Orthopedic Billing Services | Get Every Surgical and Implant Claim Paid
Transcure runs HIPAA-compliant orthopedic billing services for clinics, surgery centers, and multi-surgeon groups, coding and billing every claim under one team. Our orthopedic medical billing services cover:
- 90-day global periods tracked, with modifiers 24, 58, 78, and 79 on every post-op claim
- Implant and device-lot reconciliation on arthroplasty and spine claims
- Prior authorization by PRIA for spinal fusion, WISeR-listed procedures, and bracing
- CLAIR claim scrubbing against NCCI edits, modifier 51 sequencing, and bilateral rules
- Workers’ compensation, personal injury, and no-fault billing under each state’s rules
- Orthopedic revenue cycle management that runs end to end, from eligibility checks to A/R recovery
Our Success in Numbers
Results vary by practice size, specialty and payer mix. Across Transcure clients, these are typical results:
Thousands of Specialty
Practices Trust Transcure
Catering to
40+ Specialties
1100+ Certified
Medical Billers & Coders
Seven Proprietary
AI Agents
98% First Pass
Clean Claim Rate
How Do Our Orthopedic Billing Services Improve Revenue for Practices?
Medical billing for orthopedics turns on surgical packaging rules. A 90-day global hides post-op visits, and a same-day E/M needs modifier 25 or 57. A second procedure in the same session pays at a reduced rate. We apply one orthopedic medical billing workflow from scheduling to appeal, so each leak is caught early.
Implants billed short and missing authorizations on spine cases drain the highest-value claims. Transcure pairs AAPC-certified coders with AI-driven claim scrubbing, so coding errors surface before a claim leaves the practice. The result is cleaner surgical claims and shorter A/R timelines.
Orthopedic and Spine Practices That Trust Our Orthopedic Billing Services
Orthopedic and spine practices trust Transcure with the surgery, injection, and authorization billing their revenue depends on. Our experience covers minimally invasive spine surgery, spine and joint injections, regenerative care, and interventional pain management. We work with surgeon-led spine groups, non-surgical orthopedic practices, and interventional pain centers, including:
How Do Transcure Orthopedic Billing Services Improve Reimbursement and Accuracy?
Transcure delivers medical billing services built for orthopedic surgery with seven AI agents and 1,100+ AAPC-certified billers working each claim. Each agent owns one stage of the orthopedic RCM cycle:
How Does Transcure Handle Different Laws and Challenges Affecting Orthopedic Billing?
Orthopedic billing rules shifted across site of service, prior authorization, and payment rates in 2026. Our specialists track each change and apply it at charge entry:
Inpatient-Only List Phase-Out for Joint Replacement
CMS began a three-year phase-out of the inpatient-only list in CY 2026, removing 285 mostly musculoskeletal procedures. Removed procedures are exempt from certain two-midnight medical review activities. We confirm the setting and claim type for every joint replacement case.
ASC Covered Procedures List Expansion
The CY 2026 ASC list added revision total hip and knee arthroplasty, plus lumbar interbody fusion codes 22630 and 22633. Because Medicare coverage does not bind commercial payers, our orthopedic ASC billing team checks each contract before scheduling.
WISeR and Outpatient Prior Authorization for Spine and Knee Procedures
Since January 2026, WISeR has required prior authorization or pre-payment review in Arizona, New Jersey, Ohio, Oklahoma, Texas, and Washington. It covers cervical fusion, arthroscopic lavage and debridement of the osteoarthritic knee, vertebral augmentation, and epidural steroid injections. Outpatient hospital cervical fusion with disc removal has needed prior authorization since July 2021.
2026 Payment Changes and the 2027 Proposed Rule
CY 2026 applied a -2.5% efficiency adjustment to non-time-based services, naming orthopedic services among them. The CY 2027 proposal would cut the non-QP conversion factor from $33.40 to $32.84. It would also pay same-day E/M with a global procedure at 50% and revalue arthroplasty work RVUs.
How Does Transcure Handle Orthopedic Surgery Billing for Different Procedures?
The details inside each operative note, from implant components to fracture fragments, decide how an orthopedic claim pays. Our specialists bill each procedure below with the payer rules it carries:
Sports Medicine Billing
Our sports medicine billing covers arthroscopy and the office visits around it. Meniscectomy in one compartment (CPT 29881) bills apart from both compartments (29880), and same-knee chondroplasty stays bundled. ACL reconstruction (29888) and rotator cuff repair (29827) carry laterality, and a separately identifiable same-day E/M takes modifier 25.
Traumatology Medical Billing
Our traumatology medical billing covers femoral neck fractures (27236) and open distal radius fixation (25607 to 25609). Extra-articular fixation bills as 25607, while 25608 and 25609 follow the documented fragment count. The initial cast is included, so only replacement casting bills separately.
Spine Surgery Billing
We code cervical and lumbar fusion (22551, 22612, 22630, 22633) for disc disease and lumbar spinal stenosis. Instrumented segments are counted for +22842. Same-level decompression with a posterior interbody fusion takes +63052 or +63053, while a separate interspace bills as 63047 with modifier 59.
