Texas Orthopedic Billing Services Built for State Compliance
Our orthopedic billing services in Texas simplify billing and maximize reimbursements
- Accurately code high-volume procedures like spinal fusions and knee replacements
- Manage Texas Medicaid STAR and CHIP prior authorizations for orthopedic procedures
- Submit claims optimized for Texas Workers’ Comp (TDI-DWC) rules and limits
- Report outpatient and surgical encounters to THCIC accurately and on time
- Identify denials for orthopedic implants, braces, and advanced imaging claims
- Leverage AI RCM tools to catch coding errors and speed reimbursements
What Unique Billing Obstacles Do Texas Orthopedic Practices Face?
Because of Texas’s diverse payer environment and regulatory structure, orthopedic practices face billing challenges like:
- Texas Workers’ Compensation Treatment Guideline Variability: Different TDI‑DWC treatment guideline updates and repetitive authorization requirements lead to frequent retrospective review requests and slower reimbursement timelines.
- Medicaid Managed Care Fragmentation: With dozens of Texas Medicaid MCOs, each orthopedic coverage policy varies, requiring constant tracking of authorization rules and coding differences across counties.
- THCIC Reporting Complexity: Texas’s outpatient reporting system (THCIC) mandates orthopedic procedure and encounter submissions that differ significantly from federal data requirements.
- Regional Commercial Plan Authorization Rules: Major Texas payers (BCBSTX, UHC Southwest, Aetna) each impose unique orthopedic imaging, surgical, and post‑op authorization rules that complicate consistent billing workflows.
How Transcure Solves Complex Orthopedic Billing Issues in Texas?
Transcure supports orthopedic practices in Texas with tailored revenue cycle strategies designed for the state’s payer diversity and regulatory requirements.
Overcoming Texas Medicaid MCO Pre-Auth Delays
We reduce lengthy approval wait times using PRIA that commonly stall surgical scheduling and reimbursement, especially for high‑utilization urban regions like Houston and Dallas.
TDI‑DWC Orthotic And Prosthetic Documentation Rules
Transcure builds claims using CLAIR with required TDI‑DWC medical necessity forms and sequential treatment note checks to avoid common Workers’ Compensation denials on orthotics billing.
Long Surgery Cash-Flow Delays
With an average 24-day AR cycle, Transcure accelerates reimbursement for Texas joint replacement, spine, and trauma claims compared to a typical 40+ day orthopedic AR.
Complex Orthopedic Coding Accuracy At Scale
Using CODIN under the supervision of 1,100+ certified coders, we ensure a 99% first-pass clean-claim rate for accurate Texas submissions for CPTs like 27130, 27447, and 29881.
KPIs-Powered Reporting and Analytics
Our monthly reporting with dedicated dashboards keeps you informed of claim progress using KPIs, enabling you to track performance and make data-driven decisions.
Denial Patterns Tied To Documentation Gaps
We analyze Texas payer-specific denials for CPT/ICD mismatches and rebuild claims with DEXA using corrective evidence to reduce the denial rate to less than 1%.
Which Texas Cities Benefit Most from Transcure’s Orthopedic Billing Services?
Houston, Texas
San Antonio, Texas
Dallas, Texas
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Austin, Texas
Fort Worth, Texas
Abbott, Texas
Corpus Christi, Texas
El Paso, Texas
Plano, Texas
Irving, Texas
Our Success in Numbers
How Much Can Texas Orthopedic Practices Save by Outsourcing Billing to Transcure?
Managing in‑house orthopedic billing in Texas can be surprisingly expensive once you add salaries, benefits, software, and overhead. A typical Medical Billing Specialist in Texas earns about $42,682 per year on average, as per Salary.com. As practices often need multiple staff, a small in-house team of 2 to 3 FTEs can easily cost $120,000+.
Transcure, on the other hand, charge billing fee of 5% of net collections. This means a provider, for example, earning $500,000 in annual orthopedic revenue, will only pay $25,000 per year, saving $95,000+ annually.
Which Texas Counties Can Leverage Transcure’s Orthopedic Billing Expertise?
Andrews County, Texas
Aransas County, Texas
Bexar County, Texas
Tarrant County, Texas
Collin County, Texas
Travis County, Texas
Which Complex Orthopedic Billing Procedures Does Transcure Handle for Texas Practices?
Transcure supports Texas orthopedic practices with billing and RCM for complex procedures, ensuring accurate coding, payer compliance, and optimized reimbursement.
Total Hip Replacement (CPT 27130)
Our Texas team handles full claims management, including accurate CPT/ICD-10 coding, implant HCPCS validation (L1845, L1850), and payer-specific edits for commercial insurers and Medicaid, minimizing denials for high-cost hip arthroplasty procedures.
Total Knee Replacement (CPT 27447)
We manage coding, implant tracking, and preauthorization workflows for knee replacements across Texas hospitals and ASCs, ensuring proper reimbursement from BCBSTX, UnitedHealthcare Southwest, and local Medicaid STAR plans.
