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Orthopedic billing, coding and RCM guides

Orthopedic billing, coding and RCM guides

Orthopedic billing, coding and RCM guides

Practical answers to the revenue-cycle questions orthopedic practices ask most: modifiers and coding rules, denials and appeals, prior authorization, workers’ comp and the benchmarks that matter. Every guide cites its sources and shows when it was last updated.

Practical answers to the revenue-cycle questions orthopedic practices ask most: modifiers and coding rules, denials and appeals, prior authorization, workers’ comp and the benchmarks that matter. Every guide cites its sources and shows when it was last updated.

Practical answers to the revenue-cycle questions orthopedic practices ask most: modifiers and coding rules, denials and appeals, prior authorization, workers’ comp and the benchmarks that matter. Every guide cites its sources and shows when it was last updated.

Looking for a quick definition? Browse the Reference library →

Featured guide

Bar chart of proposed 2027 Medicare surgeon payment: total knee replacement 27447 falls from $1,159.35 to $922.17 and total hip replacement 27130 from $1,162.02 to $925.46; the conversion factor drops 1.68% to $32.8409

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Latest article

CY2027 Medicare Physician Fee Schedule: What It Means for Orthopedic Practices

CMS’s proposed 2027 fee schedule cuts the conversion factor, joint replacement RVUs and same-day E/M pay. What orthopedic practices should do now.

Bar chart of proposed 2027 Medicare surgeon payment: total knee replacement 27447 falls from $1,159.35 to $922.17 and total hip replacement 27130 from $1,162.02 to $925.46; the conversion factor drops 1.68% to $32.8409

Read More

Medicare & Payer Updates

Latest article

CY2027 Medicare Physician Fee Schedule: What It Means for Orthopedic Practices

All guides

All guides

All guides

All guides

Medicare & Payer Updates

Coding & Modifiers

Denials & Appeals

Prior Authorization

Workers’ Comp & Ancillary Services

RCM Benchmarks & Strategy

Five-step 30 to 60 day pilot plan for orthopedic coding and RCM software: measure a baseline, pick the scope, start in shadow mode, go live on a subset, allow for denial lag

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RCM Benchmarks & Strategy

How to Choose Orthopedic Coding and RCM Software in 2026: Buyer’s Checklist and Vendor Landscape

Timeline of the five Original Medicare appeal levels and filing deadlines: redetermination 120 days, reconsideration 180 days, ALJ hearing, Appeals Council and federal court 60 days each

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Denials & Appeals

How to Appeal a Medical-Necessity Denial for a Knee or Hip Replacement

Grid of ten orthopedic denial types with their typical CARC codes, from CO-197 prior authorization to OA-18 duplicate claim

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Denials & Appeals

The Most Common Orthopedic Claim Denials in 2026, and How to Prevent Them

Bar chart of proposed 2027 Medicare surgeon payment: total knee replacement 27447 falls from $1,159.35 to $922.17 and total hip replacement 27130 from $1,162.02 to $925.46; the conversion factor drops 1.68% to $32.8409

Read More

Medicare & Payer Updates

CY2027 Medicare Physician Fee Schedule: What It Means for Orthopedic Practices

Comparison of in-house, outsourced and AI-automated orthopedic billing by cost structure, control and scalability

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RCM Benchmarks & Strategy

In-House vs. Outsourced vs. AI-Automated Billing for Orthopedic Practices (2026)

Decision flow for an orthopedic injection day: if a significant, separately identifiable E/M was performed beyond the decision to inject, bill the E/M with modifier 25 plus the injection; if not, bill the injection only

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Coding & Modifiers

Can You Bill an E/M With Modifier 25 on an Orthopedic Injection Day?

Chart of four orthopedic RCM targets: days in A/R under 40, clean claim rate 90 to 95 percent or higher, denial rate under 5 percent, net collection rate 95 percent or higher

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RCM Benchmarks & Strategy

Orthopedic RCM Benchmarks for 2026: Days in A/R, Clean Claim Rate, Denial Rate and Net Collection Rate

Comparison of workers' compensation authorization and billing deadlines in California, New York and Texas

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Workers’ Comp & Ancillary Services

Orthopedic Workers’ Compensation Billing: Authorizations, Fee Schedules and Common Denials

WISeR Model summary: Original Medicare prior authorization in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington from 2026 through 2031, covering knee arthroscopy for osteoarthritis, epidural steroid injections, vertebral augmentation, cervical fusion and nerve stimulators

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Prior Authorization

WISeR Model: Which Orthopedic Services Need Medicare Prior Authorization?

Reference library

Look up a modifier, denial code or RCM metric

Look up a modifier, denial code or RCM metric

Short, sourced definitions written for orthopedic practices: what each term means, why claims get denied over it and how to prevent it.

Browse all terms

Browse all terms

Advance Beneficiary Notice (ABN)

CARC CO-11

CARC CO-16

CARC CO-197

CARC CO-4

CARC CO-50

CARC CO-97

Clean claim rate

CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F)

Days in A/R

Denial rate

Global surgical package

HCPCS G2211

Medically Unlikely Edits (MUEs)

Modifier 24

Modifier 25

Modifier 57

Modifier 58

How we write these guides

Each guide answers the question first, cites primary sources such as CMS, the NCCI manual, payer policies and state workers’ comp agencies, and shows the date it was last updated. Content is reviewed by the Rette revenue cycle team, written for orthopedic practices, and is educational rather than legal or billing advice.

See how Rette catches orthopedic denials before claims go out

See how Rette catches orthopedic denials before claims go out

See how Rette catches orthopedic denials before claims go out

Rette reads the operative note in the EHR you already use, suggests codes and checks claims against payer and NCCI rules before submission.

Get your free denial audit

Get your free denial audit