Orthopedic Medical Billing Services for Private Practices and Surgical Groups

Billing orthopedics is brutal. Miss a single modifier and a $12k surgical claim gets tossed immediately. Forget the implant invoice? That’s $4,000 flushed down the drain. Leave a follow-up visit unlinked, and the payer drops it right into “global.”

SwiftCare provides specialized orthopedic medical billing services and end-to-end orthopedic RCM for surgeons, private practices, and surgical clinics. We partner with solo docs up to 15-provider surgical groups, logging right into your existing EHR to secure every dollar you earn.

Orthopedic billing services built around global periods, implants, and modifiers

Orthopedic billing demands total precision. Generic billing templates miss specialty rules, leaving serious cash behind.

10-day and 90-day global periods tracked per case, not per patient

Major surgeries think TKAs, THAs, and multi-level fusions carry a 90-day global package. Injections and minor procedures carry 0 or 10 days. We track these by the specific case inside your EHR. That way, when a patient comes back for an unrelated joint three weeks later, your front desk doesn’t get hit with an automatic “included in global” denial.

Modifier discipline on 24, 25, 57, 58, 78, 79, 50, 51, 59, LT and RT

Modifiers make or break orthopedic claims. Use them wrong, and you’re leaving money on the table or begging for an audit.

Modifier 24: Bill an unrelated E/M visit during a post-op window.
Modifier 25: Significant, separate E/M done on the exact same day as a procedure.
Modifier 57: E/M visit where you made the call for major surgery.
Modifiers 58, 78, & 79: Staged procedures, return trips to the OR, or totally unrelated surgeries during a global period.
Modifiers 50, 51, & 59: Bilateral cases, multiple procedures, and distinct procedural services.
Modifiers LT & RT: Laterality indicators showing left or right side.

Implant, hardware, and device billing with the invoice attached

Missing invoices cause huge hardware write-offs. The second your team enters charges, our billers pull the vendor invoice, attach it directly to the claim, and bill against commercial or state workers’ comp fee schedules.

Multiple procedure payment reduction sequenced in the right order

Payers reimburse 100% on primary procedures and drop down to 50% for secondary lines. If you list a lower-paying procedure first, you lose cash. We sequence claims strictly by RVU weight and contract rates to keep your highest-paying codes at the top.

ICD-10 laterality and 7th character checked before the claim goes out

One bad digit stops a check. We double-check diagnosis codes before transmission to verify laterality (left, right, bilateral) and proper 7th characters (A for initial, D for subsequent, S for sequela).

What our orthopedics billing services
cover, from eligibility to zero balance

Our orthopedics billing services manage every step of your revenue cycle:

Eligibility and benefits verification

Coverage, deductibles, copays, and surgical benefits confirmed 24 to 48 hours prior to care.

Prior authorization for surgery, injections, and imaging

Authorizations started 14 days ahead for MRIs, viscosupplementation, and joint cases.

Surgical and office charge entry

Clean charge capture taken right from op notes and superbills.

Orthopedic CPT and ICD-10 coding review

Coders cross-check op reports for exact codes (like CPT 27447 for TKA or CPT 22612 for fusion).

Claim scrubbing and same-day submission

Pre-flight edits catch bad pointers, missing modifiers, or NPI errors before same-day submission.

Payment posting and contract variance checks

Daily ERA postings with automatic flags whenever paid amounts don’t match your contract rate.

Denial management and appeals

Swift root-cause checks and formal appeals sent with clinical notes inside 48 hours.

Aged A/R recovery and legacy A/R cleanup

Consistent follow-up on old claims lingering past 30, 60, 90, and 120+ days.

Patient statements and balance questions

Clear patient billing statements backed by helpful phone support and payment plans.

Monthly reporting your practice manager can actually read

Straightforward reports showing clean claim rates, A/R aging, collections, and denial trends.

Orthopedic RCM for the procedures your surgeons perform

Our orthopedic RCM processes match what your surgeons actually do every day.

