Orthopedic billing and revenue cycle, 50-state coverage.

What good orthopedic billing execution looks like.

The operating discipline we install on every orthopedic billing engagement.

1. Bundling edit management for surgical orthopedic claimsOrthopedic surgery claims carry extensive bundling logic (NCCI edits, modifier 59, X-modifiers). Coders working orthopedic in your state need depth in bundling rules to capture every legitimate code without triggering audits.
2. Modifier 25 / 59 discipline for office visits + proceduresyour state orthopedic practices routinely perform injections, fracture care, and casting during office visits. Modifier 25 separating E/M from procedure and modifier 59 or X-modifiers separating distinct procedures must be defensible.
3. Global period management for surgical episodes90-day global periods on most major orthopedic surgeries mean post-op visits during the global are not separately billable. your state orthopedic billing teams need disciplined global period tracking.
4. Prior authorization for orthopedic MRI and DMECommercial payers and your state Medicaid program require PA for most orthopedic MRI imaging, joint injections, and durable medical equipment. AI-supported PA automation is high-ROI for orthopedic practices.
5. Workers' comp billing workflowyour state workers' compensation cases require distinct billing workflow: state-specific WC fee schedules, employer or carrier authorization, attorney correspondence. Separate from commercial billing operations.
6. Joint replacement bundled payment coordinationTotal knee and hip replacement bundled payment programs (BPCI, CJR) coordinate hospital + surgeon + post-acute payment. your state orthopedic groups participating in bundles need cross-provider billing alignment.