ClaimCarePro

Orthopedic Billing Services

ClaimCarePro provides orthopedic billing services built around the global surgical package: each patient's 0-, 10- or 90-day window tracked, modifiers 24, 25, 57, 58, 78 and 79 applied the way Medicare pays them, fracture care and casting supplies billed, braces dispensed under DMEPOS rules, prior authorization, and workers' compensation and Florida PIP cases. Full-service billing is 6% of collections with a $1,000/month minimum, month-to-month, no setup fee. Family-owned in Clearwater, Florida, billing since 2010.

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What our orthopedic billing services include

Global surgical packages, tracked per patient

Every surgery opens a global period — 0, 10 or 90 days — and the package includes the preoperative visit from the day before a major procedure, the operation and routine postoperative care. We track each patient's global window so visits inside it are not billed as new work, and work outside the package is not given away.

Modifiers 24, 25, 57, 58, 78 and 79

57 on the visit where the decision for major surgery is made, the day before or the day of. 25 for a separate problem on a minor-procedure day. 24 for an unrelated visit inside the global period. 58 for a staged or planned procedure, 78 for a related return to the operating room, 79 for an unrelated procedure that starts its own global period.

Fracture care and casting

Closed and open fracture treatment codes include the first cast or splint and the routine follow-up inside the global period. Replacement casts are billed with the casting and strapping codes, and cast and splint supplies are billed separately where the payer pays them — Medicare does — so they are not lost inside the fracture code.

Joint injections and viscosupplementation

Large-joint aspirations and injections (20610, or 20611 with ultrasound guidance and a permanent recorded image), with RT and LT on each side, and the drug line billed by HCPCS units with JW or JZ for single-dose vials. Hyaluronic acid injections are billed to the product-specific code and the payer's coverage criteria.

Braces and DME dispensed in the office

Off-the-shelf and custom orthoses billed with the right L-code and modifiers to the DME MAC, which requires the practice to be enrolled as a DMEPOS supplier, or to the commercial plan's DME vendor. Off-the-shelf back, knee and upper-extremity braces are in the next round of competitive bidding, and we track what that means for what you dispense.

Prior authorization for surgery and imaging

Authorizations requested for arthroscopy, joint replacement, spine surgery and advanced imaging, with the conservative-care history, imaging and functional scores each plan asks for, and checked again when the CPT code, side, facility or date changes before the case.

Assistants, co-surgeons and multiple procedures

Assistant-at-surgery claims billed with 80, 82 or AS only on codes the payer allows an assistant for, co-surgery with 62, and multiple procedures ranked so the payment reduction falls on the right line — with 59 or the X modifiers only where the work was truly distinct.

Workers' compensation and Florida PIP

Work injuries billed to the carrier under the state workers' compensation fee schedule, and Florida auto injuries billed under PIP — which requires initial care within 14 days of the crash — then MedPay and the health plan, with letters of protection tracked apart from insurance A/R.

Why orthopedic claims deny — and how we prevent it

The decision-for-surgery visit billed without 57

The visit where the surgeon decides to operate is separately payable when it falls the day before or the day of a major procedure — but only with modifier 57. Without it, the visit is bundled into the global package and paid at zero.

Postoperative visits billed as new work

Routine follow-up inside a 90-day global is already paid. Billing those visits, even by accident, triggers denials and repayment requests. An unrelated visit inside the window needs modifier 24 and a diagnosis that shows why it is unrelated.

58, 78 and 79 used interchangeably

A staged procedure (58), a related return to the operating room (78) and an unrelated procedure (79) pay differently and treat the global period differently: 78 is paid at the intra-operative value and the original global keeps running, while 79 starts a new one. Using the wrong one underpays or denies.

Casting supplies and replacement casts lost

The first cast is part of fracture treatment, but replacement casts and the supplies are not. Practices that assume all casting is bundled leave the supplies and later casts unbilled.

Braces dispensed without DMEPOS enrollment

Medicare pays orthoses through the DME MAC, not the Part B contractor that pays the surgeon. Without supplier enrollment, the right L-code, a complete order and proof of delivery, a brace fitted in the office is not paid.

Authorizations that do not match the case

An authorization approved for one knee, one CPT code and one facility does not cover a case that changes side, adds a procedure or moves to another site. Re-checking the authorization against the final case before surgery is the fix.

Injury cases sent to the wrong payer

Orthopedic practices see many work and auto injuries. Billing the health plan first, missing the PIP 14-day window or losing track of a letter of protection turns a payable claim into a write-off.

Multiple procedures and distinct-procedure modifiers

Arthroscopic procedures in the same joint often bundle under NCCI edits. Modifier 59 or XS belongs only where the work was separate — a different compartment or joint, documented — and overuse is an audit target.

Orthopedic billing cost: in-house vs outsourced

What outsourced orthopedic billing costs here

Full-service orthopedic billing is 6% of collections with a $1,000 monthly minimum, month-to-month, no setup fee. Aged or denied claims are worked on a 10% contingency, paid only from what is recovered. The price is on our pricing page, not quoted after a sales call.

What in-house orthopedic billing costs

An in-house team is surgical coders, a prior-authorization coordinator, benefits, training, software and clearinghouse fees, paid whether claims pay or not. A percentage fee moves with deposits.

Where in-house orthopedic billing usually loses money

On the decision-for-surgery visit billed without 57, the casting supplies nobody billed, the brace dispensed without supplier enrollment, the injury claim sent to the wrong payer and the denial nobody had time to appeal.

