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Orthopedics billing

Orthopedic Billing Services

Joint replacements, arthroscopy, spine surgery, injections and DME, orthopedic billing covers it all, with global periods and modifiers on every claim. Specialist billers get it right.

  • Surgical coding with global periods and modifiers 24/25/57/58/79
  • Spine, joint and arthroscopy procedures coded from op notes
  • DME, bracing and injection billing with prior authorization

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96%
Clean-claim rate target
20%
Typical surgical revenue recovered
< 35
Days in A/R goal
Overview

Why orthopedic billing needs specialists

Orthopedic practices bill high-value surgeries that come with 90-day global periods. Any visit or procedure during the global needs the right modifier, unrelated E/M, staged procedures, return to the OR for complications or unrelated procedures, or it will be denied as included in the surgery.

Spine surgery coding is especially complex, with approach, levels, instrumentation and bone grafts all coded separately. Arthroscopy codes depend on compartments treated, and joint injections, viscosupplementation and imaging guidance carry their own rules and drug codes.

Practices also dispense braces and DME, manage workers’ compensation and auto claims, and often need prior authorization for MRI and surgery. An orthopedic billing partner coordinates all of this so surgeons are paid for every case and every follow-up service.

Why it's hard

Common orthopedics billing challenges

01

Global period modifiers

Services during 90-day globals need modifiers 24, 25, 57, 58, 78 or 79 to be paid.

02

Spine surgery complexity

Levels, approach, instrumentation and grafts must be coded separately and accurately.

03

Arthroscopy bundling

Multiple procedures in the same knee or shoulder follow NCCI bundling rules.

04

Prior authorization

MRI, surgery and some injections require authorization before scheduling.

05

DME and bracing rules

Orthotics need correct L-codes, documentation and supplier enrollment.

06

Workers’ comp and auto claims

Non-traditional payers require state fee schedules and extra reporting.

What's included

What a orthopedics billing partner should handle

  • Prior authorization for imaging and surgery
  • Surgical coding from operative reports
  • Global period and modifier management
  • Spine and joint replacement coding
  • Injection, viscosupplement and drug billing
  • DME and orthotic L-code billing
  • Workers’ compensation and auto claim handling
  • Denial management and appeals
  • Surgery scheduling and patient estimates
  • Surgeon productivity and revenue reports
Coding focus

Key codes in orthopedics billing

Code(s)What it covers
27447Total knee arthroplasty.
27130Total hip arthroplasty.
29881Knee arthroscopy with meniscectomy (medial or lateral) including debridement.
29827Shoulder arthroscopy with rotator cuff repair.
22551Anterior cervical discectomy and fusion, single interspace.
20610 / 20611Major joint arthrocentesis or injection, without / with ultrasound guidance.
L1833Knee orthosis, adjustable, prefabricated, off-the-shelf (example DME code).

Code examples are for orientation only. Always code from the current CPT®, HCPCS and ICD-10-CM code sets and payer policies.

Global surgery compliance

Track each patient’s global period and use modifiers only when the documentation supports them. Payers audit modifier 25 and 59 use in orthopedics closely.

How it works

Find the right billing partner in four steps

1

Share your goals

Tell us your specialty, monthly claim volume, EHR and the problems you want fixed, denials, slow A/R or staffing gaps.

2

Get a free audit

We review a sample of your claims and aging report to show where revenue is leaking and what a specialist could recover.

3

Compare vetted companies

Shortlist billers with proven orthopedics experience, transparent pricing and verified client reviews.

4

Onboard with confidence

Sign a BAA, connect your EHR and clearinghouse, and track clean-claim rate, days in A/R and collections from month one.

Compare

Top-rated medical billing companies

Billing companies listed on BillerFirms, ranked by client reviews. Ask each one about their orthopedics experience.

