California Billing Services (CBS) provides orthopedic medical billing services for the whole practice: clinic visits, injections, DME, surgery, ASC cases and California workers' comp, coded from operative reports with global periods, modifiers and California payers in mind.
You repaired the joint. Getting paid shouldn’t become the next hurdle.
Orthopedic claims carry high values, so payers look harder at them. These five leaks deserve close review.
Routine follow-up within a surgical global period is included in the surgical fee. Bill it and it may be denied; miss a real exception and you lose revenue. We track global windows and review modifiers 24, 25, 58, 78 or 79 only when the note supports them.
Multiple-procedure payment reductions make sequencing important. We review procedure value, payer rules and modifiers 51, 59 or XS, and capture supported add-on codes such as +29826.
Joint replacement, spine and arthroscopy often need approval, and a scope change in the OR can affect it. We review authorization before surgery and request updates when the procedure changes.
Braces, boots and cast supplies can be separate charges with their own documentation rules. We review the appropriate L- or Q-codes, coverage and paperwork.
California workers' comp has its own authorizations, reports and fee schedules. A separate billing track keeps these claims, disputes and lien cases visible.
Find your biggest revenue leak with an orthopedic billing review.
Built around your care
Your team focuses on clinic, surgery, DME and therapy visits. We handle the claims, payer follow-up and documentation questions behind them, so orthopedic practices can spend less time chasing payments.
One accountable team for the full orthopedic revenue cycle.
Surgical benefits, deductibles, DME coverage and IPA assignment reviewed before the visit or case.
Explore serviceAuthorization workflows for surgery, MRI, injections and DME, including benefit-manager programs.
Explore serviceCPT, ICD-10-CM, HCPCS and modifiers reviewed against operative and clinic notes.
Explore serviceProcedures, add-on codes and assistant claims captured from the full operative report.
Payments compared with contracted rates to identify underpayments on high-value cases.
Appeals supported by operative reports, imaging and conservative-care history.
Explore serviceHigh-value surgical claims prioritized, with old AR recovery scoped separately.
Explore serviceEnrollment support for surgeons, PAs and NPs across applicable payer and workers' comp networks.
Explore serviceSurgical estimates, deductibles and payment-plan workflows explained clearly.
Codes come from the full op note, not the surgeon's summary line, so approach, laterality and add-ons are reviewed together.
Clinic visits, injections, DME, surgery, ASC and workers' comp considered within one revenue cycle.
RFAs, PR-2 and PR-4 reports, OMFS billing, bill review and liens have a dedicated workflow.
Discuss a named contact who understands your surgeons, schedules and payers.
Reporting by surgeon, procedure and payer makes denial root causes and underpayments easier to review.
Review a quote based on your practice and agree on included services, fees and exit terms before signing.
Most orthopedic visits never reach the OR. We make sure the clinic side is reviewed too.
Office visits (99202–99215) reviewed for the supported E/M level. Modifier 57 may apply to a major-surgery decision; modifiers 24 and 25 have distinct requirements for unrelated or separately identifiable visits.
Arthrocentesis and joint injections (20600–20611), tendon sheath injections (20550/20551), corticosteroid and hyaluronic-acid products reviewed with the applicable current drug codes, units, NDC and guidance documentation.
X-rays (73560–73564, 73030, 72100), MRI (73721, 73221, 72148) and DXA (77080), reviewed for global billing or professional (26) and technical (TC) components.
Osteoarthritis, rotator cuff and meniscus tears, fractures and aftercare coded to full specificity. Injury codes require the appropriate encounter character; procedure laterality uses RT, LT or applicable digit modifiers.
High-value surgical claims get the closest payer review. Coding starts with the operative report.
Total knee (27447), partial knee (27446), total hip (27130), total shoulder (23472) and revisions (27134, 27486, 27487), with authorization, medical necessity and conservative-treatment documentation reviewed.
Knee (29880, 29881, ACL reconstruction 29888), shoulder (29827, +29826, 29806, 29828) and hip (29914–29916). Open and arthroscopic approaches use different codes, so coding follows the op note and applicable bundling edits.
Closed versus open treatment (25600/25605 versus 25607–25609), hip fractures (27236, 27244, 27245) and ankle fixation (27814, 27822, 27823), with restorative fracture-care rules and encounter characters reviewed.
ACDF (22551), lumbar fusion (22612, 22630, 22633), instrumentation add-ons (+22840 to +22842), carpal tunnel release (64721, 29848) and trigger finger release (26055), subject to current code and payer edits.
Ambulatory surgery center claims require separate attention to professional services, facility payment and implant contract terms. Confirm support for your ASC before engagement.
Braces and boots are dispensed in minutes but carry detailed billing and documentation requirements.
California's system has its own rules, from treatment authorization to bill review and med-legal claims.
Workers’ comp claims aging? Review RFAs, reports, underpayments and liens with our team.
Authorization, medical-group assignments and claim routing reviewed for California orthopedic practices.
