Surgical Billing Services
Expert billing for general surgery, orthopedic, and ASC practices. We handle complex modifier requirements, global periods, and multi-procedure discounting to maximize your high-value surgical reimbursements.
High-Value Surgical Revenue
Maximizing reimbursement for surgical practices nationwide
Why Surgical Billing Requires Deep Expertise
Surgical billing represents some of the highest-value claims in medical billing—and some of the most complex. A single orthopedic joint replacement can generate $15,000-25,000 in reimbursement when coded correctly. That same procedure becomes a $0 denial when modifiers are wrong, global periods are mismanaged, or component billing is handled improperly.
The complexity stems from multiple layers working simultaneously. Modifier requirements are extensive and procedure-specific. Bilateral procedures need modifier 50. Multiple procedures performed together require modifier 51 on all but the primary. Distinct procedures need modifier 59. Unusual circumstances justifying higher payment need modifier 22. Co-surgeons require modifier 62. Assistant surgeons use 80, 81, or 82 depending on the situation.
Global periods create a billing minefield. Major surgeries have 90-day global periods where post-operative care is included in the surgical payment. Minor procedures have 10-day globals. Bill a post-op visit during the global period without the right modifier, and it gets denied as inclusive. But services performed for unrelated conditions (modifier 24) or complications (modifier 78) are separately billable—and often missed.
Multiple procedure discounting slashes reimbursement when not managed correctly. When multiple procedures are performed in the same operative session, most payers pay 100% for the highest-RVU procedure, then 50% for additional procedures. Billing in the wrong order costs you money. Some payers have different reduction percentages. Medicare's multiple surgery rules differ from commercial insurance.
We built our surgical billing practice around these complexities, with coders who understand surgical terminology, know which modifiers apply to which scenarios, and track global periods automatically. The result: 97% modifier accuracy and maximum capture of every dollar your surgeons earn.
Surgical Billing Expertise Across All Specialties
Orthopedic Surgery
Joint replacements, arthroscopy, fracture care, spinal surgery. Expert handling of hardware billing, implant tracking, and the complex modifier requirements unique to orthopedics.
General Surgery
Appendectomies, cholecystectomies, hernia repairs, bowel resections. Proper coding for open vs laparoscopic approaches, conversion procedures, and unexpected findings.
ASC Billing
Ambulatory Surgery Center billing with facility fee capture, proper place of service coding, and understanding of ASC-specific payment methodologies that differ from hospital billing.
Modifier Mastery
Comprehensive modifier application: 50 (bilateral), 51 (multiple), 59 (distinct), 22 (unusual), 62 (co-surgeons), 80-82 (assistants), 78 (return to OR), and more.
Global Period Management
Automated tracking of 10-day and 90-day global periods. Proper billing of related complications, unrelated services, and staged procedures during global windows.
Revenue Optimization
Multiple procedure sequencing for maximum reimbursement, assistant surgeon billing capture, implant/hardware charges, and proper use of modifier 22 for increased complexity.
Surgical Modifiers: Getting Them Right Every Time
If there's one area where surgical practices lose the most money, it's modifier errors. Use the wrong modifier—or forget one entirely—and you're looking at denials, underpayments, or even overpayment recovery demands. Understanding exactly when and how to apply surgical modifiers is what separates mediocre billing from revenue-maximizing billing.
Modifier 50 (Bilateral Procedure) indicates a procedure was performed on both sides of the body. Bilateral knee arthroscopy, bilateral carpal tunnel release, bilateral hernia repair. Most payers pay 150% of the unilateral rate when modifier 50 is used correctly. Bill two separate line items instead of one with modifier 50, and you'll get one denied as duplicate. Bill without modifier 50 when appropriate, and you've left 50% of your payment on the table.
Modifier 51 (Multiple Procedures) tells payers that multiple procedures were performed in the same operative session. Critical point: only append modifier 51 to the secondary procedures, not the primary. The procedure with the highest RVU gets billed first without modifier 51. All additional procedures get modifier 51 and are subject to multiple procedure payment reductions—typically 50% of the normal fee.
Modifier 59 (Distinct Procedural Service) is perhaps the most scrutinized modifier in surgery. It indicates that a procedure normally bundled with another was actually performed as a distinct service. Different anatomic site, different session, different incision, or different injury. Use modifier 59 inappropriately, and you're unbundling services improperly (fraud risk). Fail to use it when warranted, and you lose payment for legitimately separate procedures.
The newer X-modifiers (XE, XS, XP, XU) provide more specificity than modifier 59. XE indicates a separate encounter. XS indicates a separate structure or site. XP indicates a separate practitioner. XU indicates an unusual non-overlapping service. Medicare prefers X-modifiers over 59 when applicable, and knowing which one to use prevents denials.
For practices experiencing repeated modifier-related denials, our Denial Code Lookup Tool provides specific guidance on common modifier denial codes and resolution strategies.
Surgical CPT Codes & Reimbursement Rates
Understanding typical reimbursement helps practices ensure proper coding and documentation. Here are common surgical procedures with Medicare reimbursement rates (commercial rates typically 150-300% of Medicare).
