Top 10 Orthopedic Billing Companies in the USA for 2026

Orthopedic billing differs from general medical billing because each case often includes multiple high-cost implants, complex revision codes, and frequent prior authorization requirements. A study by AAHKS reports that joint replacement volumes in the U.S. topped 2.15 million procedures. 

Mistakes in implant charge capture, modifier use, like 58/78/79, or site-of-service coding can create immediate and high-value denials. Making the situation worse is the rapid shift of TKAs/THAs to outpatient and ASC settings, as well as bundled-payment programs such as CJR.

Hence, many practices find that outsourcing orthopedic billing services is the only way to effectively handle UDI/implant tracking, staged vs. revision coding, and denial appeals. This is also the fastest way to protect revenue and reduce the administrative burden on clinical staff.

So, the following are the top 10 orthopedic billing companies for healthcare providers in the U.S.

1. Transcure
2. Strategic Practice Solutions
3. Outsource Management Group, LLC
4. Nexus IO
5. 3Gen Consulting
6. Metropolitan Healthcare Billing Services
7. Fellow Health Partners, Inc.
8. Advance Forward Medical Billing
9. Valley Medical Management
10. Intermountain Management Services

Let’s dive into the top orthopedic medical billing companies and what makes each one stand out.

1. Transcure

Transcure is a U.S.–based orthopedic medical billing company with a strong reputation for helping specialty practices get paid faster, reduce denials, and improve cash flow. With over 1,100 certified billers and coders serving practices nationwide, we stand out for our focus on accuracy, automation, and reporting transparency.

This is a crucial element for orthopedic practices, where complex coding and high-value procedures can otherwise lead to costly claim denials. For orthopedic clinics, Transcure’s specialized billing services are designed to handle intricate CPT, ICD-10, and HCPCS coding, proactive denial management, and insurance follow-ups.

Our use of AI-powered tools helps reduce human error, boost clean claim rates, and shorten accounts receivable cycles. This means practices get paid sooner and spend less time chasing payments. We also publish performance insights and analytics that help practice leaders spot trends, strengthen internal processes, and make smarter financial decisions. 

Location	Provide services across all 50 states
Best For	Comprehensive RCM with strong billing accuracy and automation for orthopedic practices
Key Services	Medical billing and coding Denial management and appeals AI-assisted claims scrubbing End-to-end RCM and practice audit services Transparent billing reporting
Specialties	40+ specialties (including orthopedics, pain management, surgical centers)
EHR	30+ EHRs (Athenahealth, Kareo, eClinicalWorks, AdvancedMD, and more)
KPIs Published	Clean claim rate up to 98% Accounts receivable recovery under 24 days Revenue increase of up to 20% Denial rate of less than 1% 9% increase in Medicare reimbursements 30% reduction in A/R
Pricing Model	Percentage of collections model (typically around 5%)
Founded In	2002

2. Strategic Practice Solutions

Strategic Practice Solutions (SPS) is a U.S. orthopedic-focused revenue cycle management company that helps practices maximize collections and improve cash flow. Unlike broad RCM firms, SPS specializes exclusively in orthopedic billing. 

Their expertise includes tricky areas like spine procedures, out-of-network claims, and workers’ compensation. This deep focus means practices benefit from precise coding, proactive denial management, and detailed analytics that identify root causes of revenue leakage and put money back into the practice.

Location	100 Somerset Corporate Blvd, 2nd Floor, Bridgewater, NJ
Best For	Orthopedic practices needing specialized billing expertise with a focus on complex claims and transparent reporting.
Key Services	Orthopedic medical billing and coding Denial management and complex claims resolution Orthopedic credentialing Payer policy management and appeals
Specialties	Orthopedic billing specialization
EHR	Not publicly listed
KPIs Published	Trends in denials and underpayments Payment velocity insights Practice-level revenue trends Orthopedic claim status tracking
Pricing Model	Percentage-of-collections RCM model
Founded In	2010

3. Outsource Management Group, LLC

Outsource Management Group, LLC (OMG, LLC) is a medical billing company with a combined 150+ years of collective experience in the orthopedic specialty. Its orthopedic division offers end-to-end billing, coding, claims auditing, consulting, and credentialing support. 

These are all designed to improve cash flow, minimize denials, and fix billing operations. OMG’s orthopedic coding specialists focus on the nuances of ICD-10 and CPT rules specific to orthopedic procedures. This expertise helps avoid costly coding mistakes that can delay payment or trigger audits, ultimately boosting reimbursement accuracy. 