Total joint replacement billing (TKA, THA, revisions)

Handling major joint work (CPT 27447, 27130, 27487), bundled payments, hardware components, and 90-day globals.

Spine surgery and fusion billing

Managing heavy authorization demands, hardware attachments, BMP codes, and multi-level fusions (CPT 22612, 22630, 63030).

Arthroscopy and sports medicine billing

Stopping bundled code losses on knee, shoulder, and ankle scopes (CPT 29881, 29880, 29826) using proper modifier application.

Fracture care and trauma billing

Knowing when to bill global fracture care (CPT 25605) versus separate E/M visits with cast application (CPT 29000 series).

Hand, foot, and ankle billing

Capturing small-RVU, high-volume work like carpal tunnel releases (CPT 64721) and bunionectomies (CPT 28296) so nothing gets missed.

Injections, viscosupplementation, and PRP

Proper billing for joint injections (CPT 20610), specialty J-codes (J7321–J7326), and cash/unlisted codes (CPT 0232T) backed by medical necessity.

Workers' compensation and personal injury billing

Dealing with adjusters, state fee schedules, clinical notes, and attorney liens with clean, isolated A/R tracking.

In-office DME, bracing, and orthotics billing

HCPCS L-code billing, inventory checks, and Medicare DMEPOS compliance for custom and off-the-shelf braces.

Physical therapy and in-office ancillary billing

Navigating the 8-Minute Rule, therapy caps, GP modifiers, and timed codes (CPT 97110, 97140) for internal PT setups.

ASC facility claims alongside professional claims

Submitting facility claims alongside professional surgical claims for practices using or operating Ambulatory Surgical Centers.

Assistant surgeon, co-surgeon, and PA billing

Applying modifiers 80, 81, 82, and AS based on payer-specific policies for mid-level and assistant support.

Where orthopedic practice billing services leak the most revenue

Auditing orthopedic practice billing services usually turns up revenue bleeding in these seven spots:

Post-op visits denied as global: Separate issues billed without Modifier 24 getting dropped into a 90-day surgical package.
Same-day E/M visits lost: Injections performed during a visit without Modifier 25 attached to the E/M code.
Unbilled implants: Expensive hardware written off because invoices weren't sent with the claim.
Incorrect fracture coding: Definitive care billed as basic office visits instead of global fracture codes.
Stalled workers' comp claims: Claims sitting past 120 days waiting for manual note requests from adjusters.
Prior authorization gaps: Cancellations or denials because precertification wasn't finished on time.
Unappealed E/M downcoding: Level 4 visits (99214) paid as Level 3 (99213) without anyone disputing it.

Outsourced orthopedic medical billing services compared with keeping billing in house

Switching to outsourced orthopedic medical billing services gives private practices direct control, specialty knowledge, and lower costs.

Operating Metric	In-House Staff	SwiftCare Outsourced Billing
Total Annual Cost	$65,000+ per biller (salary, benefits, software fees, training).	Percentage of collections (costs move with your actual cash flow).
Coverage	Drops during sick leave, vacations, or sudden quits.	Continuous support with dedicated account cover 52 weeks a year.
Specialty Knowledge	Depends on whatever single billers happen to know.	Certified orthopedic coders updated on specialty modifiers.
Control & Transparency	In-person, but often hidden behind manual reports.	Full view inside your current EHR with daily portal access.

Note: In-house setups can still make sense for big practices with 10+ billers and a dedicated specialty manager. For 1 to 15 provider groups, outsourcing usually means higher net collections at lower overhead.

Orthopedic billing services for small practices, private practices, and surgical groups

We shape our billing operations around how your practice is set up:

Solo and 2 to 5 provider orthopedic private practices: Dedicated RCM support without paying for a full internal team.
Orthopedic clinic billing services for multi-site and sports medicine groups: Consolidated revenue tracking across multiple clinics and TINs.
Orthopedic physician billing services for surgeons splitting time across office, ASC, and hospital: Correct place-of-service (POS) coding for facility vs non-facility rules.
Practices running in-house PT, imaging, or DME: Unified billing for professional surgical care and ancillary streams.
New practices billing their first claim: Credentialing and setup to get revenue moving right away.

