Orthopedic medical billing at a glance: Prime Medical Revenue is an orthopedic billing company based in Austin, Texas. We serve orthopedic practices, surgeons and surgery centers across the United States. Our team handles approvals, orthopedic coding and surgical billing. We also bill implants, DME, workers’ comp and personal injury claims inside your current EHR. Every client signs a BAA, and every practice gets a dedicated point of contact.
Orthopedic Billing Services Built for Orthopedic Practices
Prime Medical Revenue provides orthopedic medical billing for solo surgeons, orthopedic groups and surgery centers across the United States. As your orthopedic billing company, we take the billing work off your staff. We get insurance approvals, code each visit and surgery, send claims, follow up on unpaid ones, and fix denials.
Orthopedics is one of the hardest specialties to bill. One knee surgery can carry several codes, an implant, and a 90-day follow-up period with its own rules. Add braces, workers’ comp cases and injury claims, and small mistakes pile up fast. When that happens, claims come back unpaid and your practice waits longer for money it already earned.
Our orthopedic billing services are built around these details. You get a team that bills orthopedic claims every day. We work inside the software you already use. And every month, you see what was paid, what was denied, and what we did about it.
Our Orthopedic Billing and Coding Services
Here is what our team handles for your practice. You can hand us your full billing cycle or start with the areas that cause the most trouble today.
Prior Authorization for MRIs and Surgery
Many insurance plans must approve an MRI or a surgery before it happens. We request the approval as soon as it is booked and follow it until it comes back.
- MRIs, CT scans, joint replacements, spine surgery and arthroscopy
- Requests sent to insurers and the review companies they use, such as eviCore and Carelon
- Your front desk hears from us right away if an insurer needs more notes
Orthopedic Coding Services
Every service needs the right code. CPT codes describe what the surgeon did. ICD-10 codes explain why. Modifiers are short add-on codes that tell the insurer more, such as which side of the body was treated.
- Left and right side codes, and bilateral surgery coded correctly
- Fracture codes with the right final character for first and follow-up visits
- Claims checked against Medicare NCCI edits before they go out
See how our medical coding services work.
Surgical Follow-Up Period Tracking
Most orthopedic surgeries come with a follow-up period of 10 or 90 days. Routine visits in that window are not paid on their own. Some visits are, and they need the right modifier.
- Unrelated visits during the follow-up period billed with modifier 24
- Planned and unplanned returns to surgery billed with modifiers 58 and 78
- Unrelated surgeries in the same period billed with modifier 79
Implant and Device Billing
Joint replacements, spine fusions and fracture repairs often use implants, plates and screws. We match each implant to the surgery and bill it the way each insurer allows.
- Implant invoices and operative notes checked for every case
- Device charges kept on the right claim
- Implants that insurers pay separately never left off
DME and Orthotic Billing
Braces, splints, slings and other supports are billed with HCPCS codes. Insurers often ask for proof of delivery and a note showing why the patient needs the item.
- Knee, back and wrist braces, walking boots and slings
- Medical need and delivery records checked before billing
- Rental and purchase items billed the way each plan requires
Workers’ Comp and Personal Injury Billing
Work injuries and accident cases follow different rules from regular health insurance. The claim goes to a workers’ comp carrier, an auto insurer, or waits for a case to settle.
- Workers’ comp claims sent with the right claim number and reports
- Personal injury cases tracked until they are paid
- Texas workers’ comp fee rules applied for Texas practices
Denial Management and A/R Follow-Up
When an insurer refuses a claim, we find out why, fix it, and send it back. We follow up on every unpaid claim, oldest and largest first. Learn more about our denial management service.
- Every denial grouped by its cause
- Appeals sent before the insurer’s deadline
- Each payment recorded against the right visit with our payment posting service
Eligibility Checks and Credentialing
Before each visit, we confirm the patient’s insurance is active and covers the service. When a new surgeon joins your group, we help enroll them with insurance plans.
