Common Orthopedic CPT Codes: Billing & Coding Guidelines 2026

According to the American Academy of Orthopaedic Surgeons (AAOS), musculoskeletal conditions account for more than 126 million patient visits annually in the United States. The Centers for Medicare & Medicaid Services (CMS) reports that orthopedic billing and coding generate billions in reimbursement annually, yet improper documentation and incorrect orthopedic CPT codes result in denial rates exceeding 15% in many practices.

This comprehensive orthopedic medical coding reference provides quick access to essential orthopedic procedure codes, modifiers, and orthopedic billing guidelines, simplifying the billing process. The 2026 CPT codebook introduces critical updates affecting orthopedic surgery CPT codes, necessitating updated protocols for coding specialists and compliance teams.

Evaluation and Management (E/M) Codes

Session Time: 15-60 minutes

E/M codes form the foundation of orthopedic coding for consultations and examinations. The 2021 guidelines restructured coding based on Medical Decision Making (MDM) or total time.

CPT Code	Description	Time	MDM Level
99202-99205	New patient office visits	15-74 min	Straightforward to high
99212-99215	Established patient visits	10-54 min	Straightforward to high
99221-99223	Initial hospital care	40-85 min	Low to high complexity

Surgical Procedure Codes

Session Time: 30 minutes to 6+ hours

Orthopedic surgery CPT codes encompass reconstructive and corrective interventions (CPT range 20000-29999).

CPT Code	Description	Time	Global Period
27130	Total hip arthroplasty	120-180 min	90 days
27447	Total knee arthroplasty	90-150 min	90 days
29826	Shoulder arthroscopy, decompression	45-75 min	90 days
29881	Knee arthroscopy with meniscectomy	30-60 min	90 days
64721	Carpal tunnel release	30-45 min	90 days
22554	Anterior cervical arthrodesis	120-180 min	90 days
23472	Shoulder hemiarthroplasty	90-120 min	90 days
27758	Open tibial fracture treatment	120-180 min	90 days

Diagnostic Imaging Codes

Session Time: 5-60 minutes

Imaging codes provide objective documentation of musculoskeletal pathology, essential for orthopedic procedure codes.

CPT Code	Description	Time
73030	Shoulder X-ray, complete	10-15 min
73562	Knee X-ray, 3 views	10-15 min
73721	MRI lower extremity joint, no contrast	30-45 min
72148	MRI lumbar spine, no contrast	30-45 min
73200	CT upper extremity	15-30 min

Therapeutic Procedure Codes

Session Time: 15-90 minutes

Therapeutic codes encompass non-surgical interventions, including injections and physical medicine services.

CPT Code	Description	Time
20610	Major joint injection (shoulder, hip, knee)	15-20 min
20550	Tendon sheath injection	10-15 min
97110	Therapeutic exercises	15 min/unit
97140	Manual therapy techniques	15 min/unit

Fracture Care Codes

Session Time: 30 minutes to 4+ hours

Fracture management codes are determined by anatomical location and treatment method (closed versus open).

CPT Code	Description	Time	Treatment Type
23500	Clavicular fracture, closed, no manipulation	20-30 min	Closed
23515	Clavicular fracture, open treatment	60-90 min	Open
25605	Distal radial fracture with manipulation	30-45 min	Closed
27506	Femoral shaft fracture, open with IM nail	120-240 min	Open
28470	Metatarsal fracture, closed	15-25 min	Closed

Anesthesia Codes (00100-01999 & 99100-99140)

Session Time: 30 minutes to 6+ hours

Anesthesia codes utilize reimbursement formulas based on base units, time units, and modifying factors.

CPT Code	Description	Base Units
01214	Anesthesia for total hip arthroplasty	10
01402	Anesthesia for total knee arthroplasty	7
01638	Anesthesia for total shoulder replacement	8
99100	Extreme age qualifier (under 1 or over 70)	Add-on
99140	Emergency conditions	Add-on

Pathology & Laboratory Codes (80047-89398)

Turnaround Time: 1 hour to 5 days

Laboratory services support medical necessity documentation for orthopedic medical coding.

CPT Code	Description	Turnaround
80053	Comprehensive metabolic panel	2-6 hours
85025	Complete blood count with differential	1-2 hours
87070	Bacterial culture	24-72 hours
88305	Surgical pathology, bone biopsy	3-5 days

Radiology Codes (70010-79999)

Session Time: 5-90 minutes

Radiology codes include diagnostic and interventional imaging for orthopedic CPT codes.