Critical note on modifier sequencing: When multiple modifiers apply to the same procedure, the order matters. Pricing modifiers (50, 51, 22) come before informational modifiers (59, 76, 78). Getting the sequence wrong can result in incorrect payment calculations or system rejections.
Global Period Management: Preventing Lost Revenue
Global periods are one of the most misunderstood aspects of surgical billing—and one of the costliest when managed incorrectly. A global period is the timeframe during which post-operative care is considered included in the surgical payment. Bill separately for routine follow-up during this period, and you get denials. Miss billing for separately billable services during the global period, and you lose legitimate revenue.
Major surgeries have 90-day global periods. Total joint replacements, spinal fusions, open abdominal procedures, and most inpatient surgeries fall into this category. The global period includes all pre-operative visits (starting the day before surgery), the surgery itself, and all routine post-operative care for 90 days after surgery. This means post-op visits, wound checks, staple removal, cast changes—all included, not separately billable.
Minor procedures have 10-day global periods. Carpal tunnel release, trigger finger release, simple excisions, and many arthroscopic procedures have 10-day globals. Same rules apply—routine post-op care is included, but complications and unrelated services are separately billable with appropriate modifiers.
What IS separately billable during global periods: Services unrelated to the surgery (modifier 24). Complications requiring a return to the operating room (modifier 78). Unplanned procedures related to the original surgery (modifier 79). E/M services above and beyond routine post-op care (modifier 25). Missing these separately billable services is pure revenue loss.
Staged procedures get special handling. When a surgeon performs a procedure knowing that additional related procedures will be necessary (such as two-stage knee replacements), modifier 58 indicates the second procedure was planned. Without modifier 58, the second procedure gets denied as falling within the first procedure's global period. We track planned staged procedures and ensure modifier 58 is applied appropriately.
For more on our systematic approach to surgical billing and denial prevention, see our RCM Intelligence framework.
Surgical Billing FAQs
Do you bill for both hospital-based and ASC surgeries?
Yes. We handle both settings with full understanding of the different billing rules. Hospital-based surgeries typically involve professional fee only (surgeon's work), while ASC billing may include both professional and facility fees depending on ownership structure. We ensure proper place of service codes, understand ASC payment groupings, and know which services are bundled in ASC settings versus separately billable in hospital settings.
How do you handle assistant surgeon billing?
Assistant surgeon billing uses modifiers 80, 81, or 82 depending on who assisted. Modifier 80 is a qualified assistant surgeon (typically pays 16% of surgeon fee). Modifier 81 is a minimum assistant (rare). Modifier 82 is an assistant when a qualified resident isn't available (teaching hospitals). We track which procedures qualify for assistant surgeon payment, verify payer policies on assistant coverage, and ensure these charges aren't missed—they represent significant revenue for practices with complex cases.
What's the difference between modifier 59 and the X-modifiers?
Modifier 59 indicates a distinct procedural service, but it's vague about why the service is distinct. The X-modifiers (XE, XS, XP, XU) provide more specificity: XE means separate encounter, XS means separate structure/site, XP means separate practitioner, XU means unusual non-overlapping service. Medicare prefers X-modifiers when applicable because they reduce ambiguity. We use X-modifiers for Medicare and modifier 59 for commercial payers who haven't adopted the X-modifiers yet.
How does multiple procedure discounting work?
When multiple procedures are performed in the same operative session, most payers pay 100% for the highest-RVU procedure, then reduce payment on additional procedures—typically to 50% of the normal fee. We sequence procedures by RVU value to maximize total payment, apply modifier 51 to secondary procedures, and track payer-specific rules (some payers have different reduction percentages, some exempt certain procedures from discounting). Proper sequencing can mean thousands of dollars difference in total reimbursement.
When can I use modifier 22 for increased complexity?
Modifier 22 indicates a procedure took significantly more time, effort, or complexity than usual due to patient factors (morbid obesity, scarring, complicated anatomy) or surgical factors (unexpected findings, extensive adhesions). Documentation must clearly explain why the case was unusual and quantify increased work (e.g., "procedure took 3 hours instead of typical 1.5 hours due to extensive adhesions"). Most payers require detailed operative notes and may request peer review. When properly documented and justified, modifier 22 can increase payment by 20-50%.
Stop Leaving Surgical Revenue on the Table
Modifier errors, global period violations, and missed assistant surgeon charges cost surgical practices $120k-400k annually. Let's calculate your exact revenue gap.
Serving surgical practices nationwide. Expert billing for orthopedics, general surgery, and ASC facilities.
A-Z Medical Billing & Consulting was founded by Zain Vally, who identified persistent revenue cycle inefficiencies while operating Vally Medical Group, a multi-location occupational medicine practice across Hawaii. The hands-on experience of managing billing operations for practices spanning multiple islands revealed systematic problems in how most billing services approach complex specialty billing. Our surgical billing expertise comes from years of working with orthopedic and general surgery practices to master modifier requirements, global period management, and high-value procedure optimization. We built A-Z specifically to address these gaps through systematic prevention, aggressive pursuit of denied claims, and transparent reporting.