Joint Replacement Billing
We bill total knee arthroplasty under CPT 27447, total hip under 27130, and total shoulder under 23472. Revisions bill as 27486, 27487, 27134, 27137, or 27138 by the components replaced. Z96.6- implant status codes never serve as the primary diagnosis on revision claims.
Joint Injection Billing
Joint injections bill as 20610, or 20611 when ultrasound guidance is permanently recorded. Viscosupplementation drugs bill in their own units: J7321 per dose for Hyalgan or Supartz, and J7325 per milligram for Synvisc. Synvisc-One takes 48 units, and Medicaid claims need the NDC.
Hand Surgery Billing
Our hand surgery billing covers carpal tunnel release under CPT 64721, trigger finger release (26055), and primary wrist ganglion excision (25111). Finger and side modifiers apply on every claim. Stacked procedures are sequenced by RVU to protect multiple-procedure payment.
What Happens in the First 90 Days of Orthopedic Billing With Transcure?
Switching an orthopedic practice to Transcure follows a fixed sequence, so cash flow stays steady:
Days 1 to 7: Onboarding and Payer Setup
Onboarding finishes in 5 to 7 business days. We connect to your EHR and set up Medicare, commercial, work comp, PI, and no-fault payers. Credentialing through CAQH, PECOS, and payer enrollment completes within 60 days.
Days 1 to 30: Claim Audit and A/R Triage
Our audit reviews your last 90 days of claims. It flags post-op visits billed without modifiers 24, 58, 78, or 79, underbilled implants, and mis-sequenced procedures. Old A/R triage starts in parallel at no added cost.
Days 30 to 90: Recovery and Faster Payment
Practices typically see A/R fall by more than 30% in the first few months, with A/R days moving toward 24. Innovative Pain Care Center, a pain management practice, recovered $3 million of $23 million in A/R within 60 days.
Ongoing: Steady Collections
Denials hold under 1%, the first-pass clean claim rate stays at 98%, and claims turn around within 48 hours. Practices that outsource to Transcure see collections rise 20% or more.
Orthopedic Billing Services Serving Nationwide
Transcure delivers orthopedics billing services to practices nationwide from offices in Florida, Texas, and New Jersey. Our remote teams adapt to each state’s Medicaid program, work comp fee schedule, and no-fault rules. Claims follow the payer rules where your patients are treated.
Which Orthopedic CPT, HCPCS, and ICD-10 Codes Can Our Billing Experts Handle?
Transcure’s coders cover orthopedic CPT codes from arthroplasty and spine to arthroscopy and fracture care, plus HCPCS drug and implant codes. Each claim carries the diagnosis specificity payers require:
27447, 27130, 23472
- Total knee and hip arthroplasty, plus total shoulder arthroplasty under CPT 23472.
22551, 22612, 22630, 22633
- Cervical discectomy with fusion, plus lumbar posterior and interbody fusion.
+22842, 63030, 63047
- Posterior segmental instrumentation and lumbar laminotomy or laminectomy decompression.
29827, 29880, 29881, 29888
- Arthroscopic rotator cuff repair, knee meniscectomy, and ACL reconstruction.
64721, 26055, 25111
- Carpal tunnel release, trigger finger release, and primary wrist ganglion excision.
25607, 25608, 27236
- Open fixation of distal radius fractures and open treatment of femoral neck fractures.
20610, J3301, J7321, J7325
- Major joint injection with triamcinolone and hyaluronan drugs, billed under the correct orthopedic HCPCS codes.
C1713, C1776
- Implantable anchors, screws, and joint devices reported on hospital outpatient and ASC implant claims.
M17.11, M75.12-, M48.06-
- Orthopedic ICD-10 codes for right knee primary osteoarthritis, complete nontraumatic rotator cuff tears, and lumbar spinal stenosis.
Why Is Transcure a Better Orthopedic Billing Outsourcing Partner?
Practices comparing orthopedic billing companies weigh specialty depth, coding ownership, and pricing scope. Here is how Transcure compares with general billing vendors:
| Feature | Transcure | Other Orthopedic Billing Vendors |
|---|---|---|
| Orthopedic-Specific Billing | Surgical global, spine, arthroplasty, and DME expertise | General or multi-specialty focus |
| Coding and Billing Together | Every claim coded and billed under one team | Billing only; coding errors stay with the practice |
| Surgical Global and Implant Controls | Global-period tracking, implant reconciliation, and NCCI scrubbing | Limited surgical controls |
| Work Comp, PI, and No-Fault | Carrier setup, claim numbers, and PIP coordination | Often excluded or referred out |
| AI-Powered Revenue Cycle Management | Seven AI agents working each claim from eligibility to posting | Manual or semi-automated processes |
| Account Management | Dedicated orthopedic account manager with a 2-hour response | Shared support teams |
| Pricing Scope | Flat 5%, including credentialing and old A/R recovery | Pre-auth, statements, and credentialing often billed separately |
Why Should You Outsource Orthopedic Billing Services to Transcure?
