Orthopedics Medical Billing & RCM
Specialized orthopedic billing that turns complex surgical, fracture, and musculoskeletal documentation into clean, fully reimbursed claims.
Revenue cycle management for orthopedics
Orthopedic billing is among the most detail-intensive in medicine, spanning global surgical packages, fracture care, injections, and durable medical equipment. ClaimSphere RCM combines certified orthopedic coders with disciplined documentation review to ensure every session, procedure, and supply is captured and coded correctly.
From arthroscopy and joint replacement to spine and sports medicine, we manage prior authorizations, global periods, and the modifier sequences that determine whether claims are paid in full. Our approach reduces denials, accelerates cash flow, and lets your surgeons focus on the operating room instead of the billing office.
Orthopedics billing, done right
Surgical Coding
Expert coding for joint replacement, arthroscopy, and fracture repair with correct global-period and staged-procedure handling.
Prior Authorization
Proactive authorization management for imaging, surgery, and DME to prevent avoidable denials before care is delivered.
Fracture & Injection Care
Accurate billing for cast application, fracture management, and joint injections including the supplies and imaging involved.
Modifier Precision
Correct application of modifiers 25, 59, 78, and 79 to separate distinct services and protect surgical reimbursement.
Denial Recovery
Targeted appeals and A/R follow-up on bundling and medical-necessity denials common to orthopedic claims.
Why orthopedics practices choose us
- Certified coders fluent in ICD-10, CPT, and HCPCS for musculoskeletal care.
- Deep command of global surgical packages and staged-procedure billing.
- Prior-authorization workflows that stop denials before they start.
- Real-time A/R visibility across every surgeon and location.
- Compliance-first processes with pre-submission claim audits.
Frequently Asked Questions
How do you manage global surgical periods for orthopedic procedures?
We track each procedure's global period and apply the correct modifiers to distinguish unrelated visits, staged procedures, and returns to the operating room. This ensures you are paid for services outside the global package rather than having them incorrectly bundled.
Can you handle prior authorizations for surgeries and imaging?
Yes. Our team secures authorizations for MRIs, surgical procedures, and durable medical equipment before services are rendered. Proactive authorization is one of the most effective ways to prevent the denials that plague orthopedic practices.
Do you bill for durable medical equipment dispensed in the office?
We do. Braces, splints, and other DME supplied in your office are coded with the appropriate HCPCS codes and modifiers. We also verify coverage in advance so these items are reimbursed rather than written off.
Specialized billing for orthopedics practices
Get a free assessment of your revenue cycle from coders who know your specialty inside out.
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