Orthopedic Medical Billing Services for U.S. Healthcare Providers

Orthopedic billing is some of the most detail-heavy work in healthcare. Global surgery periods. Modifiers that change the payment on a single character. Bilateral and staged procedures, implants, braces, and injections all showing up on the same day. 360 Clinical Solutions runs the full revenue cycle for orthopedic practices, from sports medicine and joint replacement to spine and trauma, so claims go out right the first time and your surgeons can stay in the OR instead of the billing queue.

Orthopedic Revenue Cycle Management Made Simple

Ortho practices don’t run on one type of visit. On a typical Tuesday you might have a post-op check, a cortisone injection, an in-office X-ray, a cast application, and a knee scope, and every one of them follows a different billing rule. Get one modifier wrong and a payable claim becomes a denial, or worse, a payment you have to give back.

We handle the whole thing: coding, claims, denial management, insurance follow-up, and compliance. Our team brings more than ten years of working experience, and the goal is simple. Get you paid accurately, get you paid faster, and take billing off your providers’ plates.

Why Orthopedic Billing Is Different

A primary care visit is one visit with one set of codes. An orthopedic surgery is a package. The procedure, the pre-op visit, and the follow-up care are bundled into a global period, and every service you provide around that surgery has to be billed with that package in mind.

Then add everything else. Implants and hardware. Assistant surgeons. Multiple procedures in one session, each subject to bundling edits and payment reductions. In-office DME. Imaging that needs prior authorization. And a steady stream of workers’ compensation and injury cases, each with its own forms and fee schedules.

None of it is unmanageable. It just takes people who know it cold, and who check every claim against it before it goes out.

Our Medical Billing Services

Insurance Verification & Prior Authorization

Coverage confirmed and approvals secured before the MRI, the injection, or the surgery, not after a denial.

Orthopedic CPT Coding & Modifiers

Accurate CPT, HCPCS, and ICD-10 coding built from the operative note and documentation.

Charge Entry & Claims Submission

Every billable service captured, then checked against payer rules before the claim goes out.

Global Surgery Period Tracking

We track the window for every surgical patient so related visits are bundled and unrelated ones get billed.

Denial Management & Appeals

We find out why a claim was denied, correct it, and push the appeal through.

DME & Supplies Billing

Braces, splints, and casting supplies captured and billed with the right codes and documentation.

Payment Posting & Reconciliation

Every payment matched against what the contract says you should have received.

A/R Follow-Up & Collections

Aging claims worked until they’re paid, not reviewed once and forgotten.

How We Handle Your Billing

No black box. Here’s what happens to every encounter, in order.

Intake & Verification

We collect patient and insurance details and confirm coverage before the visit, including whether the procedure needs prior authorization.

Charge Capture

We make sure every billable service is captured, from the injection to the cast supplies, so nothing gets left on the table.

Coding Review

Certified coders assign CPT, HCPCS, and ICD-10 codes based on the operative note and documentation, not guesswork.

Global Period Check

Every surgical patient’s global window is tracked, so related visits are bundled and unrelated ones are billed with the right modifier.

Claims Scrubbing

Claims are checked against payer rules and bundling edits before submission. This is where most denials get stopped.

Submission

Clean claims go to the payer electronically.

Payment & Denials

Payments are posted and compared to what the contract says you should receive. Denied or underpaid claims get corrected and resubmitted.

Reporting

You see claim status, collections, and A/R without having to ask.

Common Orthopedic Services We Bill For

From the exam room to the operating room, here’s what we handle most often.

Orthopedic Billing, By Practice Type

Orthopedic Surgeons

Surgical billing with global periods, modifiers, and assistant surgeon claims handled correctly.

Sports Medicine Practices

Arthroscopy, injections, and high-volume clinic visits, billed cleanly and quickly.

Joint Replacement & Spine Specialists

High-dollar procedures where one coding error can cost thousands, and where prior authorization matters most.

Trauma & Fracture Care

Fracture care, casting, and injury claims, including workers’ comp and auto cases.

Hand & Upper Extremity Specialists

Procedure-heavy practices where bilateral and staged work is routine.

Group Orthopedic Practices

Multiple surgeons, locations, and payer contracts, run as one coordinated billing operation.

Global Surgery Periods, Explained

A global period is the window around a surgery during which related care is bundled into a single payment. Minor procedures typically carry 0 or 10 days. Major surgeries typically carry 90 days, starting the day before the procedure. Inside that window, routine post-op visits aren’t billed separately. Outside it, or for unrelated problems, they are. Payers don’t all follow the same rules, and mistakes run in both directions: you either bill what you shouldn’t, or give away what you’ve earned. We track the window for every surgical patient so neither happens.

The Modifiers That Make or Break an Orthopedic Claim

One or two characters can make a significant difference in whether an orthopedic claim is paid correctly. We pay close attention to modifiers such as 25 and 57, which are used for separate evaluation and management services around a procedure or the decision for surgery. Modifiers 58, 78, and 79 help identify staged, related, or unrelated procedures performed during a global period.

Modifier 50 is used for bilateral procedures, while RT and LT identify procedures performed on the right or left side, depending on payer requirements. Modifier 51 is used when multiple procedures are performed during the same session. For assistant surgeon billing, commonly used modifiers include 80, 82, and AS.

