Orthopedic billing
Orthopedic billing services
We handle billing for orthopedic surgeons and orthopedic practices: office visits, injections, in-office imaging, bracing and surgery, including global periods and modifiers. Claims go out within 24 hours of receiving charges, every denial is worked within 5 business days, and billing starts at 2.5% of collections.
- Global surgery periods and modifiers 24, 25, 57, 58, 78, 79
- Joint injections with correct drug units
- Workers’ compensation claims billed to the right carrier
Why orthopedic billing is different
Surgery, imaging and supplies on one patient’s account
Orthopedic billing is different because one patient can move from office visit to injection, imaging, surgery and bracing, and each step has its own rules. Most lost revenue sits in the global period and in modifiers.
Global surgical periods
Major procedures carry a 90-day global period and minor procedures usually 0 or 10 days. Visits and procedures inside that window need the right modifier: 24 for an unrelated visit, 58 for a staged procedure, 78 for a return to the OR, 79 for an unrelated procedure.
Decision for surgery
A visit where the surgeon decides to operate can be billed separately with modifier 57 for major surgery or 25 for a minor procedure. Without it, the visit is bundled into the surgery and not paid.
Injections and drugs
Joint injections (20600 to 20611) are billed per joint, with laterality and imaging guidance where used. The drug is billed with its own HCPCS J-code, and units must match the dose given.
In-office imaging
X-rays taken in your office are billed globally. When a hospital owns the equipment, only the professional component with modifier 26 is billed. Advanced imaging such as MRI often needs prior authorization.
Bracing and DME
Braces, splints and orthotics are billed with HCPCS L-codes and often require DMEPOS supplier enrollment and specific documentation. We check each payer’s rules before dispensing is billed.
Workers’ compensation
Work-injury cases are billed to the workers’ compensation carrier instead of health insurance, with the claim number, adjuster details, state fee schedule and required reports. We bill these carriers directly.
Common codes
Orthopedic codes we bill often
| Code(s) | What it is | What we watch for |
|---|---|---|
| 99202–99215 | New and established office visits | Modifier 25 or 57 when a procedure or surgery decision happens the same day |
| 20610 / 20611 | Major joint injection or aspiration, without / with ultrasound guidance | Laterality modifiers; guidance documented with a saved image |
| J-codes (e.g. J3301) | Injected drugs such as corticosteroids | Units match the dose; waste reported where the payer requires it |
| 73030 / 73560 | Shoulder and knee X-rays | Global vs. professional component (26) by who owns the equipment |
| 29881 | Knee arthroscopy with meniscectomy | Global period; bundling with other knee procedures on the same side |
| 27447 | Total knee arthroplasty | Prior authorization; 90-day global; assistant-at-surgery modifiers |
| L-codes | Braces, splints and orthotics | DMEPOS enrollment, documentation and payer-specific coverage |
Codes and rules change. We check current CPT guidance and each payer’s policy before submission.
Common denials we prevent
Orthopedic denials we stop before they happen
Most orthopedic denials trace back to the global period, missing authorizations or unit errors. We check for these during charge review.
- Visits inside a global period billed without modifier 24, 25 or 57
- Return-to-OR or staged procedures missing modifier 78 or 58
- Missing or wrong laterality (RT, LT, 50) on joints and extremities
- Surgery or MRI performed without a valid prior authorization
- Drug units that do not match the documented dose
- Work-injury claims sent to health insurance instead of the workers’ comp carrier
- Bracing claims missing required documentation or supplier enrollment
What we handle
Everything between the visit and the payment
Our core focus is behavioral health, and we bill orthopedics with the same team, the same promises and CPB-certified billers on the team.
- Insurance eligibility, benefits and authorization checks before visits and surgery
- Charge entry and coding review of procedures, modifiers and drug units
- Claim submission within 24 hours of receiving charges
- Payment posting and ERA reconciliation
- Denial correction, resubmission and appeals within 5 business days
- A/R follow-up on unpaid and underpaid claims
- Credentialing and hospital and payer enrollment for new providers
- Patient statements and balance tracking
- Monthly reports on collections, denials and A/R
Pricing
Clear pricing for orthopedic practices
Billing starts at 2.5% of collections, or a flat monthly fee. There is no setup fee and no long-term contract. Credentialing starts at $80 per payer, and 5 commercial payers are credentialed free with billing.
Common questions
Can we bill an office visit on the day of a joint injection?
Yes, when the visit is significant and separately identifiable from the injection. It is billed with modifier 25 and the note needs to support it. A visit only to perform a planned injection is usually not billed separately.
How do you handle post-op visits during the global period?
Routine post-op visits are part of the surgical package and are not billed for payment. Many practices still report them with 99024 for tracking. Visits for unrelated problems are billed with modifier 24.
Do you bill workers’ compensation?
Yes. We bill workers’ compensation carriers directly, separate from health insurance. We set up each injury case with the carrier, claim number, adjuster and employer details, and follow the state’s fee schedule, forms and documentation rules.
Do you handle prior authorizations for surgery and MRI?
We check whether an authorization is required and confirm it is on file before the claim is submitted. Requests themselves can be submitted by your team or by an optional RevenueCTRL virtual assistant.
Do you bill braces and orthotics?
Yes. We bill L-codes when your practice is enrolled as a DMEPOS supplier where required, and we check that documentation meets each payer’s coverage rules.
Is there a long-term contract?
No. There is no setup fee and no long-term contract. Terms are flexible.
Guides from our team
Learn more before you decide
Top 10 Reasons for Medical Claim Denials (And How to Fix Them Fast)
The 10 most common reasons for medical claim denials, what each one costs your practice, and the exact fix for each. Plus a denial-prevention checklist.
Read the guide →Claim Denial Codes Explained: What CO-16, CO-50, CO-197, PR-1 and Others Mean and How to Fix Them
What common denial codes mean (CO-16, CO-18, CO-50, CO-97, CO-197, PR-1 and more) and how to fix each, for mental health and medical practices.
Read the guide →Medical Billing Services for Small Practices: Complete Guide to Maximizing Revenue
Explore medical billing services for small practices, from claim submission and payment posting to denial follow-up, with practical steps to improve revenue.
Read the guide →Find out what your claims are leaving on the table
Tell us about your practice. We will review 90 days of claims and show you what is recoverable, at no cost.
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