An orthopedic billing company that works inside
your EHR: 80+ systems supported

As a direct-login orthopedic billing company, we work inside your software. You keep full control of your data without moving platforms or relearning workflows.

We log into your system, so your data and your workflow stay where they are

We handle charge entry, payment posting, and claim follow-ups right in your software.

Orthopedic-specific platforms we bill in

General EHR and PM systems

Clearinghouses and ASC systems we work in

We connect with major clearinghouses—like Availity, Waystar, and Office Ally—alongside ASC facility platforms.

Running something not on this list? What onboarding looks like

If your system isn’t listed, we run a quick remote connection check and get set up within 7 to 10 days.

An orthopedic medical billing company serving providers in all 50 states

As a national orthopedic medical billing company, we keep up with local payer trends and state rules.

Medicare rules applied by MAC jurisdiction

Strictly following Local Coverage Determinations (LCDs) across Noridian, WPS, NGS, and Novitas.

State Medicaid and workers' compensation fee schedules

Custom rules aligned with state workers’ comp fees (like California OMFS, Texas DWC, New York WCB).

Regional Blues plans and local commercial contracts

Handling policy differences between regional BCBS plans and commercial payers.

Multi-state groups billed by one team under one set of reports

Combined financial stats for multi-state groups under single dashboards.

Telehealth and cross-state licensure billing questions:

Guidance on place-of-service codes and modifiers for remote post-op checks.

Browse orthopedic billing by state

State-by-state compliance advice tailored to where you practice.

Provider enrollment and credentialing for orthopedic practices

Uncredentialed docs stall cash flow. We manage the whole credentialing cycle:

Medicare enrollment and PECOS: Applications, location updates, and revalidations in PECOS.
State Medicaid enrollment: State provider enrollment and managed Medicaid panel setup.
Commercial payer applications, contracting, and fee schedule review: Contract negotiations, applications, and fee schedule checks.
CAQH profile setup, attestation, and quarterly maintenance: Profile creation, document updates, and 90-day attestations.
Workers' compensation panel and IME enrollment: Panel sign-ups and Independent Medical Examination registries.
DMEPOS enrollment for in-office bracing and orthotics: DMEPOS accreditation help and Medicare DME supplier setup.
Hospital and ASC privileging paperwork: Privilege tracking and facility credentialing support.
Revalidation, recredentialing, and expirables tracking: Automatic tracking for licenses, DEA, malpractice insurance, and boards.
Onboarding a new surgeon or PA: when to start and what to expect: Onboarding started 90 to 120 days before a new provider begins seeing patients.
Group NPI, tax ID, and new location changes: Managing Type 2 Group NPIs, TIN updates, and location filings.

HIPAA compliance, data security, and payer audit support

How your PHI is handled and who has access: Strict role access, encrypted data pipelines, and full HIPAA alignment.
Documentation review before high-dollar surgical claims go out: Pre-submission checks on op reports for major surgical cases.
Payer audit and records request support: Direct handling of Additional Documentation Requests (ADRs), RAC audits, and payer reviews.
Signed BAA and access logging: Fully compliant Business Associate Agreements (BAAs) with login logs.

Switching orthopedic billing services companies without a revenue gap

Changing your orthopedic billing services company shouldn’t halt your cash flow.

Week 1: Access, contracts, fee schedules, EHR setup

We pull logins, contracts, fee schedules, and active A/R reports to flag immediate priorities.

Week 2: Parallel run and first claim batch

We scrub and send new claims while checking current setups to stop drops.

Your legacy A/R: We work it, we do not abandon it

Recovery specialists work your old unpaid claims (30, 60, 90, 120+ days) until paid or cleared.

