Best Orthopedics Billing Services in California | Improve Revenue and Reduce Denials
Our orthopedics billing services in California help you with:
- Accurate coding for joint replacements (CPT 27447) and complex spine surgery
- California-specific Medi-Cal and workers’ comp payer rules enforcement
- No Surprises Act compliance for bundled implants and facility fees
- Prior authorization expertise for biologics, implants, and advanced arthroscopy
- AR recovery focusing on high-dollar joint cases over 90 days
Most Common Orthopedics Billing Challenges in California
Orthopedic practices in California deal with several billing issues that can slow payments and increase denials if not handled properly.
- High-cost implant charge capture and reconciliation, which matches vendor invoices, UDI tracking, and implant pass-through billing.
- ASC conversions causing split-billing confusion between facility and professional claims, impacting reimbursement and modifiers.
- Meeting payer-specific documentation rules for MRIs, CT scans, and injections to avoid medical-necessity denials.
- Inconsistent prior-authorization documentation standards across payers lead to retrospective denials for biologics and advanced implants.
- Billing DME items like braces and supports, which require the right L-codes and detailed proof of medical necessity.
How Transcure Helps California Practices with AI-Driven Orthopedic Billing Services?
Our medical billing services for orthopedics in California combine over 25 years of expertise with powerful automation to help practices protect revenue and reduce administrative burdens:
Orthopedic-Focused Coding Accuracy with CODIN
Transcure’s coders use CODIN to check CPT codes like 27447 (TKA), 22551 (cervical fusion), and modifier-59/NCCI rules to ensure every claim meets payer-specific requirements.
Implant and Device Documentation Support
We capture implant details like screws, plates, biologics, UDI numbers, and device lots. This means accurate billing for high-cost hardware and avoids missed charges on trauma cases.
ASC and Outpatient Surgery Billing Expertise
Separate facility vs. professional claims, correct modifiers for outpatient arthroplasty, and payer rules for same-day knee, hip, and shoulder surgeries are well managed.
Faster Prior Authorizations with PRIA
PRIA automates prior authorizations for spine fusions, joint replacements, injections, PRP/biologics, and DME braces. This reduces delays caused by payer medical-necessity rules and incomplete documentation.
Compliance with California Payer and Regulatory Rules
We help practices meet strict standards like AB 72, No Surprises Act estimates, Medi-Cal ORIF billing rules, and workers’ comp documentation for hardware use and surgical justification.
AR Recovery and Denial Reduction Powered by ARIS
ARIS automates follow-ups for high-value claims like arthroplasty, fracture repairs, and spine surgeries, reducing A/R tied to implant mismatches, missing op-notes, and modifier disputes.
Our Success in Numbers
Which Cities in California Does Transcure Serve for Orthopedic Billing Services?
Los Angeles, California
San Diego, California
San Jose, California
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San Fransisco, California
Fresno, California
Sacramento, California
Long Beach, California
Bakersfield, California
Oakland, California
How Much Can California Orthopedic Practices Actually Save by Outsourcing to Transcure?
Including salary and benefits, a medical billing specialist costs around $79,252 in California, according to Glassdoor. On the other hand, Transcure charges only 5% of collections, removing fixed payroll, hiring, and training overhead. Our suite of seven AI agents accelerates collections, reduces denials, and automates authorizations for California orthopedic practices.
For a practice collecting $250,000 annually, Transcure’s fee is $12,500 versus one in-house biller at $79,252, saving about $66,752. Many clinics need 2 to 3 billing FTEs, multiplying in-house costs and making outsourcing significantly more cost-effective.
Which Counties Do We Support with Our Orthopedic Billing Services in California?
Los Angeles County
San Diego County
Orange County
Riverside County
San Bernardino County
Santa Clara County
Which Orthopedic Procedures Does Transcure Handle with Precision in California?
Orthopedic billing requires accurate coding of high-value surgeries, implant usage, and postoperative services. Transcure guarantees that every procedure is billed correctly and aligned with California payer rules.
Total Knee Arthroplasty (TKA) Billing
We manage CPT 27447 billing, implant charge capture, modifier accuracy, and payer-specific requirements for same-day TKA performed in California ASCs and outpatient surgical centers.