CPT Code	Description	Time
72100	Lumbosacral spine X-ray, 2-3 views	10-20 min
72141	MRI cervical spine, no contrast	30-45 min
77002	Fluoroscopic guidance for injections	10-20 min
78315	Bone scan, 3-phase study	2-4 hours

Medicine Codes (90281-99299 & 99500-99607)

Session Time: 5-60 minutes

Medicine codes encompass immunizations, injections, and specialized diagnostic procedures.

CPT Code	Description	Time
96372	Therapeutic injection, SC/IM	5-15 min
95851	Range of motion measurements, extremity	15-30 min
99070	Supplies and materials	N/A

Modifiers Used in Orthopedic Billing

Modifiers provide critical specificity in orthopedic billing and coding, directly impacting reimbursement accuracy.

Modifier	Description	Application
-50	Bilateral procedure	Typically reimbursed at 150%
-59	Distinct procedural service	Overrides NCCI edits
-LT/-RT	Left/Right side	Laterality specification
-22	Increased procedural services	20-40% increase in potential
-78	Return to the OR for complications	During the global period

ICD-10 Codes Used in Orthopedic Billing

ICD-10 diagnosis codes establish medical necessity for orthopedic procedure codes.

ICD-10 Code	Description
M17.11	Unilateral primary osteoarthritis, right knee
M16.11	Unilateral primary osteoarthritis, right hip
M75.100	Unspecified rotator cuff tear, right shoulder
M23.200	Derangement of the medial meniscus, right knee
S72.001A	Fracture of the neck of the right femur, initial encounter
G56.00	Carpal tunnel syndrome, unspecified limb

A Practical Guide to Using Your Orthopedic Billing and Coding Reference Effectively

This step-by-step guide maximizes the utility of orthopedic billing and coding resources for accurate claim submission and optimal reimbursement.

1. Understand the Layout

Familiarize yourself with the reference structure for efficient navigation:

• Common CPT Codes: Procedure codes frequently used in orthopedic coding (surgeries, injections, imaging)
• ICD-10 Diagnosis Codes: Codes for common orthopedic conditions (fractures, osteoarthritis, rotator cuff tears)
• Modifiers: Explains which modifiers apply to specific orthopedic procedure codes (e.g., -50 for bilateral procedures)
• Documentation Tips: Highlights required elements for accurate coding (laterality, fracture type, surgical approach)
• Payer-Specific Guidelines: Notes on authorization requirements and coverage determinations

2. Match Diagnoses with Procedures

Use the reference to quickly identify correct ICD-10 diagnosis codes for patient conditions, then locate corresponding orthopedic CPT codes for procedures performed (knee arthroscopy, joint injection, fracture fixation).

3. Check Modifiers

Apply modifiers when necessary, following orthopedic billing guidelines:

• Modifier -RT or -LT for procedures on the right or left side
• Modifier -59 for distinct procedural services
• Modifier -50 for bilateral procedures
• Ensure modifiers align with payer-specific requirements

4. Ensure Documentation Completeness

Refer to documentation requirements supporting selected codes:

• Fracture codes require details about type (open versus closed) and anatomical location
• Surgical orthopedic surgery CPT codes need laterality documentation and specific techniques used
• Joint injections require a substance administered and anatomical site documentation

5. Avoid Common Errors

Double-check for frequent coding mistakes:

• Mismatched codes (diagnosis code not justifying procedure)
• Missing laterality modifiers
• Incorrect global period billing
• Bundling violations per NCCI edits
• Use reference guidance to navigate these pitfalls in orthopedic medical coding

6. Streamline Appeals and Rejections

For denied claims, reference the guide to verify:

• Correct orthopedic CPT codes and modifiers were applied
• Documentation supports medical necessity
• Authorization requirements were met
• Payer-specific policies were followed

7. Train Staff

Use this reference as a training resource for billing staff, ensuring a comprehensive understanding of orthopedic billing and coding practices, modifier application, and documentation requirements.

8. Update Regularly

Orthopedic coding rules change annually. Ensure your reference is updated:

• Annually when new CPT codes are released (October)
• When ICD-10 updates occur (October 1)
• When payer LCD/NCD policies change
• Following CMS NCCI edit updates (quarterly)

Conclusion

Successfully completing orthopedic billing and coding requires comprehensive knowledge of orthopedic CPT codes, modifiers, and evolving orthopedic billing guidelines. The 2026 CPT updates necessitate continuous education for coding specialists. Proper code selection, modifier application, and documentation substantiating medical necessity determine reimbursement accuracy across E/M services, surgical procedures, imaging, and fracture care.

Are coding complexities impacting your practice’s financial performance? Nexus io specializes in comprehensive orthopedic billing services, delivering expertise across musculoskeletal procedures, starting from arthroscopy to complex joint replacement and spinal fusion.