The best orthopedic billing companies get four things right: they understand global periods and modifiers, they handle fracture care, injections, implants and DME correctly, they chase prior authorizations and denials before the money ages, and they report results you can verify. Orthopedics mixes office visits, in-office imaging, procedures, surgery and supplies, so a general billing team that is fine for primary care can quietly lose money here.
- Independent and mid-size orthopedic groups usually do best with a specialty-focused partner that assigns a named team, such as The Medicators.
- Large groups and surgery-center operators may need one of the orthopedic billing companies that is built for high claim volume and facility billing.
- Practices that want software first can start with a platform that bundles billing, since some orthopedic billing companies sell billing with their software, then add a team when denials rise.
Before you compare orthopedic billing companies, see where your own revenue is slipping. The Medicators offers a free practice analysis that reviews your A/R, denials, payer activity and workflow.
Why Orthopedic Billing Is Harder Than Most Specialties
Orthopedic revenue passes through many billing rules at once. These are the pressure points that cost practices money.
| Orthopedic issue | How it costs you money | What to ask a partner |
| Global surgical periods (often 10 or 90 days) | Visits inside the global window billed wrongly or missed | How do you track global periods by patient and procedure? |
| Modifiers such as 25, 57, 58, 78, 79, 50 and 51 | Denials, bundling and underpayment | Who reviews modifier use before claims go out? |
| Fracture care | Casting and follow-up are bundled into the fracture code | How do you handle fracture care and cast supplies? |
| Joint injections and viscosupplementation | Drug and administration billed or documented incorrectly | How do you bill injections and product costs? |
| In-office x-rays and MRI | Professional and technical components mixed up | Do you separate and track both components? |
| Implants and surgery-center billing | Missing or low reimbursement for devices | How are implants captured and billed? |
| Prior authorization | Surgeries and imaging denied for no approval | Who obtains and tracks authorizations? |
| Workers’ compensation and injury cases | Slow payment and complex rules | How do you manage injury-case billing? |
| Braces and DME | Wrong HCPCS or missing documentation | How do you bill and track DME? |
Orthopedic billing companies that skip these steps quietly lose money. Rules and payer policies change every year, so a good partner updates its coding process continuously.
The 10 Orthopedic Billing Companies You Can Choose From
Orthopedic practices usually pick from ten kinds of partner among orthopedic billing companies. Each profile shows where the partner is based, who it suits and what to watch for.
1. The Medicators
- Location: Offices in Davis, California and Naperville, Illinois, serving healthcare practices across the United States.
- Best for: Independent orthopedic practices, multi-provider groups and growing clinics that want a dedicated billing and revenue cycle team across 30+ specialties.
- Watch for: Ask for orthopedic references, the names of the coders assigned to your account and a sample monthly report before signing.
The Medicators is a US medical billing and revenue cycle company that, by its own account, has supported healthcare practices for more than 20 years. The sections below explain how it works.
2. An orthopedic-only specialist biller
- Location: Varies, often a smaller regional firm.
- Best for: Groups that want deep orthopedic coding knowledge and nothing else.
- Watch for: A narrow focus can mean limited capacity, thin coverage when staff are out and fewer services beyond billing.
3. A national enterprise RCM firm
- Location: Headquartered elsewhere, serving many states.
- Best for: Large groups and health systems that need scale, analytics and standardized workflows.
- Watch for: Smaller groups may get less personal attention, and minimum volume rules may apply.
4. A software-bundled billing service
- Location: Usually national.
- Best for: Practices already on the same practice management and EHR system who want one vendor.
- Watch for: Services can be rigid, and your billing is tied to the software, so switching one means switching both.
5. A hospital-aligned biller
- Location: Often remote, with hospital clients.
- Best for: Orthopedic groups employed by or closely tied to hospitals.
- Watch for: It may be more than an independent group needs, and physician-practice focus can be thin.
6. A surgery-center-aware biller
- Location: Varies.
- Best for: Groups that own or use an ambulatory surgery center and need facility-side billing.
- Watch for: Confirm how implants, supplies and case costs are tracked.
7. A multi-specialty outsourcing firm
- Location: Varies.
- Best for: Practices that want one partner across orthopedics and other specialties.
- Watch for: Ask for orthopedic-specific references, not only general experience.
8. A lower-cost offshore-based service
- Location: Overseas teams serving US practices.
- Best for: Practices focused mainly on price.
- Watch for: Ask where patient data is handled, how HIPAA and business associate terms are enforced and who answers during US hours.
9. A coding and audit-only firm
- Location: Varies.
- Best for: Practices that keep billing in-house and need coding review.
- Watch for: It will not follow up on claims or work denials for you.