See all companies
5.0 5 reviews

Who We Are We are Prime Medical Billing Solutions, LLC, a results-driven medical billing and revenue cycle partner headquartered in Atlanta, Georgia. Since about 2015, we have operated with the belief that true value lies in partnering, rather than merely contracting, with providers to ensure personalized attention and peak revenue performance. Founded by seasoned billing professionals with 20+ years of combined expert experience, our home office in Atlanta supports both individual practices and larger provider groups. Our team is passionate about maximizing reimbursements and simplifying the billing journey step by step. What Services We Offer We provide a comprehensive suite of services designed to optimize every phase of the revenue cycle: Claims processing & billing management, including electronic, UB‑04, and HCFA‑1500 formats Accounts receivable and collections, focusing on paid-to...

Atlanta, Georgia
Founded 2015
Claims ProcessingDenial ManagementCredentialing (Payer & License)
No reviews yet

GreenSense Billing is a trusted leader in medical billing and revenue cycle management, providing comprehensive solutions tailored to the unique needs of healthcare providers across the United States. Our mission is to streamline administrative complexities, optimize reimbursements, and enhance financial performance, allowing medical professionals to focus on delivering exceptional patient care. Our Services • We offer end-to-end medical billing and revenue management solutions, including: •  Medical Billing & Coding - Accurate claims processing to maximize reimbursements and minimize denials. •  Revenue Cycle Management (RCM) - A holistic approach to managing claims, payments, and collections. •  Provider Credentialing - Seamless enrollment with insurance networks to ensure timely reimbursements. •  Financial Solutions - Data-driven insights and financial reporting to optimize practice...

Las Vegas, Nevada
Founded 2003
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Let’s face it, medical billing shouldn’t be the most challenging part of running a practice. At Medical Lean Management, we take the chaos out of revenue cycle management so you can get back to what matters: delivering excellent patient care. Based in Corona, California, we’re not just another faceless billing company, we’re your partners in efficiency, here to simplify the financial side of healthcare. Why Us? Because We Get It. Paperwork piles up. Claims get denied. Regulations keep changing. It’s enough to make anyone’s head spin. That’s where we step in. We don’t just process claims, we optimize your entire revenue cycle, cutting through the red tape to get you paid faster and with fewer headaches. Our goal? To make your billing so smooth, you’ll wonder how you ever managed without us. Here’s How We Help: ✔ Fewer Denials, More Revenue - Our precision-driven approach slashes claim den...

Corona, California
Founded 1994
Claims ProcessingDenial ManagementRevenue Cycle Management
No reviews yet

Overview & Mission Access Revenue Hawaii, founded in 2022 in Holualoa, Hawai‘i, is a specialized medical billing and revenue cycle management (RCM) company with a primary focus on behavioral and mental health providers. Drawing deeply from social work roots, the leadership team recognized the administrative friction mental health professionals face, credentialing delays, complex payer regulations, EMR documentation requirements, and chose to build a firm that helps clinicians focus fully on patient care. Their mission centers on removing financial and operational barriers so therapists, counselors, and behavioral health groups can thrive financially while delivering quality care to Hawai‘i’s communities. Origin Story & Local Presence The company was born out of a clear insight: behavioral health providers in Hawai‘i suffer unique administrative challenges. From intricate Medicaid billing...

Chandler, Arizona
Founded 2007
Claims ProcessingDenial ManagementRevenue Cycle Management
Pricing

How much does orthopedics billing cost?

Most billing companies charge a percentage of what they actually collect, so their incentive matches yours. Complex specialties sit at the higher end of the range because of prior authorizations, modifiers and appeal work.

Percentage of collections
4% - 7%

Most common. You pay only on money collected.

Per claim
$4 - $10

Predictable for high-volume, low-complexity claims.

Hourly / FTE
$12 - $35/hr

Dedicated billers working inside your systems.

Typical market ranges; actual quotes depend on claim volume, payer mix and scope. Compare quotes from several companies.

FAQ

Orthopedics billing FAQs

A set period (0, 10 or 90 days) after surgery during which related follow-up care is included in the surgical payment.

For an unrelated procedure performed by the same physician during the postoperative period of another procedure.

Yes, when a significant, separately identifiable E/M service is documented, the visit is billed with modifier 25.

Yes, with correct L-codes, documentation, and supplier enrollment requirements.

Yes, including state fee schedules, required reports and adjuster follow-up.

Typically 4% to 7% of collections.

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