- Eligibility and benefits checks before appointments and surgery
- Credentialing and payer enrollment for new providers
- Fewer claims denied for coverage problems
Orthopedic Surgery Billing We Handle
Orthopedic surgery billing is where most of your revenue sits. It is also where most mistakes happen. These are the procedures our team bills every week.
Joint Replacement
Knee and hip replacements, including revisions. We check the implant, the side of the body and the 90-day follow-up period.
Spine Surgery and Fusion
Fusions, decompressions and instrumentation across several levels. Each level and each piece of hardware is coded on its own line.
Arthroscopy
Knee and shoulder scopes, including repairs done in the same session. We code open and scope work correctly, so related work is not denied as part of another procedure.
Fracture Care and Casting
Fracture repair, closed treatment, casts and splints. Follow-up fracture visits are coded so they are not mixed up with the first visit.
Sports Medicine
Office visits, injections, X-rays and minor procedures for active patients. We bill the visit and the procedure separately when the notes support it.
Surgery Center Claims
Facility claims for surgery centers, separate from the surgeon’s own claim. Both claims are checked so they match.
Two procedures in one surgery? Surgeons often do more than one procedure in the same session. Insurers usually pay the main one in full and the others at a lower rate. We list them in the right order, so the main procedure is paid in full.
Why Orthopedic Practices Choose Prime Medical Revenue
Many companies offer medical billing. Fewer understand orthopedic claims. Here is what makes our orthopedic billing company a good fit for orthopedic practices.
A Team That Knows Orthopedics
We bill surgery, implant, DME and injury claims every day. You do not have to teach us your specialty.
We Work Inside Your Systems
You keep your current health record and practice software. We log in and do the work there, so your staff has nothing new to learn.
You See Every Denial
We report denials by cause each month. You see what went wrong, what we fixed, and what is still open.
Answers Within One Business Day
When your team has a billing question, we reply within one business day. Urgent surgery approval problems get priority, and we aim to reach your team the same day.
Patient Data Kept Safe
We follow HIPAA-compliant processes. Only the team members who need your information for their work can access it.
A Free Review Before You Decide
We look at your recent claims and show you where money is getting stuck. You decide after you see the findings.
Here is how our approach compares with a general billing service.
| What matters | General billing service | Prime Medical Revenue |
|---|---|---|
| Surgery follow-up visits | Often billed when they should not be | Tracks every 10-day and 90-day period |
| Left and right side | Easy to miss on claims | Checked on every procedure |
| Implants | Billed only if someone enters them | Matched to every surgery |
| Braces and DME | Billed without delivery records | Checked for medical need and delivery |
| Workers’ comp and injury cases | Treated like regular insurance | Sent to the right carrier and tracked |
| Monthly reporting | Totals only | Payments, denials and unpaid claims explained in plain terms |
Get a Free Orthopedic Billing Review
How to Choose the Best Orthopedic Billing Company
The best orthopedic billing company for your practice is the one that knows surgical claims, works in your software, and shows you every result. Use these checks when you compare companies. Here is how we meet each one.
| What to check | Why it matters | How Prime Medical Revenue meets it |
|---|---|---|
| Orthopedic experience | Surgery, implant, DME and injury claims follow their own rules | We bill these claims every day |
| Follow-up period tracking | Visits billed inside a surgery’s follow-up period get denied | Every 10-day and 90-day period tracked |
| Works in your software | Switching systems costs time and money | We already work in Epic, eClinicalWorks, NextGen, athenahealth and many more |
| Workers’ comp and injury cases | These claims go to different payers with different rules | Billed and tracked until they are paid |
| Clear reporting | You should see where your money is, not just totals | Monthly report with denials by cause and A/R aging |
| HIPAA and a BAA | The law requires a BAA with your billing company | We sign a BAA with every client |
| Proof before you commit | You should see the problems before you pay to fix them | A free orthopedic billing review first |
Orthopedic Billing Software We Already Work In
You do not need to change your software to work with us. Our team already bills in the systems most orthopedic practices use. We log in to your system and do the billing work there.