Outsourced orthopedic billing lets surgeons focus on cases while specialists manage globals, implants, and injury claims. Transcure pairs certified coders with AI agents for medical billing that work each claim end to end:
Master Command Dashboard
Live first-pass rates, A/R days, denial trends, and collections sit in one view, without waiting for month-end reports.
Dedicated Orthopedic Account Manager
One account manager owns your practice, answers within 2 hours, and coordinates coding, payer follow-up, and denials.
Old A/R Recovery Included
Aging claims from your previous billing setup are worked inside the same 5% fee, with no separate recovery charge.
80% Denied Claim Recovery
Structured appeals with operative notes attached recover 80% of denied claims, including bundling and authorization denials.
Multi-Site and ASC Scalability
Billing scales as you add surgeons, clinic locations, or ASC cases, without hiring billing staff.
Credentialing in 60 Days
CAQH, PECOS, and payer enrollment finish within 60 days at no added cost, so new surgeons bill sooner.
How Does Transcure Handle Orthopedic Denial Management and Payer Takebacks?
Modifier errors on surgical claims can trigger recoupments long after payment. An HHS-OIG audit found 69 of 100 sampled surgical services did not comply, most billed without required co-surgery or assistant-at-surgery modifiers. Medicare’s FY 2025 improper payment rate reached 6.55%, or $28.83 billion.
Coding and billing every claim together lets errors surface before submission. Our orthopedic denial management covers modifier 62 and 80, 82, and AS documentation, global-period checks, and structured appeals. When an audit arrives, we prepare the defense package from the chart.
Which EHR Systems Does Transcure Support for Orthopedic Billing?
Transcure works inside 43+ EHR and practice management systems, so orthopedic documentation moves from operative note to claim without re-entry. Our coders pull op notes and implant logs without changing clinical workflows.
Our Certifications
Our orthopedic billing team holds AAPC certifications and works under HIPAA and ISO 27001 controls.
What Orthopedic Practices Nationwide Say About Our Medical Billing Services
Across the U.S., orthopedic, spine, and pain practices describe how Transcure changed their denials, A/R, and collections. Here is what some of them say:
Clinic Manager
Axis Spine and Orthopedics, IL
“We had a year of ungenerated patient statements, a payment posting backlog, and unpaid claims. Transcure worked through all of it. Reliable orthopedic billing services in Illinois.”
Interventional Pain Specialist
Ospina Medical, NY
“Secondary billing was throwing errors constantly until Transcure found and corrected the root cause. Our NY orthopedic practice now has stable posting and patient balances that make sense.”
Interventional Pain Specialist
Innovative Pain Care Center, NV
“Claims were going to the wrong payers, and rejections were high. Transcure corrected the payer IDs, rebilled everything, and our Nevada surgery center billing has a far lower rejection rate.”
Rated Highly by Practices Nationwide
Practices rate Transcure highly for billing accuracy and responsiveness across major review platforms.
Frequently Asked Questions About Orthopedic Billing
Get answers to the most common questions orthopedic practices ask about our orthopedic billing services, CMS compliance, and reimbursement rules.
What Does an Orthopedic Billing Service Do?
An orthopedic billing service manages the revenue cycle for surgeons and clinics: eligibility, prior authorization, coding, claim submission, payment posting, denials, and A/R follow-up. It applies surgical rules such as global periods and multiple-procedure reductions across office, ASC, and hospital work.
How Much Do Orthopedic Billing Services Cost?
Transcure bills orthopedic practices a flat 5% of monthly collections, whatever the practice size. That fee covers end-to-end RCM, credentialing, and old A/R recovery, so nothing is billed separately.
What Are the Most Common CPT Codes in Orthopedic Billing?
Common orthopedic CPT codes include 20610 for joint injection, 27447 for total knee arthroplasty, and 27130 for total hip arthroplasty. Knee arthroscopy often bills as 29881, while spine and shoulder practices bill 22551, 29827, and 23472.
What Are the Most Common Orthopedic Claim Denials?
The most common orthopedic denials are CO-197 for missing authorization and CO-97 for services bundled into a procedure or global period. Others include CO-4 for modifier errors, CO-16 for missing information, and CO-50 for medical necessity. Most are preventable with front-end authorization checks and pre-submission scrubbing.
Do You Bill Workers' Compensation, Personal Injury, and No-Fault Claims?
Transcure bills workers’ compensation, personal injury, and no-fault claims for orthopedic practices in every state we serve. We set up each carrier, capture claim numbers and adjuster authorizations, and apply state fee schedules. We also coordinate PIP benefits with health coverage.
Orthopedic Billing Knowledge Center
Explore the latest Orthopedic billing insights to enhance practice performance and profitability.
Compare the top 10 orthopedic billing companies in the USA. Explore features, pricing, services, and benefits to find the best billing partner.
Orthopedic medical billing explained end-to-end: front-desk workflow, coding, prior auth, implant and UDI rules, denial prevention, and more.
Orthopedic CPT codes for arthroplasty, arthroscopy, fracture, and spine. Find modifiers, global periods, and more in one 2026 reference.