Spinal Fusion Surgery (CPT 22558, 22612)
Transcure oversees complex spine procedure billing, including layered coding for multiple vertebral levels, documentation compliance per Texas Medicaid and commercial payer rules, and denial prevention for high-cost fusion surgeries.
ACL Reconstruction (CPT 29888)
For sports medicine and ligament repair, we accurately code arthroscopic procedures, track graft implants, handle payer-specific modifiers, and secure prior authorizations to ensure full reimbursement for these high-ticket ACL surgeries.
Shoulder Arthroplasty (CPT 23472, 23470)
We handle shoulder replacement billing, including prosthesis HCPCS codes, documentation of surgical approach, and alignment with Texas payer coverage policies, reducing claim rejections and maximizing collections.
Complex Fracture Fixation (CPT 25605, 26600, 27786)
Transcure manages coding for internal/external fixation, multi-device use, and surgical approach documentation, ensuring compliance with Texas-specific payer requirements while capturing appropriate reimbursement for high-cost fracture repairs.
Why Are Texas Orthopedic Practices Choosing Transcure for Billing?
With multiple billing companies available across Texas, orthopedic practices choose Transcure for state-specific payer expertise and surgical revenue protection.
Dedicated Texas Orthopedic Billing Manager
Each practice is assigned a billing manager trained in Texas Medicaid STAR plans, regional commercial payer policies, and orthopedic surgical documentation workflows.
Surgery-First Revenue Workflow Design
We structure billing pipelines around complex surgical events like joint replacements, spine cases, and trauma, ensuring authorizations, implant charges, and operative reports are tied together.
Texas Managed-Care Rule Mapping
Our billing logic is configured to Texas Medicaid STAR and commercial plan policy libraries, so claims are assembled to each plan’s orthopedic coverage and documentation expectations.
Implant and Hardware Charge Integrity
Transcure reconciles operative implant logs with HCPCS line-items and payer carve-out rules, preventing underbilling or post-payment takebacks on prosthetics and fixation hardware.
How Can Transcure’s AI Agents Transform Orthopedic Billing for Texas Practices?
High-value orthopedic claims in Texas often stall due to missed authorizations, incorrect implant coding, payer-specific edits, and late denial responses. Transcure’s AI RCM agents solve this at scale:
ELIXA verifies Texas commercial and Medicaid eligibility instantly, PRIA accelerates prior authorizations for surgeries and imaging, CODIN assigns precise CPT, ICD-10, and HCPCS codes for complex procedures, CLAIR scrubs claims against Texas payer edit rules before submission, and DEXA detects denial trends and rebuilds appeals automatically.
The result is faster payments, fewer rejections, and stronger cash flow without increasing staff workload.
Which EHR Platforms Can Transcure’s Texas Orthopedic Billing Team Work In?
We know Texas practices don’t want workflow disruption, so Transcure’s orthopedic billing specialists operate directly inside your existing EHR environment without requiring changes.
Why Are Texas Orthopedic Practices Confident in Transcure’s Billing Support?
Read our partners’ success stories to see how Transcure’s OB/GYN billing services drive financial growth and efficiency.
Jackie Judd
Practice Manager
Wilson Creek Internal Medicine
As a practice manager, I was looking to streamline the medical billing process. I tried other companies, but they were all complicated and took too much of my time. Fortunately, I found Transcure. They excel in tailoring solutions to fit my requirements.
Amber Vaughan
Office Manager
Idaho Kidney & Hypertension Institute
We are a large practice with 15 providers. Transcure has been working with us for the last 5 years. This billing company has been a great asset to us. I work with Transcure and they provide everything I ask for. The team is friendly and very pleasant to work with.
Ashlee Rose
Practice Manager
Harding Memorial Healthcare
We’ve been working with Transcure for 8 years now and I just wanted to say how happy we are with their services. They always get back to us quickly and are very easy to work with. They get my bills paid in record time and help us to generate millions in revenue.
Frequently Asked Questions (FAQs)
Why do some Texas commercial payers deny joint replacement claims more often?
Regional payers like BCBS of Texas and UnitedHealthcare Southwest apply stricter documentation requirements or bundle edits on joint arthroplasty claims, triggering denials without payer-specific coding rules.
Can orthopedic practices in Texas recover revenue from frequent modifier-related denials?
Yes, Transcure targets patterns such as incorrect modifier 59 use on same-day procedures or missing laterality modifiers, helping practices recover hundreds of thousands in denied claims.
How should a Texas orthopedic practice handle THCIC reporting for outpatient surgeries?
Texas practices must submit accurate outpatient encounter and procedure data to THCIC, or risk claim rejections and reporting penalties tied to state quality measures and reimbursement audits.
What are common CPT/ICD-10 coding pitfalls for high-value orthopedic claims?
Orthopedic billing errors often stem from incorrect CPT assignment, missing laterality modifiers, or outdated ICD-10 codes, which can result in denials or underpayments without specialist oversight.