Location	1153 16th Street, Bedford, IN
Best For	Orthopedic practices seeking experienced billing support with broad RCM and practice management services.
Key Services	Orthopedic and medical billing Certified coding and audits Revenue cycle consulting Credentialing support Staff training and implementation
Specialties	Orthopedic billing and coding
EHR	Not publicly listed
KPIs Published	Internal clean claim accuracy focus Denial reduction emphasis Billing cycle efficiency improvements
Pricing Model	Percentage of collections
Founded In	2002

4. Nexus IO

Nexus IO is an orthopedic revenue cycle management company that blends advanced technology with specialized medical billing support. They aim to help healthcare practices improve cash flow, reduce denials, and secure faster payments. 

Orthopedic practices get AI-assisted claim scrubbing, real-time eligibility verification, and certified medical coders from Nexus IO. This helps streamline complex coding for procedures like joint replacements, fracture care, and spine surgeries. Nexus also offers credentialing assistance and focused AR recovery services, which help practices avoid payer delays.

Location	3720 E La Salle Street Suite 101, Phoenix, AZ
Best For	Practices seeking AI-enhanced RCM with certified coders to reduce denials and boost clean claim performance
Key Services	Orthopedic medical billing and coding AR recovery and denial management Credentialing support  Eligibility verification and reporting
Specialties	30+ specialties including orthopedics, cardiology, oncology, and more
EHR	Claims to integrate with all major EHR/PMS platforms
KPIs Published	98% clean claim rate  97% collection ratio 20 to 30% revenue growth  Reduced A/R days by ~30%
Pricing Model	Percentage of collections (not fixed, dependent on claim volume)
Founded In	2015

5. 3Gen Consulting

3Gen Consulting is a revenue cycle management (RCM) firm that blends experienced billing teams with advanced technology to help orthopedic practices. With over 19 years in the field, the company combines deep medical coding expertise with AI-assisted systems, like CodeGen-i, RevGen-i, and RiskGen-i.

This helps increase claim accuracy and accelerate reimbursements, a major benefit for orthopedic practices that deal with high-value procedures and detailed payer rules. The firm’s comprehensive reporting and denial insights help practices identify bottlenecks and strengthen revenue cycle performance over time.

Location	1321 Upland Drive, Suite 1780, Houston, TX
Best For	Practices wanting a full-service RCM partner that improves billing accuracy and financial outcomes.
Key Services	End-to-end medical billing and coding  Accounts receivable and denial management  Eligibility verification and prior authorization  Charge entry and payment posting  Provider enrollment, payer contracting, compliance support
Specialties	25+ specialties (including orthopedics, home health, cardiology)
EHR	Multi-platform support with claims integrations (contact for specifics)
KPIs Published	100% charges captured and billed Over 95% accuracy 24-hour turnaround time
Pricing Model	Custom percentage of collections or bundled RCM packages
Founded In	2006

6. Metropolitan Healthcare Billing Services

Metropolitan Healthcare Billing Services (MHBS) is a New Jersey–based medical billing firm for orthopedic healthcare practices. They help improve collections and reduce administrative workload. With over a decade of experience and a dedicated team of certified coders and billing specialists, MHBS focuses on customized billing strategies.

This is a major advantage for orthopedic practices that handle complex coding, out-of-network claims, and unique payer policies. One standout strength is their out-of-network billing expertise, where skilled negotiators work to secure fair reimbursement rates and appeal underpayments.

Location	151 Industrial Way East, Building C, Suite 1, Eatontown, NJ
Best For	Orthopedic and specialty practices seeking personalized billing support with strong out-of-network claims expertise.
Key Services	Medical billing and coding Out-of-network billing and appeals  Credentialing support  Contract negotiation  Accounts receivable follow-up
Specialties	15+ specialties (orthopedics, cardiology, pathology, internal medicine)
EHR	Greenway Intergy, GMed, eClinicalWorks, Practice Fusion, Compulink
KPIs Published	Out-of-network reimbursement optimization  Faster AR resolution timelines  Claim submission accuracy focus
Pricing Model	Percentage of collections
Founded In	2010

7. Fellow Health Partners, Inc.

Fellow Health Partners is an RCM and billing partner that helps orthopedic clinics improve collections and reduce denials. The agency strengthens your financial performance through a mix of technology, talent, and training. Its proprietary SAVi™ suite combines automation, real-time analytics, workflow optimization, and compliance tools.

This is a big help for busy orthopedic practices that need accurate coding, faster payments, and clear financial reporting. The company’s services span provider enrollment, eligibility checks, coding, charge entry, payment posting, and denial management. All are designed to capture more revenue and reduce administrative burden.

