Florida Orthopedic Billing Demystified: Compliance, Codes & Collections
Orthopedic billing in Florida is a complex but essential part of running a successful practice. Between compliance challenges, evolving payer rules, and accurate coding, even the most skilled orthopedic surgeons need billing processes that are sharp, compliant, and collection-focused.
In this blog, we’ll demystify orthopedic billing in Florida by diving into:
Common CPT codes
Critical compliance requirements
Efficient collection strategies
Understanding Orthopedic CPT Codes
Correct CPT coding ensures accurate reimbursement. Here are the most commonly used CPT codes in orthopedic practices:
Common Evaluation and Management (E/M) Codes
CPT Code Description 99203 New patient office visit, moderate complexity
99213 Established patient office visit, low complexity
99214 Established patient office visit, moderate complexity
Fracture Care & Casting
CPT Code Description
25600 Closed treatment of distal radial fracture (Colles)
27786 Closed treatment of tibial shaft fracture
29075 Application of long arm cast
29345 Application of long leg cast
Injections
CPT Code Description
20610 Aspiration/injection of major joint (e.g., knee)
20605 Aspiration/injection of intermediate joint (e.g., elbow)
Surgical Procedures
CPT Code Description
29881 Knee arthroscopy with meniscectomy
23410 Repair of rotator cuff tear
27130 Total hip arthroplasty
27447 Total knee arthroplasty
Pro Tip: Always pair CPT codes with appropriate ICD-10 codes to support medical necessity and avoid denials.
Compliance Essentials in Florida
Florida has a growing regulatory focus on healthcare fraud prevention, making orthopedic billing compliance more crucial than ever.
Key Areas of Compliance:
Medical Necessity: Ensure thorough documentation supports the procedure.
Modifier Usage: Avoid overuse or misuse of modifiers like -25, -59, -RT, -LT.
Incident-to Billing: Florida Medicaid and Medicare have strict requirements — non-compliance can trigger audits.
Balance Billing Restrictions: Florida law limits what can be billed to patients outside insurance coverage for in-network providers.
Top Compliance Tips:
Conduct internal audits quarterly.
Use checklists for pre-op and post-op billing compliance.
Stay updated on CMS, Florida Blue, and Medicaid policies.
Streamlined Collections for Orthopedic Clinics
Billing is only half the equation — collections are where revenue cycle success is measured.
Best Practices:
Verify Insurance Pre-Visit
Confirm eligibility, benefits, and pre-authorization requirements.
Implement Transparent Financial Policies
Provide estimates and get signed agreements before surgery.
Automate Claims Follow-Up
Use billing software to flag and follow up on unpaid claims.
Appeal Denials Promptly
Focus on common denial reasons: lack of documentation, incorrect modifiers, or out-of-network services.
Outsourcing Option
Consider working with a Florida-based orthopedic billing company to:
Maximize collections
Reduce billing errors
Focus more on patient care
Florida-Specific Payer Notes
Here’s what to keep in mind for major payers:
Florida Blue (BCBS): Rigid pre-authorization rules for joint replacements and MRI procedures.
Humana & UnitedHealthcare: Strict bundling edits — watch your modifier usage closely.
Medicaid of Florida: Requires NCCI edit compliance and restricts retroactive authorizations.
Closing Thoughts
Orthopedic billing in Florida isn’t just about submitting claims — it’s about precision, compliance, and continuous optimization. From CPT code accuracy to collections and payer-specific policies, having a skilled billing team (or partner) is critical for success.
