Orthopedic billing is among the most code-intensive in medicine — surgeries, implants, modifiers, global periods, and prior auth every day. We know every rule.
Common Billing Challenges
These are the six billing failure points we see most often — and the ones our team resolves systematically from day one.
Billing procedures within the global period without proper modifiers is the #1 audit trigger in orthopedics. We track every global period per surgeon, per payer.
Hardware, bone grafts, and biologics each have separate billing rules. We capture every HCPCS pass-through code and coordinate with your rep on invoice documentation.
Modifiers 51, 59, LT/RT, 78, 79, and AS are used daily in orthopedic billing. Incorrect application causes denials and audit flags — our coders apply them precisely.
Arthroplasties, spine procedures, and arthroscopies all require prior auth with detailed clinical documentation. We manage the full auth lifecycle before surgery is scheduled.
ASC facility fee billing has different rules than hospital outpatient. We handle both facility and professional component billing correctly for each setting.
Third-party liability billing requires different forms, different timely filing windows, and lien tracking. We manage WC and auto claims alongside commercial payers.
Key Procedure Codes
Our coders hold specialty-specific credentials and train continuously on the codes that drive the most revenue — and the most denials — in that specialty.
| CPT Code | Description | Common Issue |
|---|---|---|
| 27447 | Total knee arthroplasty | Global period + modifier 59 required |
| 29827 | Rotator cuff repair, arthroscopic | Modifier 50/LT-RT + implant invoice |
| 22612 | Lumbar arthrodesis, posterior | Multiple procedure discounting |
| 20610 | Aspiration/injection, major joint | Auth documentation package |
| 27130 | Total hip arthroplasty | Place of service: ASC vs hospital |
| 97110 | Therapeutic exercises | Separate forms, separate TFL |
Why Rcmaxis
We're not a generalist billing service that added a specialty module. Our team is built around specialty-specific expertise.
Every coder on your account holds the specialty coding credential relevant to your field — not a generic CPC only.
Significantly above the 13.2% industry denial rate for your specialty. Fewer rejections means faster payment and less write-off risk.
Full EHR integration, payer enrollment verification, and charge capture setup in 2 weeks — with zero disruption to your clinical schedule.
One point of contact who knows your practice, your payers, and your billing history — available for weekly calls and monthly performance reviews.
Month-to-month engagement. We earn your business every month by improving your collections — not by locking you in.
Live visibility into your collections, denial rate, aging AR, and payer performance — updated daily, reviewed monthly with your account team.
Straight answers to what practices usually ask before they switch.
Free revenue assessment for qualified practices. We audit your last 90 days of claims, identify every revenue leak, and show you a clear path to better collections — at no cost.