Health Record and Practice Systems
- Epic
- Oracle Health (Cerner)
- eClinicalWorks
- NextGen
- athenahealth
- AdvancedMD
- Tebra (Kareo)
- CareCloud
- DrChrono
- CureMD
- MicroMD
- Practice Fusion
- Amazing Charts
Billing Software and Clearinghouses
- CollaborateMD
- OpenPM
- Office Ally
- Any clearinghouse your practice already uses
Using a system that is not on this list? Tell us during your free review, and we will check it with you before you decide.
Orthopedic Claims We Fix Every Day
These are common claim problems in orthopedic practices. Each one looks small. Each one costs real money when it is missed. Here is how our orthopedic billing company handles them.
Visit Denied After Surgery
- The problem
- A patient came in for a new problem during the 90-day follow-up period. The insurer treated it as routine aftercare and paid nothing.
- What we do
- We add modifier 24 and check that the note shows the visit was for something unrelated.
- What it protects
- Payment for real visits your surgeon provided.
Second Procedure Paid as Nothing
- The problem
- Two procedures were done in one session, but the claim listed them in the wrong order.
- What we do
- We list the main procedure first and add the right modifier to the others.
- What it protects
- Full payment for the main procedure and fair payment for the rest.
Left Knee Billed as Right
- The problem
- The claim said right knee, but the notes said left. The insurer rejected it.
- What we do
- We check the side of the body on every claim against the operative note.
- What it protects
- Clean claims that are paid the first time.
Brace Claim Denied
- The problem
- A knee brace was billed without proof that the patient received it.
- What we do
- We check delivery and medical need records before the claim goes out.
- What it protects
- Steady payment for the DME your practice provides.
Orthopedic Practices We Support
Every orthopedic practice runs differently. We fit our work to the way your practice runs.
Solo Orthopedic Surgeons
You want billing off your desk without hiring a full billing team. Our small practice medical billing service is built for this.
Orthopedic Groups
Multi-location and larger groups with many surgeons, hospital cases and new providers joining. We keep every provider’s claims moving.
Spine and Sports Medicine Practices
High-value spine surgery and busy sports medicine clinics with injections, X-rays and minor procedures.
Practices With Surgery Centers or DME
Groups that own a surgery center or dispense braces. We bill the facility, the surgeon and the DME on the right claims.
Our Orthopedic Billing Process
Moving your billing should not slow down your cash flow. Here is how we set up your orthopedic revenue cycle management, step by step.
- Free orthopedic billing review. We look at your recent claims, denials and unpaid balances. Then we show you where money is getting stuck.
- Agreement and secure access. We sign a Business Associate Agreement, which HIPAA requires, and set up secure access to your practice software.
- Handover of open claims. We take over your unpaid claims, including workers’ comp and injury cases, and keep working them while new claims begin.
- Go live. We start billing new visits, surgeries and DME inside your current system.
- Monthly review. We walk you through your report and agree on the next steps together.
Start With a Free Billing Review
Monthly Orthopedic Billing Reports You Can Trust
Each month you get a simple report. It shows how your billing is doing in plain numbers, with notes on what we changed. Here is what every report covers.
Orthopedic Billing Services Nationwide From Austin Texas
Prime Medical Revenue bills for orthopedic practices across the United States. See the states we serve. Our team works from our office at 5900 Balcones Drive in Austin, Texas. We also work closely with orthopedic practices in Houston and Dallas.
Billing happens inside your practice software and insurer websites. That means your location does not change the service you get. An orthopedic group in Florida gets the same team as a practice in Austin.
Orthopedic practices in Austin can meet our team in person at our office on Balcones Drive, just off MoPac. We support practices across the Austin area, including Round Rock, Cedar Park, Georgetown, Pflugerville, Lakeway, Kyle and San Marcos.
