procedures are typically paid at 50% — proper sequencing maximizes total reimbursement.
2
Workers compensation orthopedic cases use state-specific fee schedules that are often higher than commercial rates. Bill to the correct WC carrier with state-required forms.
3
Joint injection codes (20610-20611) changed in 2015 — use 20610 for major joints and 20604/20606 for small/intermediate joints. Many practices still use the old codes.
4
Document implant manufacturer and catalog number for joint replacements — this supports device-specific reimbursement from payers with separate implant payment policies.

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What We Handle for Orthopedics Practices

Joint replacement coding
Arthroscopic surgery billing
Spine procedure coding
Fracture care with global management
Implant billing
Workers comp orthopedic claims

Why Choose Go Medical Billing for Orthopedics

Our orthopedic coders handle joint replacement, arthroscopy, spine, and trauma billing daily with full modifier expertise.

We serve orthopedics practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.

Orthopedics Billing by State

We handle orthopedics billing in all 50 states. Select your state for location-specific payer details, Medicaid rules, and Medicare MAC policies.

CaliforniaTexasFloridaNew YorkPennsylvaniaIllinoisOhioGeorgiaNorth CarolinaMichiganNew JerseyVirginiaMassachusettsArizonaTennesseeMarylandIndianaMissouriWisconsinColorado
View all 50 states

Related Resources

Medical Billing & Coding ServicesA/R Recovery ServicesCredentialing & ContractingCase Studies & ResultsPricing

Frequently Asked Questions

We track costs, verify payer policies, and code for maximum cost recovery.
Yes. Every 10- and 90-day period tracked with correct follow-up billing.

Get Expert Orthopedics Billing Support

Stop losing revenue to orthopedics coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.

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