Orthopedics Billing Services
Surgical procedures, fracture care global periods, modifier stacking, implant billing. Orthopedic billing demands specialty expertise.
Why Orthopedics Billing Requires Specialty Expertise
Orthopedics spans office visits, injections, imaging, casting, surgical procedures, and post-op care. A single knee arthroscopy can involve multiple codes with modifier 59/XE. Global periods affect follow-up billing.
Common Orthopedics CPT Codes
Our coders handle these orthopedics codes daily. This is not an exhaustive list.
2026 Medicare Allowables for Orthopedics CPT Codes by State
Medicare reimbursement for orthopedicsprocedures is not a single national number. Each code's allowable is adjusted by your state's Geographic Practice Cost Index (GPCI) and processed under that state's Medicare Administrative Contractor (MAC), so the same orthopedics CPT code pays a different amount in California than it does in Texas or Florida. The table below shows the 10 core orthopedicscodes our coders bill priced at each state's 2026 locality. The non-facility figure is what an office-based practice collects. The facility figure applies when the service is performed in a hospital-based setting.
Commercial carriers in each state typically reimburse above these Medicare benchmarks and state Medicaid below them, but the Medicare allowable is the contracting anchor every payer negotiation starts from. Compare any individual code across all states with our Medicare fee calculator by state.
| Code | Orthopedics Procedure | CA | TX | FL | NY | PA | IL | OH | GA | NC | MI |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 20610 | Major joint or bursa aspiration or injection | $74.84 | $68.04 | $73.05 | $76.07 | $68.55 | $71.54 | $65.47 | $67.92 | $64.64 | $68.22 |
| 20611 | Major joint injection with ultrasound guidance | $115.04 | $103.09 | $108.85 | $114.96 | $103.55 | $106.44 | $98.70 | $102.25 | $98.25 | $102.22 |
| 27130 | Total hip arthroplasty | $1,194.17 | $1,149.88 | $1,291.37 | $1,285.82 | $1,169.13 | $1,274.38 | $1,129.30 | $1,171.69 | $1,087.16 | $1,193.45 |
| 27447 | Total knee arthroplasty | $1,191.65 | $1,147.31 | $1,287.74 | $1,282.60 | $1,166.42 | $1,270.85 | $1,126.77 | $1,168.89 | $1,084.96 | $1,190.47 |
| 29826 | Shoulder arthroscopy with subacromial decompression | $147.84 | $146.32 | $166.07 | $162.75 | $149.22 | $164.59 | $145.14 | $150.19 | $138.60 | $153.68 |
| 29881 | Knee arthroscopy with meniscectomy | $546.52 | $509.92 | $560.77 | $571.13 | $516.08 | $551.00 | $495.19 | $514.19 | $482.74 | $520.12 |
| 73721 | MRI lower extremity joint without contrast | $233.45 | $202.00 | $207.78 | $225.77 | $201.80 | $202.00 | $190.75 | $197.83 | $192.79 | $196.04 |
| 73030 | X-ray shoulder, complete, two or more views | $40.97 | $35.27 | $36.47 | $39.62 | $35.25 | $35.39 | $33.22 | $34.55 | $33.55 | $34.24 |
| 73562 | X-ray knee, three views | $48.88 | $41.85 | $43.17 | $47.08 | $41.78 | $41.84 | $39.32 | $40.91 | $39.78 | $40.52 |
| 99213 | Established patient office visit, low MDM | $104.31 | $94.46 | $98.20 | $103.97 | $94.79 | $96.44 | $90.97 | $93.60 | $90.84 | $93.44 |
Full Orthopedics fee detail by state
2026 Medicare allowables for orthopedics CPT codes in California, processed under Noridian Healthcare Solutions (Jurisdiction E). See California medical billing.
| Code | Description | Non-Facility | Facility |
|---|---|---|---|
| 20610 | Major joint or bursa aspiration or injection | $74.84 | $40.46 |
| 20611 | Major joint injection with ultrasound guidance | $115.04 | $51.02 |
| 27130 | Total hip arthroplasty | $1,194.17 | $1,194.17 |
| 27447 | Total knee arthroplasty | $1,191.65 | $1,191.65 |
| 29826 | Shoulder arthroscopy with subacromial decompression | $147.84 | $147.84 |
| 29881 | Knee arthroscopy with meniscectomy | $546.52 | $546.52 |
| 73721 | MRI lower extremity joint without contrast | $233.45 | $233.45 |
| 73030 | X-ray shoulder, complete, two or more views | $40.97 | $40.97 |
| 73562 | X-ray knee, three views | $48.88 | $48.88 |
| 99213 | Established patient office visit, low MDM | $104.31 | $59.65 |
Source: 2026 Medicare Physician Fee Schedule, locality-adjusted by state MAC. Figures are for reference and contracting benchmarks, not a guarantee of payment.
Orthopedics Billing Challenges We Solve
Common billing problems in orthopedics and how our team handles them.
Surgical Bundling
Multiple procedure codes per surgery with correct modifier usage.
Global Period Management
10- and 90-day globals affect follow-up billing.
Implant Billing
Device cost recovery requires payer-specific knowledge.
Workers Comp
Separate fee schedules and documentation requirements.
Common Orthopedics Denial Reasons
We prevent these before submission and appeal aggressively when they occur.
Revenue Opportunities Most Orthopedics Practices Miss
Payer-Specific Orthopedics Billing Tips
Orthopedics Billing Best Practices
Practical tips from our coding team to maximize reimbursement and minimize denials.
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What We Handle for Orthopedics Practices
Why Choose Go Medical Billing for Orthopedics
Our orthopedic coders handle joint replacement, arthroscopy, spine, and trauma billing daily with full modifier expertise.
We serve orthopedics practices in all 50 states, starting at 2.49% of collections. Our credentialing team handles payer enrollment, and our A/R specialists recover aging claims.
Orthopedics Billing by State
We handle orthopedics billing in all 50 states. The 2026 Medicare allowables for orthopedics CPT codes in every state are in the fee table above. Open any state below for its full payer environment, Medicaid rules, and Medicare MAC policies.
Frequently Asked Questions
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Stop losing revenue to orthopedics coding errors and preventable denials. Call 888-701-6090 for a free billing assessment.