What we need from your staff and what we handle

Your team gives system access and basic notes; we take care of coding reviews, submissions, postings, denials, and reports.

Your first 90 days and what we report

Clear monthly metrics on clean claim rates, collection speed, and fixed revenue leaks.

Why orthopedic practices choose SwiftCare over other orthopedic medical billing companies

Orthopedic practices move to SwiftCare from other orthopedic medical billing companies for three simple reasons:

Results from orthopedic practices we bill for

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Orthopedic medical billing FAQs

How much do orthopedic medical billing services cost?

Orthopedic medical billing services usually cost between 4% and 7% of net monthly practice collections. Pricing shifts based on total volume, provider count, case mix, and extra needs like workers’ comp or credentialing.

What percentage do orthopedic billing companies charge?

Most specialty billing services charge between 3% and 8% of collections. This covers claim scrubbing, authorization tracking, coding reviews, and manual denial appeals.

Is there a setup fee or a long-term contract?

Setup fees are usually waived with a standard 1-year agreement. Contracts include performance terms with a 60-day exit clause if targets aren’t met.

Is outsourcing cheaper than hiring an in-house biller?

Yes. An internal biller costs $55,000 to $75,000 yearly once benefits, software, taxes, and training are added. Outsourcing cuts overhead and ensures full team coverage without downtime.

What is the global period for orthopedic surgery?

Major surgeries (like total joints or spine fusions) have a 90-day global package. Injections and minor procedures carry 0 or 10 days. Standard post-op care during these windows is bundled into the surgical fee.

Do you handle workers' compensation billing?

Yes. We track authorizations, attach clinical notes, check state fee schedules, and follow up on delayed payments.

Can you bill in-office DME, braces, and orthotics?

Yes. We bill HCPCS L-codes for custom and off-the-shelf items, check benefits, and keep Medicare DMEPOS requirements compliant.

Do you bill physical therapy inside an orthopedic practice?

Yes. We handle therapy codes (97000 series), apply the 8-Minute Rule, track therapy caps, and attach GP modifiers.

Can you bill an office visit on the same day as a procedure?

Yes, if the evaluation is separate and significant. Add Modifier 25 for minor procedures or Modifier 57 when the visit leads to a decision for major surgery.

Which modifiers are used most in orthopedic billing?

Common modifiers include 25 (separate E/M), 57 (decision for surgery), 24 (unrelated post-op visit), 58/78/79 (staged or unrelated surgical returns), 50 (bilateral), 51/59 (multiple/distinct procedures), and LT/RT (laterality).

How do you bill for implants and surgical hardware?

Implants are billed with HCPCS or CPT codes plus the vendor invoice attached, following payer rules or state workers’ comp fee schedules.

Should fracture care be billed as global fracture care or as an E/M plus casting?

If the surgeon provides definitive care, bill global fracture care (CPT 25605, etc.). If care is temporary or transferred, bill an E/M level with cast application (CPT 29000 series) and supplies.

What is the most common reason orthopedic claims get denied?

Top reasons include missing modifiers (25, 57, LT/RT), lack of prior authorizations, unattached implant invoices, and billing post-op checks during 90-day global windows.

What EHR systems do you work with?

We log into your software—including orthopedic systems like Nextech, ModMed, and Exscribe, as well as general platforms like Epic, Athenahealth, eClinicalWorks, and NextGen.

How long does credentialing take for a new orthopedic surgeon?

Commercial credentialing takes 60 to 120 days, while Medicare/Medicaid takes 30 to 90 days. Start onboarding 90 to 120 days before a doctor sees patients.

Get a free orthopedic billing audit

What we review in the audit

We run a complete 90-day review of your claims, payments, open denials, and A/R aging to spot missing modifiers, unbilled hardware, and underpaid surgical services.

What you get back and when

Within 5 business days, you receive a clear audit report breaking down revenue losses, coding errors, industry benchmarks, and an action plan to collect unpaid claims.