Orthopedic Billing Services
Orthopedic billing encompasses a wide range of surgical and non-surgical procedures with complex global period rules, fracture care coding, and implant-specific documentation requirements. From arthroscopic procedures and joint replacements to casting and DME supplies, each service has distinct billing rules. Our orthopedic billing specialists ensure accurate coding across the full spectrum of musculoskeletal care.
Who This Page Is For
Common Billing Friction in Orthopedic
Global Period and Post-Operative Care Rules
Orthopedic surgical procedures have 10-day or 90-day global periods during which follow-up care is included in the surgical fee. Billing for complications, unrelated services, or return trips to the OR during the global period requires specific modifiers.
Fracture Care Coding Complexity
Fracture treatment coding depends on whether care is surgical or non-surgical, open or closed, with or without manipulation, and the specific anatomic site. Initial fracture care includes follow-up visits within the global period.
Implant and Device Pass-Through Billing
Joint replacement and fixation hardware billing requires matching specific implant codes to procedure codes, with facility and professional component splits that vary by payer and site of service.
Arthroscopy Multi-Procedure Bundling
Arthroscopic procedures performed through the same portal are frequently bundled by payers. Proper use of modifier 59 and documentation of separate surgical sites or approaches is essential to capture all performed procedures.
Orthopedic-Specific Payer Issues We Watch For
UnitedHealthcare
Issue: Applies multiple procedure discount to bilateral joint procedures (50 modifier) more aggressively than Medicare, sometimes reducing the second side to 25% instead of 50%
Our approach: We verify UHC bilateral procedure reimbursement rates and appeal underpayments when the discount exceeds the contracted bilateral reduction percentage
Medicare
Issue: 90-day global surgical period includes all follow-up care related to the surgery — billing E/M visits during the global period without modifier 24 for an unrelated condition results in denial
Our approach: We track global surgical periods for every orthopedic procedure and apply modifier 24 for unrelated conditions or modifier 58 for staged procedures during the global period
BCBS
Issue: Requires prior authorization for all joint replacement procedures and denies claims when conservative treatment documentation (6 months of physical therapy, injections, NSAIDs) is not included in the auth request
Our approach: We compile prior authorization packages with documented conservative treatment history, diagnostic imaging, and functional limitation assessments per BCBS criteria
Aetna
Issue: Bundles certain fracture care codes with the initial E/M visit, denying the fracture management code when billed on the same day as the emergency or office visit
Our approach: We separate initial fracture evaluation from fracture management billing when both are performed and document distinct services with modifier 25 on the E/M component
What We Handle
Surgical Procedure Coding
Accurate coding of arthroscopic, open surgical, and minimally invasive orthopedic procedures with proper modifier application.
Fracture Care Billing
Complete fracture care coding including initial treatment, global period management, and complication billing.
DME and Supply Billing
Billing for braces, orthotics, crutches, and other orthopedic supplies with correct HCPCS codes and documentation.
Global Period Tracking
Monitoring 10-day and 90-day global periods to ensure correct modifier usage for services during post-operative windows.
Sports Medicine Billing
Specialized coding for sports medicine services including regenerative medicine procedures and concussion management.
Key Orthopedic CPT Codes
| CPT Code | Description | Avg. Reimbursement |
|---|---|---|
| 27447 | Total knee arthroplasty | $1,850 |
| 27130 | Total hip arthroplasty | $1,950 |
| 29881 | Knee arthroscopy with meniscectomy | $825 |
| 29827 | Shoulder arthroscopy with rotator cuff repair | $1,450 |
| 20610 | Arthrocentesis, major joint | $85 |
| 20680 | Hardware removal, deep | $620 |
| 29826 | Shoulder arthroscopy with acromioplasty | $980 |
| 28296 | Bunionectomy with osteotomy | $1,100 |
Real Results
The Challenge
An 8-provider orthopedic group was losing revenue on multi-procedure surgical cases, missing implant pass-through billing at its ASC, and not capturing in-office physical medicine services performed by staff
Our Approach
We corrected multi-procedure surgical coding with proper modifier application, implemented implant billing workflows for the ASC, and launched in-office physical medicine and DME code capture
Key Outcomes
- check_circle Surgical revenue per case increased by $380 average
- check_circle ASC implant billing added $11,200 per month
- check_circle In-office physical medicine revenue added $5,600 per month
- check_circle Annual practice revenue increased by $298K
“We had no idea our ASC was eating implant costs instead of billing for them. MedPrecision set up the pass-through billing and it was like finding free money.”