Because payer requirements can vary, we incorporate each payer’s specific modifier rules into our claim checks. This helps reduce billing errors, improve claim accuracy, and avoid unnecessary denials.

The Billing Problems That Actually Hurt Orthopedic Practices

Global Period Mistakes

Billing a related visit inside the window gets denied. Missing an unrelated one leaves money on the table.

Modifier Errors

A wrong or missing modifier turns a payable claim into a denial, and it’s one of the most common orthopedic coding errors.

Bundling and Multiple Procedure Edits

Payers bundle and reduce payment on same-session procedures, and the rules differ by payer and by code pair.

Prior Authorization Gaps

MRIs, injections, and surgeries often need approval first. No authorization, no payment.

Bilateral and Staged Procedures

These are easy to mis-code, and easy for payers to deny as duplicates.

DME and Supply Leakage

Braces and casting supplies get dispensed but never billed, or billed without the right documentation.

Orthopedic Billing vs. General Medical Billing

They share a foundation, but orthopedics adds layers general billing never touches.

General Medical Billing

Standard visit and procedure claims, mostly one service at a time.

Non-Surgical Orthopedic Billing

Office visits, injections, imaging, casting, and DME, each with its own coding and payer rules.

Surgical Orthopedic Billing

Global periods, modifiers, bundling edits, assistant surgeons, implants, and staged procedures.

Why the difference matters

A biller who’s strong on general claims can still get orthopedics wrong, because the rules behind most ortho denials (global periods, bundling, modifiers) barely exist in general billing.

Payers and Injury Claims We Handle

Ortho practices bill a wider mix of payers than most. Commercial plans, Medicare, and Medicaid, plus workers’ compensation and auto or personal injury cases. Each has its own forms, fee schedules, and timelines, and injury claims often add attorneys, adjusters, and letters of protection on top. We learn how each payer works and build it into your billing, so a complicated injury case doesn’t sit unbilled.

In-Office DME and Supplies

Braces, splints, walking boots, and casting supplies are real revenue, and they’re easy to lose. Items get handed to patients without a charge entered, or billed without the documentation a payer wants. Some payers also require DME enrollment before they’ll pay at all. We capture the charge, use the right HCPCS codes, and check each payer’s requirements first.

What Working With Us Looks Like

Getting started with us is simple. We begin with a free practice audit to review your current billing process, identify where revenue may be leaking, and show you what can be improved. Once you decide to move forward, we handle the setup, including connecting with your systems, loading payer information, and addressing outstanding claims. After everything is in place, you get paid and stay informed as claims move through the billing process, payments are posted, and you receive clear updates without having to chase anyone.

Signs It's Time to Get Billing Help

Most practices don’t switch billing partners because of one bad month. They switch because the same problems keep showing up. Sound familiar?

Why Practices Outsource This

Less Admin Work

Billing stops eating your front-desk and clinical staff’s time.

Fewer Errors

A dedicated coding and claims process catches what a generalist team misses.

Fewer Denials

Verification, authorization, and modifier checks happen before submission, not after rejection.

Faster Payment

Clean claims and consistent follow-up shorten the gap between service and payment.

Fewer Compliance Headaches

Someone else tracks payer policy changes so you don’t have to.

Surgeons Stay Surgeons

Less billing noise means more time in the OR and the exam room.

About 360 Clinical Solutions

360 Clinical Solutions is a medical billing and revenue cycle management company built for U.S. healthcare providers. Orthopedics is one of the specialties we serve. We handle patient information under HIPAA safeguards and keep claims moving so reimbursement stays predictable.

360 Clinical Solutions at a Glance

Company	360 Clinical Solutions
Industry	Medical Billing & Revenue Cycle Management
Service	Orthopedic Medical Billing
Audience	U.S. Orthopedic Practices
Availability	Nationwide in the United States
Related Services	Medical Billing, Credentialing, Eligibility Verification, Medical Coding, Denial Management, Payment Posting

Frequently Asked Questions

What is a global surgery period and how does it affect billing?

It’s the window around a surgery, usually 0, 10, or 90 days, when related pre-op, operative, and routine post-op care is bundled into one payment. We track the window for every surgical patient, so related visits aren’t billed separately and unrelated ones go out with the right modifier.

Do you bill for DME like braces and casts dispensed in-office?

Yes, where your payer allows it. We bill braces, splints, and casting supplies with the right HCPCS codes, and we check each payer’s DME enrollment and documentation requirements first.

What are the most common orthopedic coding errors?

Missing or wrong modifiers, related visits billed inside a global period, unbundled procedures, laterality mistakes, and diagnosis codes that don’t support the procedure. Nearly all of them can be caught before submission.

Can you bill for both surgical and non-surgical orthopedic services?

Yes. Office visits, injections, imaging, DME, and surgery all run through one billing operation, but each is coded and tracked on its own rules.

How do you handle bilateral and staged procedures?

We code bilateral work with the right modifier or RT/LT pairing for each payer, and we tie staged procedures back to the original surgery so related stages aren’t denied as part of the global package.

Do orthopedic billing rules differ by payer?

A lot. Payers disagree on global periods, modifier use, multiple-procedure reductions, prior authorization, and DME. We map each payer’s rules and build them into how your claims are checked.

Get Started Today

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