Orthopedic billing for practices and groups: office visits and the decision for surgery, joint replacement, arthroscopy and fracture care with their global periods, joint injections, and braces and other equipment, worked inside the software you already use.
Orthopedic billing services turn every visit, procedure and device into a paid claim. Each surgery is tracked through its global period, visits inside it are billed only when the rules allow, injections and devices are coded with their units and documentation, and every payment, denial and patient balance is followed until it is resolved.
$189M
in improper Medicare payments to orthopedic surgery in CMS’s 2025 review, a 6.3% improper payment rate
48.2%
improper payment rate on medical equipment and supplies, such as braces, billed by orthopedic surgeons in the same review
Most orthopedic revenue comes with a global period attached. A major surgery includes the visit the day before, the operation and 90 days of routine follow-up care in one payment, so the visits, casts and procedures that happen afterward are paid only when they fall outside it or carry the right modifier. Add fracture care billed as a package, injections with drugs and imaging, and braces billed to a separate Medicare contractor with their own documentation rules, and the calendar decides many claims.
Where the service falls in the global period decides the claim. That is why we track every surgery’s global period and check each visit and procedure against it before the claim goes out, not after it is denied.
Most orthopedic practices bill surgery, fracture care and injections or equipment in the same week, often for the same patient.
Pays forJoint replacement, arthroscopy, spine and other surgery, with 90 days of routine follow-up care included.
Where it breaks
What we do
Pays forClosed and open treatment of fractures, with the first cast and routine follow-up included in the fracture code.
Where it breaks
What we do
Pays forJoint injections, hyaluronic acid treatments, and braces and other equipment dispensed in your office.
Where it breaks
What we do
A major surgery has a 90-day global period. One payment covers the visit the day before or the day of surgery, the operation and routine follow-up care for 90 days, including care for complications that do not need a return to the operating room. Minor procedures have a 0-day or 10-day period. Inside the period, a service is paid separately only when a modifier tells the payer why.
Modifier 57 marks the visit where the decision for a major surgery was made, the day before or the day of. Modifier 24 is an unrelated visit during the post-op period, 58 a staged or planned procedure, 78 a return to the operating room for a related problem, and 79 an unrelated procedure. Each one has to be supported by the note, and a 58 or 79 starts a new global period, while a 78 does not.
What we do: we record the global period for every surgery we bill and check each later visit and procedure against it. If a service falls inside one, we confirm from the note whether it is unrelated, staged or a return to the operating room before we bill it, or hold it as part of the surgery.
Orthopedic claims depend on surgical modifiers, fracture care rules and the global period each surgery opens. The table covers the most common, with what payers check on each. Commercial plans add their own authorization and bundling rules, and we check each one.
| Code | What it covers | What payers look for |
|---|---|---|
| 99202 to 99215 | Office visits (E/M) | The level matches the decision making or time documented; modifier 57 when the decision for a major surgery was made, 25 before a minor procedure. |
| 99024 | Post-op visit inside a global period | Reported with no charge, so the visit is recorded but not billed. |
| 27447 | Total knee arthroplasty | A 90-day global period, with RT or LT. |
| 27130 | Total hip arthroplasty | A 90-day global period, with RT or LT. |
| 29881 | Knee arthroscopy with meniscectomy | A 90-day global period; chondroplasty in the same knee is included. |
| 29827 | Shoulder arthroscopy with rotator cuff repair | A 90-day global period; other procedures in the same shoulder checked against NCCI edits. |
| 2560025605 | Closed treatment of a distal radius fracture, without and with manipulation | The first cast and 90 days of routine care included. |
| 2907529405 | Short arm and short leg cast application | Billed for replacement casts, or when the practice only stabilizes and refers the patient. |
| 2061020611 | Large joint injection, without and with ultrasound guidance | 20611 includes the ultrasound, with a permanent image recorded; the drug billed separately. |
| J7321J7325 | Hyaluronic acid knee injections, such as these two products | Each product has its own code and unit; authorization from many plans. |
| L-codes | Braces and orthoses | Billed to the Medicare equipment contractor with the order, fitting and medical need documented. |
The visit the day before or the day of a major surgery, when that is where the decision was made.
An office visit during the post-op period for a problem unrelated to the surgery. Modifier 24 explained
A second procedure planned at the first surgery, or more extensive than it; a new global period starts.
A related procedure for a complication; paid for the operation only, with no new global period.
A procedure during the global period for an unrelated problem; a new global period starts.
Which side was treated, so procedures on both sides are not read as duplicates.
Sources: Medicare Claims Processing Manual, chapter 12, section 40 (global surgery); Medicare NCCI Policy Manual, chapter I (general correct coding) and chapter IV (musculoskeletal system); Medicare equipment contractor coverage rules for orthoses. CPT is a registered trademark of the American Medical Association; the descriptions above are summaries. Reviewed October 2026.
It is not for every practice. If you are a hospital-employed group whose billing the hospital handles, you do not need us. And if your in-house team keeps denials low and receivables current, keep them, and consider a periodic billing audit instead.
We look at your clean-claim rate, your denials by payer and reason, global periods and surgical modifiers, injections and equipment, authorizations, and your aging receivables, and tell you what we find, whether or not you go further with us.
We get access to your practice management system and clearinghouse, load each payer's authorization and bundling rules and your fee schedules, list open global periods and pending authorizations, and agree how escalations work. Most practices are live within one to two weeks.
Visits, procedures and equipment are coded and claims submitted within 24 hours. Rejections are corrected the same day, remittances posted as they arrive, global periods, modifiers and laterality checked, and denials worked to their cause, all inside your system.
A report you can read in ten minutes: what was billed and collected by payer, site and service line, what was denied and why, authorizations pending, and what is aging.
You do not change systems to work with Summit Billing Solutions. We work in the practice management and EHR systems below, and through the clearinghouse you already use. If your EHR is not shown, ask; the list grows as we onboard practices.
95-98%
First-pass claim rate
24 hrs
Claims submitted within
28
Average days in A/R
Orthopedic revenue is concentrated in surgery, with office visits, fracture care and equipment around it. Most billing companies take a percentage of collections; a few charge flat monthly or per-claim fees. A percentage ties the fee to getting each surgery and its follow-up paid.
Summit Billing Solutions charges between 3% and 9% of monthly collections. What moves the number for an orthopedic practice is the mix of office, surgery and equipment work, surgical volume, authorization volume, and how clean the receivables are when we take them on, which is why we quote your exact rate after the free account review, not before.
3% to 9%
of monthly collections
We bill for more than 40 specialties, for practices in all 50 states, from Salem, New Hampshire. Each one has its own codes, modifiers and payer rules.
A free account review looks at your clean-claim rate, your denials by payer and reason, global periods and modifiers, injections, equipment and authorizations, and your aging receivables, and tells you what we would change. No cost, no obligation, and no pressure to continue. What the review covers, step by step, is on the free account review page.
50A Northwestern Dr Ste 3, Salem, NH 03079-4827
603-207-3172
(866) 906-3116
info@summitbillingsolutions.com
Mon - Fri @ 9am - 5pm