Why General Billing Teams Miss Orthopedic Issues
General billing staff handle dozens of specialties and rarely develop the depth needed for orthopedic coding nuances. Here is what gets missed.
Modifier and bundling errors
Specialty-specific modifier rules and CCI edits are frequently overlooked by teams that do not work exclusively in orthopedic.
Under-coding high-complexity visits
Orthopedic encounters often qualify for higher-level E/M codes, but generalist billers default to mid-level codes to avoid audit risk.
Missed payer-specific rules
Each payer has unique coverage and documentation requirements for orthopedic procedures that general teams rarely memorize.
Slow denial turnaround
Without specialty knowledge, appeal letters lack the clinical specificity needed to overturn orthopedic denials quickly.
“Orthopedic practices generate revenue from three sources — surgical procedures, in-office physical medicine, and DME. Most practices optimize the surgical coding but leave the other two revenue streams significantly underbilled.”
MedPrecision Billing Team
Orthopedic Surgery Coding Specialist
Transition Plan
Switching billing partners should not disrupt patient care or cash flow. Our transition plan is designed for zero downtime.
Discovery and Specialty Audit
We review your current orthopedic billing workflows, denial patterns, and payer mix to build a tailored onboarding plan.
System Integration
We connect to your EHR and practice management system, configure specialty-specific code sets, and validate charge capture workflows.
Parallel Billing Period
We run billing in parallel with your current process for 2-4 weeks to verify accuracy before taking over completely.
Full Transition and Reporting
Once validated, we assume full billing responsibility with monthly reporting dashboards and a dedicated account manager.
Orthopedic Billing Terms
- Global Surgical Period
- The post-operative period (0, 10, or 90 days) during which follow-up care related to the surgery is included in the procedure's reimbursement. Major orthopedic procedures have 90-day global periods. Unrelated services require modifier 24.
- Implant Pass-Through
- Separate billing for high-cost orthopedic implants (joint prostheses, spinal hardware) that are not included in the procedure's facility fee. Requires manufacturer invoice documentation and correct HCPCS coding.
- Multiple Procedure Reduction
- Payment reduction applied to additional procedures performed during the same surgical session. In orthopedics, affects bilateral procedures and same-session operations on different body areas.
- Fracture Care Coding
- The distinction between initial fracture evaluation (E/M code) and fracture management (treatment code including follow-up care). Different coding applies for surgical vs non-surgical fracture treatment.
- Modifier 59 (Distinct Procedural Service)
- Used in orthopedics to indicate that procedures performed on different anatomic sites or during different surgical sessions are separate services. Common for multi-site arthroscopic procedures.
- Bilateral Modifier (50)
- Applied when the same procedure is performed on both sides of the body during the same session. Reimbursement is typically 150% of the single-procedure rate, but payer-specific bilateral reduction policies vary.
Last updated: 2025-02-18
Common Questions
Common questions about orthopedic billing services.
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Request Review arrow_forwardHow do you handle billing during the 90-day global period?
Services during the 90-day global period are typically included in the surgical fee. However, we bill separately for unrelated E/M visits (modifier 24), return trips to the OR for related procedures (modifier 78), and unrelated procedures (modifier 79). We track global periods for every surgical patient to capture all billable services.
What is the difference between initial fracture care and subsequent fracture care billing?
Initial fracture care includes the treatment code plus a global period covering follow-up visits. If a different provider takes over fracture management, subsequent care is billed using different codes. We ensure proper coding based on whether your practice provided initial or assumption-of-care treatment.
Do you bill for orthopedic implants and hardware separately?
In facility settings, implants are typically billed by the hospital separately from the surgeon's professional fee. In office-based ASC procedures, we ensure implant costs are captured through appropriate billing channels and HCPCS codes specific to the device used.
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