For Texas practices, we already know the local rules. That includes Novitas, the Medicare contractor for Texas, and Texas Medicaid through TMHP. It also includes the Texas Division of Workers’ Compensation fee rules. And it covers commercial plans such as Blue Cross Blue Shield of Texas, UnitedHealthcare, Aetna, Cigna and Humana.
What this page covers: billing for orthopedic visits, surgery, fractures, implants, DME and injury claims. Is your practice mainly focused on spine injections and pain treatment? Our team bills those too. You can also see all the specialties we bill for.
Orthopedic Billing Quick Facts
| Company | Prime Medical Revenue |
|---|---|
| Office | 5900 Balcones Drive STE 100, Austin, TX 78731 |
| Service area | All 50 states, with local support in Austin, Houston and Dallas |
| Practices we serve | Solo orthopedic surgeons, orthopedic groups, multi-location groups, spine and sports medicine practices, surgery centers |
| Services | Prior authorization, orthopedic coding, surgical follow-up tracking, implant billing, DME and orthotic billing, workers’ comp and personal injury billing, surgery center claims, denial management, A/R follow-up, payment posting, eligibility checks, credentialing |
| Software | Epic, Oracle Health (Cerner), eClinicalWorks, NextGen, athenahealth, AdvancedMD, Tebra and other EHR and billing systems, plus any clearinghouse |
| Data security | HIPAA-compliant processes and a signed BAA with every client |
| Response time | Within one business day, with same-day contact for urgent authorization issues |
| Reporting | Monthly report with days in A/R, collection rate, clean claim rate, denials by cause and A/R aging |
| How to start | Free orthopedic billing review, then a clear quote |
Orthopedic Billing FAQs
The best orthopedic billing company knows surgical claims and works in your current software. It also reports every denial by cause. Prime Medical Revenue is an orthopedic medical billing company based in Austin, Texas. We bill surgery, implants, DME and injury claims for practices across Austin and the United States.
Pricing depends on your practice size, how many claims you send each month, and which services you need. We start with a free review of your billing. After that, we give you a clear quote, so you know the cost before you decide anything.
Yes. We bill workers’ comp claims to the right carrier with the claim number and reports they need. We also track personal injury cases until they are paid. For Texas practices, we follow the Texas Division of Workers’ Compensation fee rules.
Yes. We bill braces, splints, walking boots, slings and other supports. Before each claim goes out, we check the medical need and delivery records. Insurers often deny DME claims without them.
Yes. We bill facility claims for surgery centers as well as the surgeon’s own claims. We check that both claims match, so one does not hold up the other.
We already work in Epic, Oracle Health (Cerner), eClinicalWorks, NextGen, athenahealth, AdvancedMD, Tebra and many other systems, plus any clearinghouse. You keep the software you use today. We log in to your system and do the billing work there.
Nothing gets dropped. We take over your open claims, including workers’ comp and injury cases, and keep working them while new claims start. We work the largest and oldest ones first.
It depends on your software, how many claims you send, and how quickly secure access is set up. After your free review, we give you a clear start date and a step-by-step plan, so there are no surprises.
Yes. Every practice gets a dedicated point of contact for billing questions and service requests. We reply within one business day. Urgent surgery approval problems get priority, and we aim to reach your team the same day.
Yes. We sign a Business Associate Agreement, or BAA, with every client. HIPAA requires this agreement between a practice and its billing company. It sets out how we protect your patients’ health information.
We serve orthopedic practices across the United States. Our team is based in Austin, Texas, and we work closely with practices in Houston and Dallas. Billing is done inside your software and insurer websites, so practices in any state get the same service.
Get a Free Orthopedic Billing Review
If your surgery claims keep coming back unpaid, or your billing staff is stretched thin, let us take a look. Our free review shows where your money is getting stuck. Then you decide if our orthopedic medical billing team is the right fit for your practice. Want a deeper check first? Start with a medical billing audit.