Noridian JE Part B requirements, NCCI and MUE edits, and plan-specific authorization for joint replacement, spine and imaging.
Review Anthem Blue Cross, Blue Shield of California, Health Net, Aetna, UnitedHealthcare and Cigna requirements, including programs routed through Evolent, Carelon, eviCore or TurningPoint. Confirm your specific payer arrangements with our team.
Review IPA or medical-group assignment, referrals and the Division of Financial Responsibility before billing the responsible payer.
For delayed payments, review applicable California prompt-pay and interest rules and the appropriate DMHC or Department of Insurance escalation path.
Review surgical authorization, IPA routing and payer underpayments together.
Billing performance reviewed by surgeon, procedure and payer.
Track claims accepted without preventable corrections.
Review denial trends by surgeon, procedure and payer.
Monitor the time between service and payment.
Prioritize older surgical, DME and workers' comp balances.
Compare collections with the amount contractually collectible.
| Modifier | Use in orthopedics |
|---|---|
| 24 / 25 | Unrelated E/M in a postoperative period / significant, separately identifiable E/M on a procedure day |
| 57 | E/M leading to the decision for major surgery |
| 58 / 78 / 79 | Staged or related procedure / unplanned return to the OR / unrelated procedure during a postoperative period |
| 51 / 59 / XS | Multiple procedures / distinct procedural service / separate structure, when payer edits and documentation support use |
| 50 / RT / LT | Bilateral or one-sided procedures |
| 54 / 55 / 56 | Surgical care only / postoperative management only / preoperative management only |
| 62 / 80 / 82 / AS | Co-surgeon / assistant surgeon / assistant when qualified resident unavailable / PA, NP or CNS assistant-at-surgery |
| 22 | Substantially increased procedural work, documented |
Modifier selection follows the operative and clinic documentation, current code set and payer edits. Code examples are not a substitute for case-specific coding review.
Clinic and surgical billing support without building a full internal billing department.
Consistent coding and reporting across surgeons and subspecialties.
Clinic, injection, DME and surgical revenue in one view.
Approach-, level- and fracture-specific coding review.
Discuss professional and facility claim reconciliation and implant reimbursement requirements.
RFAs, reports, OMFS billing and liens organized in a separate workflow.
For therapy referrals, see physical therapy billing.
A team that knows your specialty
Coders and billers familiar with orthopedic workflows review every claim before it goes out and keep you updated with clear monthly reporting.
Agree on a transition schedule with prior AR worked alongside new claims.
Agree on a review of surgical, clinic, DME and workers' comp claims.
Review the BAA and authorized EHR, ASC and payer-portal access.
Review professional and facility fee schedules, implant carve-outs and applicable DWC rates.
Coordinate new claims and prior AR responsibilities.
Agree on charge-capture workflows and global-period tracking.
Review reporting by surgeon, procedure and payer.
Discuss a quote for clinic, surgery, DME, workers’ comp and ASC billing. Confirm rates, included services, provider tiers and contract terms with our team.
Practice-specific quote
Practice-specific quote
Practice-specific quote
Opening or expanding a practice? Discuss credentialing, payer enrollment and ASC billing setup, with old AR recovery scoped separately.
Injection visits and complex surgical cases have different values and billing needs. Discuss a fee based on collections received rather than billed charges, and ask whether a hybrid arrangement fits your group.
Confirm clearinghouse fees, eligibility, coding, claims, payment posting, denials, appeals, statements and reporting. Agree on additional charges, setup fees, ASC pricing and exit terms before signing.
Compare the proposed fee with your actual collections, global-period denials, missed DME charges and workers’ comp delays. Review your own numbers without assuming a guaranteed revenue increase.
Discuss all seven questions with our team before you sign.
| Consideration | In-house billing team | California Billing Services |
|---|---|---|
| Cost | Staff, software and clearinghouse costs | Practice-specific quote and agreed service scope |
| Surgical coding depth | Depends on staffing and training | Discuss surgery, ASC and DME coding needs |
| Global-period tracking | Requires an internal tracking process | Case-level tracking workflow |
| Workers' comp and liens | Requires California-specific expertise | Separate California billing workflow |
| PTO and turnover | Plan for staffing gaps | Agree on continuity and backup coverage |
Discuss access to your existing system and confirm compatibility before your transition.
Plus Riverside, the Inland Empire and Orange County.
HIPAA and CMIA-aligned data handling, a Business Associate Agreement and controlled access are central to billing setup. Review role-based access, encryption and audit-trail requirements with our team before sharing practice data, including operative notes, imaging and clinic records. Review pre-bill NCCI and MUE checks, coding reviews and documentation requirements for high-value cases.
Request a practice-specific quote for a solo surgeon, orthopedic group, MSO or practice with an ASC. Confirm the rate, provider tiers, included services, additional fees and exit terms before signing.
Can't find what you're looking for? Contact our billing specialists
Review global-period denials, missed add-on and DME charges, workers’ comp delays, payer underpayments and aging AR with our team. Discuss the audit scope before sharing claims.