10. A management services organization with billing
- Location: Varies.
- Best for: Groups that want billing as part of a wider management package.
- Watch for: Control and contract terms can be heavy, so review exit rights carefully.
Not sure how broad your partner should be? Read medical billing company vs RCM company. Orthopedic billing companies also overlap with pain management billing, so see our guide to pain management billing companies if you perform many injections.
Why Orthopedic Practices Choose The Medicators
The Medicators works across 30+ specialties, including orthopedics, cardiology, pediatrics, psychiatry, pain management and internal medicine, and supports individual practices, group practices and larger organizations. See the full specialties list. Practices that want to outsource orthopedic billing often start here for three reasons: a named team, steady follow-up and clear reports. That focus is how The Medicators stands apart from many other orthopedic billing companies.
How we recover lost orthopedic revenue, step by step
- A free practice analysis first. We review your A/R, denials, payer activity and workflow so the plan begins with your data. Request it here.
- Coverage checks before the visit. Our eligibility verification services confirm insurance before care, which helps reduce avoidable rejections.
- Prior authorization support for orthopedic surgery. Authorizations for surgery and imaging are tracked ahead of the date of service so approvals are not missing at billing time.
- Orthopedic coding and modifier support. Claims are prepared with ICD-10, CPT and HCPCS support adapted to orthopedic workflows, including fracture care billing, injections and global periods.
- Follow-up on every aging claim. Outstanding balances get consistent contact through our A/R management services. If you have a large backlog, read our guide to medical billing companies for high A/R.
- Orthopedic denial management. Denials are worked, and the cause is fixed so the same error does not return. See our guide to denial management.
- Enrollment that keeps claims payable. New surgeons and locations need payer enrollment before they can bill. Our credentialing services help keep participation and billing details accurate.
- One accountable partner. Our RCM services connect the whole cycle from eligibility to final payment.
Where orthopedic revenue leaks, and how we respond
| Leak | Typical sign | Our response |
| Visits billed inside a global period | Denials or take-backs | Track global periods and check before billing |
| Missing or wrong modifiers | Bundling denials | Review modifier use before submission |
| Fracture care coded as separate services | Underpayment or denial | Apply fracture care rules and review documentation |
| Injections and product costs missed | Revenue never billed | Match documentation to drug and administration codes |
| No authorization for surgery or MRI | Denied for no approval | Track authorizations ahead of services |
| DME not billed or billed wrongly | Unpaid braces and supplies | Review HCPCS use and documentation |
| Aging balances | Rising A/R over 90 days | Scheduled follow-up by payer |
What you can expect
- Specialty-focused handling: billing workflows adapted to each specialty’s coding and payer patterns.
- EHR compatibility: the company works with platforms that include eClinicalWorks, NextGen, Allscripts, GE Healthcare, Greenway and Practice Fusion, and reviews yours before onboarding. See the EHR page.
- Compliance focus: the company states its workflows are HIPAA-compliant and follow CMS, payer and ICD-10 and CPT standards.
- Support: the company states it offers round-the-clock billing support and a 99% client retention rate. Ask for references to confirm.
We do not promise a fixed collection increase. Results depend on your specialty mix, payer mix and starting point.
Common Orthopedic Codes a Billing Partner Must Handle
A competent team at any of the orthopedic billing companies you shortlist should be comfortable with codes like these. Always confirm against the current CPT code set and payer policy.
| Code | Service |
| 99213 / 99214 | Office visit, established patient |
| 20610 | Large joint injection or aspiration |
| 29881 | Knee arthroscopy with meniscectomy |
| 27447 | Total knee arthroplasty |
| 27130 | Total hip arthroplasty |
| 73721 | MRI of a lower extremity joint |
A good partner can explain how each code is bundled, which modifiers apply, how global periods run and what documentation payers expect.
Workers’ Compensation and Injury Billing for Orthopedic Practices
Many orthopedic patients arrive after a work or accident injury. Workers’ compensation billing for orthopedic practices follows state fee schedules and its own forms, deadlines and approval steps, and injury cases may involve liens or letters of protection. Ask every one of the orthopedic billing companies you shortlist how many injury-case claims they handle and how they track them. If these cases make up a large part of your revenue, require a written process.
DME Billing for Orthopedic Practices
Braces, supports and other equipment bring their own HCPCS codes and supplier rules. DME billing for orthopedic practices needs clear documentation, accurate coding and tracking of what was dispensed. Ask whether the orthopedic billing companies on your list handle DME in the same workflow as your visits and procedures.
Orthopedic Billing Company Pricing: What to Expect
Orthopedic billing company pricing usually follows one of four models:
- Percentage of collections: a share of what is collected, often bundled with full service.