Do they know global surgery, not just CPT?

Ask any orthopedic billing company how it tracks global periods per patient, when it uses 57 versus 25, and how 78 and 79 are paid. A specific answer is a better sign than a logo list.

Will they sign a BAA, and can you leave?

Any company handling your patients' claims should sign a Business Associate Agreement before it sees a record. ClaimCarePro signs a BAA and bills month-to-month with no setup fee and no exit fee.

Who is behind the work?

ClaimCarePro is a family-owned billing company in Clearwater, Florida, billing since 2010, with 30+ years combined billing experience, a bench of experienced part-time billers scaled onto accounts as needed, and AI automation that checks each claim before it goes out.

How we take over your orthopedic billing

  1. 1

    Free coding and A/R review

    We review 90 days of claims, operative notes and remittances for global-period errors, missing 57 and 24 modifiers, unbilled casting supplies, brace claims, injury cases on the wrong payer and authorization denials.

  2. 2

    Recover the aged and denied claims

    Denied visits corrected with the right modifier, unbilled supplies and replacement casts billed inside the filing limit, and PIP and workers' compensation balances followed up, on a 10% contingency.

  3. 3

    Map surgeons, sites and payers

    Each surgeon's office, ASC and hospital sites set up; each payer's authorization list and assistant-at-surgery rules loaded; DMEPOS enrollment confirmed for the braces you dispense.

  4. 4

    Global tracking and daily coding

    Operative notes coded the day they are signed, each patient's global window recorded, and every visit checked against it before the claim is sent.

  5. 5

    Posting, follow-up and reporting

    ERAs posted, denials worked by cause, secondary claims sent, patient balances billed, and a monthly report by surgeon, procedure and payer.

  6. 6

    Credentialing kept current

    New surgeons and APPs enrolled before their first clinic day, facility privileges tracked, and revalidations filed before a lapse.

Orthopedic billing services: questions buyers ask

How much do orthopedic billing services cost?
Most orthopedic billing companies charge a percentage of collections. ClaimCarePro charges 6% of collections with a $1,000 monthly minimum, month-to-month, with no setup fee. Aged or denied claims are worked on a 10% contingency. Credentialing is a flat $250 per payer application, or $1,750 per provider for the new-practice bundle.
Should an orthopedic practice outsource billing or keep it in-house?
Compare the whole cost. In-house billing is surgical coders, an authorization coordinator, benefits and software, paid whether claims pay or not. An outsourced fee moves with collections. The deciding number is usually what global-period errors, missed modifiers, unbilled supplies and unappealed denials are costing the practice today.
What is included in the orthopedic global surgical package?
For a major (90-day) procedure: preoperative visits from the day before surgery once the decision is made, the operation, routine postoperative visits and care such as dressing changes and removing sutures, casts and splints. Complications that do not need a return to the operating room are included too. Minor procedures have a 0- or 10-day global.
When do you use modifier 57 instead of 25?
Modifier 57 marks the visit where the decision to perform a major (90-day) surgery was made, on the day before or the day of surgery. Modifier 25 marks a separately identifiable visit on the day of a minor procedure. Medicare does not pay 57 on the day of or day before a 0- or 10-day procedure.
What is the difference between modifiers 58, 78 and 79?
58 is a staged or planned related procedure during the postoperative period. 78 is an unplanned return to the operating room for a related procedure, paid at the intra-operative value while the original global period keeps running. 79 is an unrelated procedure by the same physician, and a new postoperative period begins with it.
Can casting supplies be billed separately from fracture care?
Yes, where the payer pays them; Medicare pays splint and casting supplies separately from the surgical package. The fracture treatment code includes the first cast or splint and routine follow-up, but replacement casts are billed with the casting and strapping codes, and the supplies are billed with their own HCPCS codes.
Can an orthopedic office bill Medicare for braces it dispenses?
Yes, if the practice is enrolled as a Medicare DMEPOS supplier and meets the supplier standards. Orthoses are billed with L-codes to the DME MAC, with a complete order and proof of delivery. Off-the-shelf back, knee and upper-extremity braces are included in the next round of competitive bidding.
How do you bill bilateral or ultrasound-guided joint injections?
A large-joint injection is 20610, or 20611 when ultrasound guidance is used and a permanent image is recorded. Each side is billed with RT or LT, or modifier 50 where the payer wants it. The drug is billed separately by HCPCS units, with JW or JZ on single-dose vials.
Do you bill workers' compensation and auto-injury orthopedic cases?
Yes. Work injuries are billed to the carrier under the state workers' compensation fee schedule. Florida auto injuries are billed under PIP, which covers care only if initial treatment starts within 14 days of the crash, then MedPay and the health plan, with letters of protection tracked separately.
How do you switch orthopedic billing companies without losing claims?
Give notice under your current contract, keep access to the billing system through the run-out, and pull an aging report plus the list of patients inside a global period and open authorizations. A typical switch takes two to four weeks, with new claims flowing after mapping and old claims worked in parallel.

See what your orthopedic A/R is actually worth

Last updated October 29, 2026. Reviewed by Jacob Greenberg, founder, ClaimCarePro. Send us 90 days of claims and operative notes and we will show you the bundled decision-for-surgery visits, the unbilled casting supplies and braces, and the injury claims on the wrong payer that can still be corrected. Billing is 6% of collections, month-to-month, no setup fee.

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