Orthopedic Billing: The Guide for Surgery and Sports Medicine Practices

High-performing billing partners provide specialized billing for orthopedic surgery and sports medicine practices — global period management, implant billing, prior authorization for elective procedures, and systematic AR follow-up. Performance-based billing that captures the full value of complex orthopedic cases.

95%+Clean Claim Target
<5%Denial Rate
<35Days in AR Target
11.6%Natl. Avg Denial Rate
Orthopedic Billing

Orthopedic billing is among the most complex in surgical specialties — global periods, implant billing, laterality modifiers, arthroscopic code selection, and prior authorization for all elective procedures create a billing environment where errors are frequent and revenue leakage is significant. A single joint replacement case involves the surgeon's fee, implant billing, assistant surgeon, and anesthesia — each with separate rules and payer-specific nuances. Orthopedic practices with specialized billers consistently outperform those using generalist billing staff by 20–35% in net collections per case.

Image: Orthopedic surgeon / operating room with joint replacement procedure

Orthopedic Procedures We Specialize In

Joint Replacement

TKA (27447), THA (27130), shoulder (23472). 90-day global period management. Implant component billing (L-codes). Prior auth with conservative treatment documentation.

Arthroscopic Surgery

Knee arthroscopy (29880–29889), shoulder arthroscopy (29821–29828), hip arthroscopy (29860–29863). Arthroscope + procedure code selection. Bilateral and multiple-procedure modifier rules.

Fracture Care

Closed (no surgery) and open reduction/internal fixation (ORIF) codes. Fracture care global periods. Post-fracture follow-up during global period modifier compliance.

Spine Surgery

Discectomy, laminectomy, fusion procedures (22610–22630). Instrumentation add-ons. Prior auth with imaging and conservative treatment documentation.

Sports Medicine

ACL reconstruction (27407), rotator cuff repair (23412), meniscal repair (29882). Competition-injury documentation for workers' comp claims. Return-to-play visit billing.

Office Procedures

Joint injections (20610/20611), aspiration, casting/splinting (29000–29799), durable equipment dispensing. Same-day E&M and procedure billing rules (-25 modifier).

Full Orthopedic Billing Services

Global Period Management

Tracking all patients in a global period, applying correct modifiers (-24, -25, -57, -79) for services inside global periods, and ensuring no billable services are bundled incorrectly into the surgical fee.

Prior Authorization

Complete auth packages for elective surgical procedures — imaging documentation, conservative treatment failure evidence, physician clinical notes — submitted and tracked for every scheduled procedure.

Implant & Supply Billing

Implant billing separate from the surgical fee where permitted. HCPCS L-code selection for orthotics and prosthetics. Cost report documentation for hospital-based billing.

Modifier Accuracy

Laterality (-LT/-RT), bilateral (-50), multiple procedures (-51), assistant surgeon (-80), and distinct service (-59/-XS) modifiers applied correctly for every claim — the biggest driver of orthopedic coding errors.

ASC vs. Hospital Billing

Correct place of service (22 = outpatient hospital, 24 = ASC) with appropriate fee schedules. Professional component billing coordinated with facility billing to prevent splits and duplications.

Workers' Comp Billing

Workers' compensation claims require separate payer enrollment, different fee schedules, and injury documentation. We manage workers' comp billing alongside commercial claims for orthopedic practices with high WC volume.

Orthopedic Billing FAQ

The global surgical period is the time after surgery during which routine post-op care is included in the surgical fee — 90 days for major procedures (joint replacement, spinal fusion), 10 days for minor procedures. Services during the global period for related conditions cannot be billed separately without a modifier. Modifier -24 = unrelated E&M during global period; modifier -79 = unrelated procedure; modifier -78 = return to OR for related complication. Billing routine post-op visits as E&M codes without checking global period status is the most common orthopedic billing compliance error.
Orthopedic implants are typically billed separately from the surgical procedure. In the ASC setting, implants above a threshold are pass-through billable using HCPCS C-codes. In the hospital outpatient setting, implant billing rules vary by payer. For professional billing (the surgeon's fee), implants are typically not in scope — the surgeon bills the CPT procedure code and the facility bills the implant separately. Confusion between professional and facility billing for implants is a common cause of missed revenue and claim conflicts.
The top orthopedic billing errors are: (1) billing E&M during global period without modifiers; (2) wrong laterality modifier (-LT/-RT) or missing bilateral (-50) on bilateral procedures; (3) arthroscopic code selection errors — billing the arthroscope code alone instead of the arthroscope + procedure code; (4) missing add-on codes for additional structures addressed in the same session; (5) wrong place of service (22 vs. 24) affecting the applicable fee schedule and implant billing rules; (6) missing prior auth for elective procedures.
Yes — most commercial payers and Medicare Advantage plans require prior authorization for elective orthopedic procedures. Joint replacements, arthroscopic surgery, and spine procedures typically require PA with imaging documentation and evidence of conservative treatment failure (PT, injections). Emergency and trauma orthopedic procedures do not require prior auth, but post-emergency elective procedures (e.g., delayed ORIF scheduling) may. Without a PA management workflow, orthopedic practices face high surgical denial rates.

Get a Free Orthopedic Billing Audit

We'll review your global period compliance, modifier accuracy, prior auth denial rate, and AR by procedure — and show you where your orthopedic practice is leaving revenue on the table.