Lumbar Spinal Fusion Billing
Our team handles coding for multilevel fusions, device add-ons, instrumentation codes, and strict documentation rules required by Medi-Cal and commercial payers.
Rotator Cuff Repair (Arthroscopic) Billing
Arthroscopic repairs are billed using the correct anchor counts, proper debridement bundling rules, and documentation supporting medical necessity for instability and chronic tendon tears.
ORIF for Fractures Billing
Hardware details, surgical approach (open vs. percutaneous), and precise fracture-site coding are documented to meet California workers’ comp and Medi-Cal surgical billing standards.
Hip Replacement (THA) Billing
Accurate coding for implant reconciliation, modifier use, and adherence to payer rules. We support proper billing for advanced prosthetic components and same-day discharge cases.
Arthroscopic Meniscus Repair
Lateral, medial, or combined repairs are coded accurately, while unbundling risks are minimized, and payer-specific rules are applied for complex sports injuries.
Why Should California Orthopedic Practices Outsource Their Medical Billing to Transcure?
Orthopedic billing in California comes with strict payer rules and high denial rates tied to implants and trauma cases. Transcure perfectly handles every step so practices stay profitable and compliant.
Dedicated Orthopedic Account Manager
You get a California-focused billing expert who supervises claims and audits documentation. They coordinate with surgeons to get accurate coding for high-value orthopedic procedures.
Expertise in California Workers’ Compensation Cases
We manage orthopedic work-injury claims, required documentation, lien filing, and state-specific billing rules. This reduces delays common with fracture repairs and repetitive-stress conditions.
Implant-Heavy Billing Experience
Transcure accurately bills plates, screws, biologics, and joint prosthetics by payer guidelines. This prevents underbilling and captures full reimbursement for hardware-intensive surgeries.
Expert in Outpatient and ASC Orthopedic Billing
We optimize reimbursement for same-day orthopedic surgeries by managing bundling rules, medical necessity criteria, and modifiers required by regional payers and Medi-Cal.
Why Do Transcure’s AI Agents Make Us the Best Choice for California Orthopedics?
Transcure’s suite of seven AI agents automates eligibility, prior-auths, coding, claim-scrubbing, denials, A/R follow-ups, and payment posting. This reduces manual work, preventing common denials and speeding reimbursements. Moreover, we complement our agents with certified coders and billers.
Agents like PRIA offer over 97% accuracy for prior-auths while CODIN automates CPT/ICD extraction and NCCI/MUE checks. Similarly, DEXA and ARIS fix denials and perform A/R follow-ups. All these together cut errors and accelerate cash flow for implant-heavy orthopedic practices.
Which Orthopedic Billing EHRs Does Transcure Work With?
Transcure supports 32+ orthopedic-friendly EHR and PM systems, allowing California practices to outsource billing without changing their existing workflow.
How California Orthopedic Practices Gain from Partnering With Transcure?
See how clinics across California rate Transcure’s impact through the experiences shared by the long-term partners of our orthopedic billing services:
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)
Which CPT codes most commonly trigger denials in orthopedics?
Orthopedic denials often involve high-value codes like total knee, total hip, and spine fusion procedures due to modifiers, bundling, or documentation errors. Accurate coding and strict NCCI compliance from Transcure significantly reduce these preventable denials.
How should I bill implants and track UDIs to ensure reimbursement?
Implants should be billed with complete device details, including UDI, lot, and serial information, to meet payer requirements. Proper reconciliation between operative notes and vendor invoices ensures full implant reimbursement.
How do AB-72 and the No Surprises rules affect out-of-network orthopedic billing?
AB-72 and the federal No Surprises Act prohibit balance billing for non-emergency care at in-network facilities and limit out-of-network collection practices. Transcure helps providers comply with disclosure and billing restrictions.
Are there special workers’ compensation billing rules for orthopedic care in California?
Yes, workers’ comp uses the OMFS, specific electronic billing standards, and strict lien-filing rules and timelines. Transcure uses the DWC billing guides to avoid rejections and preserve collections.