Orthopedic medical billing services
Surgical global periods that swallow legitimate visits, bilateral and multiple-procedure reductions, and in-office supplies and DME that most practices never bill at all.
Also called: Orthopaedics · Orthopedic Surgery. We keep one page per specialty rather than a page per name.
Why orthopedics billing is different
Orthopedics is a surgical specialty running an outpatient clinic, and the two halves follow different rules. A major procedure carries a 90-day global period; a minor one carries 10 days. Inside that window, a related visit is not separately billable and an unrelated one is — but only if the claim says so with a modifier. Practices that do not track global periods lose money twice: they write off visits they could have billed, and they bill visits they could not.
The second problem is what happens in the treatment room. Casting and splinting supplies, durable medical equipment, and injection materials are separately payable, and a large share of independent orthopedic practices never bill them. The work is done, the supply is consumed, and no charge is ever created.
Third, orthopedics carries one of the heaviest prior-authorisation loads in outpatient medicine. Advanced imaging, most arthroscopic and joint replacement procedures, and a growing list of injectables all require authorisation, often through a delegated musculoskeletal benefit manager with its own clinical criteria.
Codes we work with
The families this specialty actually bills, and where each one carries a rule worth knowing.
| Family | Range | Notes |
|---|---|---|
| Musculoskeletal surgery | 20000–29999 | Organised by anatomic site, from shoulder through foot |
| Arthroscopy | 29800–29999 | Diagnostic and surgical, dense NCCI bundling within a compartment |
| Joint and tendon injections | 20600–20611, 20550–20553 | Ultrasound guidance separately reportable where documented |
| Casting, splinting and strapping | 29000–29799 | Application only; the supply is billed separately |
| Casting supplies | Q4001–Q4051 | Material codes by body part and casting type |
| In-office radiology | 73000–73725 | Component split where the practice owns the equipment |
| Orthotics, braces and DME | L0450–L4631 | Requires a written order and, for many payers, prior authorisation |
| Evaluation and management | 99202–99215, 99024 | 99024 records a post-operative visit inside the global period |
Modifiers that matter
And the specific way each one is most often misused in this specialty.
| Modifier | Use | Common error |
|---|---|---|
| 50 | Bilateral procedure | Billed as two lines instead of one bilateral line, producing a duplicate denial |
| LT / RT | Laterality | Omitted entirely, so same-day contralateral work reads as a duplicate |
| 51 | Multiple procedures in one session | Applied to add-on codes, which are exempt from the reduction |
| 59 / XS / XU | Distinct procedural service, separate site or unusual non-overlapping service | Modifier 59 used where the specific X modifier is required, or used to bypass a valid bundling edit |
| 58 / 78 / 79 | Staged, unplanned return to theatre, or unrelated procedure in the global period | Left off, so the claim denies as included in the global package |
| 24 | Unrelated E/M during a post-operative period | Not applied, so a legitimate unrelated visit is written off |
| 25 | Separate E/M on the same day as an injection | Applied by default rather than where a distinct evaluation is documented |
Top denial reasons
With the CARC code you will see on the remittance, and what we do to stop each one recurring.
| Denial | CARC | How we prevent it |
|---|---|---|
| Service included in the surgical global package | CO-97, CO-B15 | Global periods tracked per patient, with 24/58/78/79 applied on the evidence |
| Procedure not authorised | CO-197 | Authorisation determined at scheduling for imaging, arthroscopy and injectables |
| Bilateral or laterality conflict read as a duplicate | CO-18 | Bilateral billing rules applied per payer, LT/RT enforced on every line |
| Missing or invalid modifier | CO-4, CO-16 | Modifier logic applied at coding, not repaired after the denial |
| Diagnosis does not support the procedure | CO-50 | LCD and payer policy checked against conservative-care documentation |
Prior authorisation in this specialty
Orthopedics has one of the highest authorisation burdens in outpatient care. MRI and CT are almost universally managed through a benefit manager. Arthroscopic procedures, joint replacement and spinal surgery typically require documented failure of conservative care over a defined period — physical therapy notes, injection history and imaging findings assembled into one submission. Viscosupplementation and biologics carry their own criteria. We determine the requirement per payer and CPT, assemble the clinical package, track it on a fixed cadence, and escalate to peer-to-peer review rather than letting a scheduled procedure slip.
Where revenue leaks
- Casting, splinting and DME supplies consumed in the clinic and never charged
- Unrelated visits inside a global period written off because modifier 24 was not applied
- Bilateral procedures billed in a way the payer reads as a duplicate
- Imaging performed in-office but billed globally when only the professional component is payable
What we do for orthopedics practices
The parts of the cycle where this specialty gains the most, framed for how it actually bills.
Prior Authorization Services
Auth requests submitted, tracked, and escalated so procedures aren't delayed.
See prior authorizationMedical Coding
Certified CPC and CCS coders assign and validate ICD-10, CPT, and HCPCS codes from your documentation.
See medical codingDenial Management & Appeals
Root-cause analysis, corrected claims, and clinical appeals filed inside payer deadlines.
See denial managementAccounts Receivable Recovery
We work aged and legacy receivables other billers gave up on.
See A/R recoverySee what this specialty is losing in your practice
We run the analysis against orthopedics benchmarks, not a generic template. Send 90 days of claims data and keep the report either way.
Questions about orthopedics billing
Do you track surgical global periods?
Yes, per patient and per procedure, so unrelated visits inside the window are billed with modifier 24 rather than written off.
Can you bill our DME and casting supplies?
Yes. Supply and orthotic codes are billed alongside the application procedure, with the written order documented.
How do you handle bilateral procedures?
Per payer. Some require a single line with modifier 50, others two lines with LT and RT. We apply the rule that payer actually uses.
Do you assemble conservative care documentation for authorisations?
Yes — therapy notes, injection history and imaging findings are assembled into one submission against the payer’s own criteria.
Adjacent specialties
Specialties whose billing shares rules, payers or authorisation patterns with this one.