Orthopedic Billing Services for
Practices, Surgeons, and ASCs

Orthopedic claims are some of the hardest in medicine to get paid correctly. A single knee replacement can sit inside a 90-day global period, involve implants and a surgery center, and need a different modifier for every follow-up visit that is not routine. Medix Revenue Group bills for orthopedic surgeons and practices across the United States, so post-op visits, staged procedures, and fracture care are coded and paid the way the payer’s rules allow.

Why orthopedic billing is different

Orthopedic revenue is rarely lost through denials alone. A lot of it is never billed, because a legitimate visit or return to the OR gets absorbed into the surgical package. The main pressure points:

Global periods. Major procedures carry a 90-day package (the day before surgery plus 90 days after). Minor procedures carry 0 or 10 days. The CMS global indicator on each CPT code decides what is bundled.
Fracture care. Many closed-treatment fracture codes include the first cast or splint and follow-up visits, and the right ICD-10 seventh character depends on the encounter and healing status.
Facility and professional claims. Surgeon, assistant, surgery center, implants, and supplies are billed separately under different rules.
Laterality and staging. Left, right, bilateral, and staged procedures each change the modifier and the payment.
Mixed payers. Commercial, Medicare, workers' compensation, auto, and attorney-lien cases run on different clocks.

Orthopedic billing services we provide

Orthopedic revenue is easy to lose. Global periods, modifier rules, fracture care, implants and prior authorizations all affect whether a claim gets paid in full. Medix covers the whole revenue cycle for your practice, from verifying coverage before the visit to collecting the last patient balance. Our coders and billers work from the operative report, so each claim reflects what your surgeons actually did. You get cleaner claims, fewer denials, faster payments and monthly reports that show where your money is going.

Charge capture and medical coding review

Certified coders match every billed CPT and ICD-10 code to the surgeon’s operative report. Missed procedures, wrong modifiers and unbilled implants get caught before the claim goes out.

Insurance eligibility verification

We confirm coverage, deductibles and referral rules before the visit or surgery. That prevents front-end denials and surprise patient balances.

Prior authorization

We submit and track authorizations for surgery, MRI, injections and therapy, then follow up until approval. Procedures are not delayed or denied for missing auth.

Clean claim submission

Claims are scrubbed with NCCI edit checks for bundling conflicts, modifier errors and global-period issues before submission. More claims are paid on the first pass.

Denial management and appeals

We work every denial to its root cause and file appeals with supporting documentation. We also fix the upstream issue so the same denial doesn’t repeat.

A/R follow-up

Unpaid and underpaid claims are chased by aging bucket until they are resolved. Nothing sits in A/R unworked, and your days in A/R stay low.

Payment posting

Insurance payments and patient payments are posted accurately and checked against your contracted rates. Underpayments are flagged and your ledger matches your deposits.

Patient statements and balance follow-up

Clear statements and timely reminders collect patient balances. Your staff doesn’t spend time on billing calls.

Provider credentialing and payer enrollment

We handle applications, CAQH and payer enrollment for new surgeons so they can bill in-network without delays.

Monthly reporting and analytics

You get days in A/R, denial reasons, and collections by surgeon and CPT code each month. It shows where revenue is leaking and which surgeons and procedures drive collections.

Global periods and modifiers in orthopedic billing

Common Surgical Billing Modifiers

Situation	Modifier	What to Document
Unrelated E/M by the same surgeon during the global period	24	A different problem than the surgery
E/M on the day of, or day before, a major (90-day) procedure that leads to the decision to operate	57	The decision for surgery
Significant, separately identifiable E/M on the same day as a minor procedure, such as a joint injection	25	Evaluation work apart from the procedure
Planned or staged related procedure during the global period	58	That the second procedure was planned or staged
Unplanned return to the OR for a related problem	78	The complication; no new global period starts
Unrelated procedure during the global period	79	A distinct diagnosis; a new global period starts
Split care: surgery only, post-op care only, pre-op care only	54 / 55 / 56	The transfer of care; used on the procedure code, not on E/M

Routine post-op visits that the global package already pays for are tracked with 99024 (no charge). Since 2025, CMS has also tightened documentation requirements when post-op care transfers to a provider outside the surgeon’s group. It also created add-on code G0559, which that provider can bill once per 90-day period with their post-op E/M visit when there was no formal transfer of care. Payer rules vary, so we check each contract.

Fracture care billing and coding

Closed fracture treatment codes generally include the first cast or splint and follow-up care for that fracture during the code’s global period. The period (0, 10, or 90 days) depends on the specific code. This builds on the global period rules above. We check these common failure points on every fracture claim:

E/M billed with fracture care: An E/M visit is billed without a separately identifiable evaluation, which leads to a denial.
Wrong ICD-10 seventh character: The character must match the encounter: initial, subsequent routine, delayed healing, nonunion, malunion, or sequela.
Missing laterality: Claims without left or right specified are rejected or denied.
Split care after a transfer: Care shared with another provider needs the correct modifiers and documentation.

