Orthopedic Billing
Orthopedic billing is among the most complex in healthcare; high-value surgical claims, modifier-sensitive coding, workers' compensation cases, and payer-specific rules create constant denial risk. ProtoMed's certified orthopedic billing specialists handle every claim with the precision your practice demands. Fewer denials. Faster reimbursements. More revenue.
98%+
Clean Claim Rate
We review every claim before submission, catching laterality errors, global period conflicts, modifier mismatches, and prior authorization gaps that trigger denials.
Why Choose Us
Orthopedic practices deal with some of the highest-value claims in medicine: joint replacements, spine surgeries, arthroscopies, fracture repairs, and complex trauma cases. A single modifier error, an incorrect laterality code, or a missed prior authorization can cost your practice thousands in denied or underpaid claims. Generalist billing teams simply do not have the orthopedic-specific knowledge to prevent those losses.
ProtoMed's certified orthopedic billing specialists understand the full complexity of musculoskeletal coding, from standard arthroscopy codes and global period rules to workers' compensation billing and No Surprises Act compliance. We catch errors before they reach the payer and follow up on every denial until your practice collects what it has earned.
Every biller on your account holds active AAPC and AHIMA credentials with hands-on experience in orthopedic-specific CPT coding, modifier rules, and payer guidelines.
We review every claim before submission, catching laterality errors, global period conflicts, modifier mismatches, and prior authorization gaps that trigger denials.
We securely log into your existing EHR (Epic, Athenahealth, eClinicalWorks, and more) with zero disruption to your daily clinical workflow.
From charge capture and eligibility verification to submission, denial appeals, and payment posting, we manage the complete orthopedic billing cycle.
Every rejected claim is investigated, corrected, and resubmitted. We recover the orthopedic revenue your practice is owed, including complex spine and workers' comp cases.
Monthly reports and real-time billing data give you a clear picture of your collections, denial patterns, and overall revenue performance by procedure and payer.
Our Expertise
Orthopedic billing covers hundreds of CPT codes across joint, spine, trauma, and sports medicine categories, each with its own modifier rules, global period requirements, and payer-specific documentation standards. Our certified coders know every nuance.
Total knee and hip arthroplasty: primary and revision with laterality modifiers
Arthroscopy: knee, shoulder, hip, ankle with procedure-specific add-on codes
Spine procedures: cervical, thoracic, lumbar including fusion and instrumentation
Shoulder procedures: rotator cuff repair, SLAP, labrum, and acromioplasty
Wrist and forearm: fracture repair, carpal tunnel, and ligament reconstruction
Leg and ankle procedures: fracture fixation, tendon repair, and ligament surgery
E/M visits with same-day procedures: modifier -25 and global period compliance
Procedure-Specific Billing
Every orthopedic procedure comes with its own coding complexity, documentation requirements, and payer coverage rules. ProtoMed's certified team handles them all, including the difficult claims other billing companies avoid.
Total knee, hip, and shoulder arthroplasty claims require precise laterality coding, implant documentation, and post-operative global period management. We ensure every replacement claim is coded correctly, submitted on time, and recovered in full, including revision procedures.
Spine is the most complex coding area in orthopedics. From single-level discectomies to multi-level fusion with instrumentation, we apply the correct approach codes, add-on codes, and payer-specific bundling rules, and we pursue every denial on high-value spine claims.
Arthroscopic procedures require careful distinction between diagnostic and operative coding, correct portal and technique documentation, and proper add-on code use. We capture the full value of every arthroscopy encounter across knee, shoulder, hip, and ankle procedures.
Workers' comp billing follows different rules than standard insurance: fee schedules, state-specific forms, and payer authorization requirements all vary. Our team handles workers' comp claims correctly from the start, reducing delays and ensuring your practice gets paid by every payer type.
Fracture billing hinges on accurate coding of treatment type, location, and displacement status. We correctly apply closed versus open treatment codes, manage global period rules for subsequent care, and capture co-management and assistant surgeon claims where applicable.
Rotator cuff repairs, ACL reconstructions, and tendon procedures each carry unique documentation and modifier requirements. We ensure complete and accurate coding for sports medicine cases, including proper use of modifiers -62 and -80 for co-surgeon and assistant surgeon billing.
Our Process
A structured four-step process that protects your revenue from pre-authorization through final payment, on every claim, including the complex ones.
We review your current orthopedic billing setup, identify revenue leaks, and securely access your existing EHR and practice management systems. No disruption to your clinical schedule: we work inside the systems you already use.
Our certified coders review every encounter, verify prior authorization and patient eligibility, and assign the correct CPT codes, modifiers, and diagnosis codes for each orthopedic procedure. Accurate coding before submission means fewer denials and maximum reimbursement on every claim.
Clean, payer-compliant orthopedic claims are submitted on time to all payer types: commercial insurance, Medicare, Medicaid, and workers' compensation. We track every claim, follow up persistently, and escalate denials and appeals until your practice receives full payment.
Payments are posted accurately, underpayments and exceptions are flagged immediately, and you receive clear monthly reports tracking your collections, denial rates, and revenue performance by procedure and payer.
Let ProtoMed's certified orthopedic billing specialists take the complexity off your plate, including your most difficult spine, workers' comp, and high-value surgical claims. We'll audit your current billing, identify what's being left on the table, and start recovering it.
Get your free orthopedic billing audit today. A ProtoMed expert will reach out within 24 hours.