- Flat monthly fee: predictable, but not tied to results.
- Per-claim fee: can suit lower volumes.
- Hybrid: a base fee plus a performance portion.
Compare quotes from at least three orthopedic billing companies on the same scope, and ask:
- What is included, and what costs extra (appeals, authorizations, DME, credentialing)?
- Are there setup or minimum fees?
- Does the price change when I add a surgeon or location?
- What happens to fees if a payer takes money back?
To get a quote that uses your own numbers, start with the free practice analysis. It works especially well for orthopedic billing for small practices, where one biller often carries everything. Weighing a hire instead? Compare the math in outsourced medical billing vs in-house billing.
How to Hire an Orthopedic Billing Company
To hire from among orthopedic billing companies with less risk, use this order:
- Pull a baseline: days in A/R, A/R over 90 days, denial rate and net collection rate.
- List your surgeons, locations, payers, subspecialties and whether you run a surgery center.
- Ask for a written scope showing who handles eligibility, authorizations, coding, DME and appeals.
- Request a sample report and orthopedic references from groups of your size.
- Review a short pilot or a sample of your claims before a long contract.
When to Switch Orthopedic Billing Companies
Consider switching if you see:
- A/R over 90 days growing for several months
- The same denial reasons returning every month
- Global period and modifier errors repeating
- Reports with totals but no payer or reason detail
- Slow answers or no named contact
If this sounds familiar, ask for a free practice analysis before you decide. It shows what is recoverable so you can compare partners with facts. A fair comparison of orthopedic billing companies starts with your own data.
Metrics to Track After You Start
| Metric | What it shows | Common target |
| Net collection rate | Collected vs collectible | Around 95% or higher |
| Days in A/R | Speed of payment | Roughly 30 to 40 days |
| A/R over 90 days | Money at risk | Under about 15% to 20% |
| Clean claim rate | Quality at submission | Around 95% or higher |
| First-pass denial rate | Front-end health | Around 5% or lower |
| Prior authorization denials | Authorization health | Falling month over month |
Use these numbers to judge any of the orthopedic billing companies on your shortlist after the first 90 days. Not sure how to read your aging buckets? See our guide to reading an A/R aging report. Record a baseline before any partner starts.
Questions to Ask Before You Sign
Use these with every one of the orthopedic billing companies on your shortlist.
- Who works my account, and what are their credentials?
- How many orthopedic practices do you serve, and in which subspecialties?
- How do you track global periods and modifiers?
- How do you handle fracture care, injections, implants and DME?
- Who handles prior authorizations?
- How do you handle denials, appeals and aged claims?
- Which systems do you integrate with?
- How do you protect patient data and meet HIPAA requirements?
- Who owns my data if I leave, and how do I exit?
Red Flags
When you shortlist orthopedic billing companies, watch for these:
- A guaranteed revenue increase before seeing your data
- No orthopedic references
- No named contact or team
- Vague answers about global periods and modifiers
- Long contracts with heavy exit fees
Frequently Asked Questions
Who are the best orthopedic billing companies in the USA? The best fit depends on your size, subspecialty and payer mix. Look for orthopedic coding depth, a named team, steady follow-up and clear reports.
How much do orthopedic billing companies charge? Many orthopedic billing companies charge a percentage of collections, while others use flat, per-claim or hybrid fees. Compare what each quote includes.
Can a billing company handle global periods? Good orthopedic billing companies track them by patient and procedure. Ask how this is done and how errors are caught before claims are sent.
Do orthopedic billing companies handle prior authorization? Many orthopedic billing companies do, but not always in the base price. Confirm in writing who obtains and tracks approvals for surgery and imaging.
Can a billing company handle workers’ compensation claims? Some orthopedic billing companies do. Ask how many injury-case claims they handle and how they follow state rules.
Can small practices outsource orthopedic billing? Yes. Small practices often gain the most, because one person usually handles billing along with everything else.
How long does onboarding take? Typically several weeks, depending on systems, payers and open claims.
What should I send to get started? A recent A/R aging report, a few months of remittances and your payer mix. The free practice analysis will tell you what is needed.
Your Next Step: Free Practice Analysis
If you are comparing orthopedic billing companies, begin with your own numbers. The Medicators will review your A/R, denials, payer activity and workflow, then tell you where revenue is stuck and what it would take to fix it.
- Request your free practice analysis
- Or call +1 (888) 277-1460
Related Reading
- Top 10 Cardiology Billing Companies in the USA
- Top 10 Pain Management Billing Companies in the USA
- Best Medical Billing Companies for Denial Management
- Outsourced Medical Billing vs In-House Billing
- Medical Billing Company vs RCM Company
- The Medicators FAQs