Location	3500 Sunrise Highway, Building 100, Suite 200, Great River, NY
Best For	Practices seeking technology-augmented RCM with deep analytics and compliance focus.
Key Services	End-to-end revenue cycle management Provider enrollment and credentialing Coding and auditing services  Denial management and appeals  Advanced reporting and analytics (SAVi™)
Specialties	12+, like orthopedics, anesthesia, pain management, cardiology,
EHR	Integrates with practice infrastructure and major EHR/PMS platforms
KPIs Published	98.5 % collections against contract  99.9 % clearinghouse claim acceptance  Reduced denial rates (up to 50 %)  Credentialing turnaround improvement (10 days)
Pricing Model	Customized RCM pricing
Founded In	2016

8. Advance Forward Medical Billing

Advance Forward Medical Billing (AFMB) is a medical billing company for orthopedic practices that focuses on maximizing physician revenue. They do this through accurate coding, proactive claim review, and personalized service. The team’s 150+ years of combined billing, coding, denial management, and appeals experience help minimize costly errors.

They also promise to reduce denials and accelerate reimbursement, which is especially beneficial for orthopedic practices dealing with complex procedural codes. AFMB’s approach emphasizes front-end claim scrubbing and tailored coding review before submission, significantly reducing delays and improving clean claim rates.

Location	10127 Morocco St, Ste 195, San Antonio, TX
Best For	Orthopedic practices seeking hands-on billing support and proactive claim management.
Key Services	Medical billing and coding Front-end claim scrubbing and compliance  Denial management and appeals  Reporting and revenue cycle analysis  Patient collections support
Specialties	10+ Orthopaedic surgery, sports medicine, spine procedures, wound care
EHR	Not publicly listed
KPIs Published	Focus on claim accuracy and fewer denials  Emphasis on expedited reimbursements 100% based in the U.S.
Pricing Model	Percentage-of-collections billing model
Founded In	N/A

9. Valley Medical Management

Valley Medical Management is an orthopedic medical billing and revenue cycle partner serving physicians and specialty practices. Unlike larger firms that lock clients into long-term contracts, Valley offers short-term contracts, as little as 3 months, with easy cancellation terms.

This gives practices a risk-free way to test their service and see improvements quickly. Their approach is built around a 9-step revenue recovery system designed to maximize reimbursement and push down denials. Valley also focuses on claim follow-up, accurate coding, insurance eligibility checks, and transparent reporting.

Location	2155 W March Lane, Suite 2D, Stockton, CA
Best For	Practices seeking flexible contracts and measurable revenue improvement without long-term commitment.
Key Services	Medical billing and coding Claim follow-up and denied claim pursuit Insurance verification and eligibility Monthly reporting and insights Revenue recovery system implementation
Specialties	5+, including orthopedics, pain management, urology, and mental health
EHR	Not publicly listed
KPIs Published	Revenue increase projections (up to 20 % per year) Short contract performance evaluation period  Denial management emphasis
Pricing Model	Flexible subscription models
Founded In	2010

10. Intermountain Management Services

Intermountain Management Services (IMS) is a U.S. medical billing firm that has been helping orthopedic healthcare providers simplify billing and improve collections. They have been in the field for over 40 years, offering certified coding expertise with personalized service.

The agency offers to support practices with accurate claim submission, credentialing assistance, and ongoing collection follow-up. Its long history and consistent client referrals underscore its ability to deliver dependable support, which can help orthopedic practices reduce administrative burden and focus more on patient care. 

Location	3555 Potomac Way, Idaho Falls, ID
Best For	Practices seeking a seasoned billing partner with a track record of strong collection performance.
Key Services	Medical billing and coding Collection management and deposit processing Provider credentialing support Statement fabrication and reporting
Specialties	5+ specialties (anesthesia, OB/GYN, mental health, ambulance)
EHR	Uses NetPractice PM billing software (CompuGroup Medical platform)
KPIs Published	95 % average collection rate (on adjusted charges)  Long-term client retention and referrals  Over 159 combined years of staff experience
Pricing Model	Percentage of collections + one-time setup fee (~$2,500)
Founded In	1982

Frequently Asked Questions

1. Do total joint replacements require prior authorization? Who enforces this?

Many commercial payers and some Medicare programs require prior authorization for hip/knee replacements; rules vary by insurer and plan. Always check the patient’s payer policy and obtain authorizations before elective joint surgery.

2. How should clinics code and bill platelet-rich plasma (PRP) injections?

Report PRP with CPT/HCPCS 0232T (PRP injection, any site) where accepted, but verify payer coverage, as many consider PRP experimental and deny payment. Document clinical rationale and check payer policy before billing. 

3. What practical steps cut orthopedic claim denials fastest?

Focus on front-end eligibility/prior-auth checks, pre-submission claim scrubbing, accurate implant and operative documentation, and a denial-tracking root-cause process to fix repeat errors. These actions reduce rework and speed cash flow. 

4. How does billing differ for the same orthopaedic procedure in an ASC vs hospital outpatient setting?

ASCs bill a facility fee under the ASC payment system, separate from the surgeon’s professional fee. Hospitals use OPPS/APCs and UB-04 forms with different covered items and payment rules. Confirm site-specific coverage and modifier rules before billing.