Getting authorizations for surgery and advanced imaging, and documenting medical necessity for joint procedures, are just as important as the coding itself.
Why specialized orthopedics billing matters
Orthopedic surgery billing depends on understanding global packages: what's included, what's separately payable, and which modifier tells the payer why.
Our orthopedic medical billing services
- Surgical claims with global period tracking
- Fracture care and casting/strapping billing
- Joint replacement and arthroscopy claims
- Joint injections and drug billing
- DME and bracing claims where applicable
Every engagement includes our full medical coding services workflow, adapted to orthopedics rules.
Orthopedics coding and claims management
Examples of the codes and rules our team works with every day:
90-day global
Major procedures include related pre-op (day before), intra-op and post-op care for 90 days.
Modifier 57
Decision for surgery on an E/M the day before or day of a major procedure.
Modifiers 24 / 79
Unrelated E/M or unrelated procedure during a post-op period.
Modifiers 25 / 59
Separately identifiable E/M with a minor procedure, and distinct procedural services; payers may prefer X{EPSU} modifiers.
Codes are examples, not coding advice. We apply current CPT®, ICD-10-CM, HCPCS and payer policy to each claim.
Common orthopedics billing challenges and claim denials
Global period conflicts
Post-op visits billed without the right modifier are denied as included.
Fracture care choices
Billing global fracture care vs E/M plus casting must reflect who will provide follow-up.
Authorizations
MRI, surgery and some injections often need prior authorization.
Bilateral and multiple procedures
Modifiers 50, 51, RT/LT and multiple procedure payment rules affect reimbursement.
How our RCM services help orthopedics practices
Our orthopedic revenue cycle management coordinates surgical authorizations, global tracking and implant documentation so high-value claims don't stall.
Insurance eligibility and benefits verification
We verify surgical benefits, deductibles and authorization requirements before procedures are scheduled. Learn about verification.
Payment posting and accounts receivable
We check multiple-procedure reductions are applied correctly and flag underpayments. Unpaid claims are followed up through our A/R management process.
Denial management and appeals
We appeal global period and bundling denials with operative notes. See our denial management services.
Credentialing and enrollment
We credential orthopedic surgeons and APPs, including hospital and ASC-related payer enrollments. Insurance credentialing is $150 per payer.
Why orthopedics providers choose Cyber Sense
- Transparent pricing: 4% of monthly insurance collections, no hidden fees or minimums
- We work inside your existing EHR / PM system
- Billers who understand orthopedics payer rules
- Monthly reports on collections, denials and A/R
- No patient-level data collected through marketing forms; access to your systems is role-based
Our orthopedics medical billing workflow
- 1Practice review and onboarding
- 2Eligibility and authorization checks
- 3Coding review and charge entry
- 4Claim scrubbing and submission
- 5Payment posting and reconciliation
- 6Denial work and A/R follow-up
- 7Monthly reporting and review call
Orthopedics medical billing FAQs
Do you track global periods?
Yes, by procedure and date, so post-op visits and unrelated services are billed correctly.
Can you get surgical authorizations?
Yes, through our prior authorization support.
Do you bill workers' compensation?
Ask us about your state — rules and fee schedules vary by state.
Do you handle injection drug billing?
Yes, with HCPCS J-codes and units matching documented dose.
What is the cost?
4% of monthly insurance collections.
Orthopedics billing articles
- Orthopedic Global Surgical Periods: Review the Episode Before Billing the VisitReview orthopedic global surgical periods, postoperative exceptions, transfer records, and claim checks without treating every follow-up as separately billable.
- Fracture Care or Visit-Based Services? Document the Treatment ResponsibilityDistinguish fracture care from visit-based orthopedic services using treatment records, responsibility checks, global review, and payer-specific safeguards.
- Joint Replacement Authorization Records: Build a Traceable Surgical PacketBuild joint replacement authorization records that connect clinical evidence, payer criteria, procedure details, scheduling changes, and final claim review.
- Orthopedic Modifiers 25 and 59: Two Different Documentation QuestionsSeparate modifier 25 E/M review from modifier 59 procedure review with orthopedic examples, documentation checks, NCCI limits, and payer-specific safeguards.
- Orthopedic Injection and Aspiration Claims: Reconcile the Note, Drug, and ChargeConnect orthopedic injection and aspiration notes with anatomic sites, drug quantities, guidance records, E/M review, and payer-specific claim requirements.
- Orthopedic Diagnosis Review: Laterality and Injury Encounter CharactersReview orthopedic laterality and injury encounter characters using clinical treatment phases, conflict resolution, current code sets, and claim-level checks.
- Orthopedic DME and Orthoses: Control the Order-to-Claim HandoffOrganize orthopedic DME and orthosis claims around valid orders, clinical support, delivery evidence, item coding, and payer-specific release requirements.
- Orthopedic Surgery Denial Appeals: Match the Evidence to the DisputeBuild orthopedic surgery appeals around the actual denial, service-date policy, indexed clinical evidence, correct filing route, and documented follow-up.
- Postoperative A/R Reconciliation: Separate Included Care from Unresolved ClaimsReconcile postoperative orthopedic A/R by surgical episode, separating included care, payment posting errors, disputed exceptions, and follow-up ownership.
- Orthopedic Billing Outsourcing: Plan the Transition Around Active EpisodesPlan an orthopedic billing outsourcing transition with episode ownership, authorization continuity, claim controls, legacy A/R mapping, and acceptance checks.
- Orthopedic E/M Coding: New vs. Established Patients and Medical Decision MakingHow orthopedic practices apply the three-year new patient rule across subspecialties, select office E/M levels by MDM or time, and avoid common E/M denials.
- In-Office Imaging in Orthopedic Claims: X-Rays, Interpretations, and Outside FilmsHow orthopedic practices bill in-office X-rays and other imaging, document interpretations, handle outside films and avoid duplicate component billing.
- Physical Therapy Services Inside Orthopedic Practices: Billing and ComplianceHow orthopedic groups that employ physical therapists bill therapy services: enrollment, plans of care, GP modifier, incident-to limits and Stark considerations.