Orthopedic Procedures We Bill and the Challenges Behind Them

Common Orthopedic CPT Codes We Bill

CPT	Procedure	Watch-out
27447	Total knee arthroplasty	90-day global. Bilateral and staged cases need clear laterality; payers differ on modifier 50 versus RT/LT.
27130	Total hip arthroplasty	90-day global. Revisions use different codes, so confirm against the operative report.
29881	Knee arthroscopy with meniscectomy	The code includes chondroplasty in the same or separate compartment. Unbundling is a common NCCI denial.
29827	Arthroscopic rotator cuff repair	Report arthroscopic subacromial decompression with add-on 29826 where the payer allows.
29888	Arthroscopic ACL reconstruction	Prior authorization is commonly required; verify before the case is scheduled.
22612	Posterior lumbar fusion	Additional levels (22614), instrumentation (22840 series), and bone graft codes are frequently missed add-ons.
64721	Carpal tunnel release	Approval depends on documented conservative care; many payers require prior authorization.
20610 / 20611	Joint injection, without or with ultrasound guidance	Same-day E/M needs modifier 25. Ultrasound guidance is included in 20611, so a separate imaging code is an error.
73000 series	X-rays	The professional and technical split depends on who owns the equipment and who reads the image.

Surgery centers, implants, and facility claims

The surgeon’s claim, the assistant surgeon (modifier 80, 82, or AS) or co-surgeon (modifier 62) claims, and the surgery center’s facility claim are separate claims with separate edits. Before claims go out, we reconcile the operative report, the implant log, and the scheduled procedure, and we track implant and supply charges that payers carve out of the facility payment.

In-office ancillaries and DME

X-rays, casting and splinting supplies, braces and orthoses, and viscosupplementation injections produce steady revenue when charge capture is complete. We compare what is dispensed against what is billed, and we check medical necessity and authorization for DME before the claim is sent.

Prior authorization and denial management

Prior authorization for imaging, surgery, implants, injections, and therapy is the most avoidable source of orthopedic denials. We verify benefits and request authorization before the date of service, then attach the approval number to the claim. The denials we see most often in orthopedics:

A post-op visit denied as included in the global period
Missing or incorrect laterality
A modifier 59 or X-modifier mismatch on bundled procedures
Medical necessity for imaging, injections, or surgery
Missing prior authorization
Timely filing

We appeal with the operative report and the payer’s policy attached, and we trace each denial back to the step that caused it.

Orthopedic practices we support

Solo and group practices, hospital-employed surgeons, and surgeons who own a surgery center. Subspecialties include joint replacement, spine, sports medicine, hand and upper extremity, foot and ankle, trauma, and pediatric orthopedics. Practices that add physical therapy, podiatry, chiropractic, or urgent care services can bill them with the same team.

How we get started

1. Free billing review

We review recent claims and A/R to find unbilled post-op visits, aging claims, and top denial reasons.

2. Setup

Credentialing, payer enrollment, EHR and practice management access, and global period rules are loaded.

3. Go-live

Charges flow to us daily and claims are scrubbed before submission.

4. Monthly reporting

Collections, days in A/R, and denial rate by surgeon and CPT code.

What orthopedic billing costs

Most billing companies charge a percentage of collections, and the rate moves with surgical volume, surgery center and implant work, injury-case mix, and how much old A/R needs cleanup. Medix Revenue Group charges 3% to 8% of collections, with no long-term contracts and no hidden fees. You pay a percentage of what we collect for you, and you can leave with 30 days’ notice.

Why orthopedic practices choose Medix Revenue Group over other orthopedic medical billing companies

Orthopedic groups that move their billing to us usually do so for these reasons:

Coders who know your specialty: Our certified team handles the billing rules unique to orthopedics, from post-surgery global periods to modifier selection and bundled procedure edits, so claims are coded right the first time.
No revenue lost to missed follow-up: We check authorizations up front and stay on each claim until it’s paid, so money doesn’t slip away in the gaps.
Fits the tools you already use: We connect to your current EHR or practice management system, so your team keeps its workflow and nothing has to be moved or rebuilt.

Performance You Can Expect

Find out how much post-op revenue is sitting unbilled.

Frequently Asked Questions (FAQs)

What do orthopedic billing services include?

Coding review, eligibility and prior authorization, claim submission, denial management, A/R follow-up, payment posting, patient billing, credentialing, and monthly reporting. We handle surgeon, surgery center, and ancillary claims.

How much do orthopedic billing services cost?

Most companies charge a percentage of collections, and published guides put orthopedic billing at roughly 3% to 8%. Your rate depends on surgical volume, surgery center work, injury-case mix, and A/R cleanup.

What are the most common orthopedic billing codes?

High-volume codes include total knee arthroplasty (27447), total hip arthroplasty (27130), knee arthroscopy with meniscectomy (29881), arthroscopic rotator cuff repair (29827), posterior lumbar fusion (22612), joint injections (20610 and 20611), fracture care, and E/M visits.

How do you handle global periods?

We load the global indicator (000, 010, or 090) for each surgical code, flag every post-op visit, and bill unrelated visits with modifier 24, unrelated procedures with 79, and decisions for surgery with 57, each with supporting documentation.

What is the difference between modifier 78 and modifier 79?

Modifier 78 is an unplanned return to the OR for a related problem during the global period, and it does not start a new global period. Modifier 79 is an unrelated procedure during the global period, and it starts a new one.

Can you work with our current EHR?

Yes. Tell us which EHR and practice management system you use. We confirm access and workflow during the free billing review.

Do you handle credentialing for new surgeons?

Yes. See our credentialing services.

Orthopedic Billing Services for Practices, Surgeons, and ASCs