Top Orthopedic Billing Companies Reviewed in 2025: Compare 7 Expert RCM Services

In today’s complex healthcare landscape, specialized billing is no longer a luxury—it’s a necessity. If you're running an orthopedic practice, general medical billing companies might not cut it. You need a partner who understands orthopedic-specific CPT codes, surgical bundling rules, high-volume procedures, and payer nuances. That’s where dedicated orthopedic billing companies come in. They help practices boost clean-claim rates, reduce AR days, and stay compliant with constantly evolving CMS regulations.

This article reviews seven of the best orthopedic billing companies in 2025 and dives deep into their core strengths, services, and what makes each stand out in the orthopedic RCM space.

Whether you're switching providers, scaling your practice, or seeking to cut denials in half, this guide is your starting point to make an informed, revenue-driven decision.

What Are Orthopedic Billing Companies?

Orthopedic billing companies specialize in revenue cycle management (RCM) for musculoskeletal practices, handling the complex coding, claims processing, and collections unique to orthopedic care. Unlike general medical billing services, these companies understand the intricacies of:

• Surgical procedure coding (CPT codes for joint replacements, arthroscopies)
• Complex modifier usage for bilateral procedures
• Workers' compensation claim processing
• Imaging study billing and bundling rules
• DME (Durable Medical Equipment) billing coordination

Key Benefits:

• 15-25% increase in collection rates
• 40-60% reduction in claim denials
• 30-50% decrease in accounts receivable aging
• Compliance with orthopedic-specific regulations

7 Best Orthopedic Billing Companies (2025)

Let’s dive into the top orthopedic billing companies that consistently deliver high clean-claim rates, deep orthopedic expertise, and innovative RCM technologies. These firms aren’t generic. They’re built (or specialized) for orthopedic practices. We’ve reviewed them based on industry reputation, client retention, coding expertise, AR reduction, and CMS compliance.

sprypt.com — The Intelligent Ortho Billing Engine

When it comes to orthopedic billing with precision and power, sprypt.com stands in a league of its own. Tailored for orthopedic and surgical practices, this firm brings automation, AI, and clinical-rule integration into the RCM pipeline—delivering both high performance and regulatory alignment.

Why sprypt.com Leads the Pack

• Clean-Claim Rate: Over 98%, significantly reducing denials.
• AI-Powered Coding Audits: Ensures CPT and ICD-10 accuracy before submission.
• Real-Time Dashboards: Visualize denials, collections, payer trends.
• CMS 2025 Ready: Built-in compliance alerts for orthopedic-specific updates.
• All-In-One RCM: From eligibility to payment posting—including workers’ comp and accident-related billing.

Sprypt doesn’t just “bill claims”—they proactively manage revenue. Their system flags documentation gaps before submission, reducing delays from insurers. Their coders specialize in orthopedic modifiers and complex surgical coding (e.g., arthroscopy with graft, fusion procedures). They also handle DME billing and manage prior auths for joint injections, imaging, and more.

Their analytics suite allows you to monitor AR buckets, payer-wise rejections, and provider performance—all in real-time. What sets Sprypt apart is its hybrid RCM model: you get automation, human coders, and real-time insights all in one system.

If your orthopedic clinic is tired of chasing payments, underbilling surgeries, or dealing with billing teams who don’t “speak ortho,” sprypt.com is your best bet for 2025.

PGM Billing — Trusted Since 1981

PGM Billing is a longstanding name in the medical billing world with a dedicated focus on orthopedic billing. With over 40 years of experience and a highly responsive support model, PGM serves both small clinics and large orthopedic surgery centers.

What Makes PGM a Solid Choice?

• 24-Hour Claim Turnaround: Fast, accurate claim submissions.
• Orthopedic Specialization: Expertise in spine, trauma, and joint billing.
• Customizable EHR Integration: Works with most orthopedic EHRs.
• Denial Management Team: Proactive appeals with orthopedic coding logic.
• Transparency: Monthly reports, CPT analytics, and AR dashboards.

PGM is especially strong in handling complex surgical codes, post-op global periods, and the coordination of benefits. They offer dedicated account managers and follow CMS and commercial payer guidelines with regular internal audits. Their pricing is mid-range but delivers high ROI by keeping AR low and collections strong.

Clients often praise PGM for their responsiveness and billing transparency. You always know where your claims stand, and they’ll flag documentation issues proactively—something solo billers often miss.

Plutus Health — RCM Analytics That Drive Collections

Plutus Health has carved out a reputation in the orthopedic billing market by combining revenue cycle management with real-time analytics. They cater to multi-site orthopedic practices, ambulatory surgery centers (ASCs), and pain management groups seeking full transparency and data-driven revenue strategies.

What Sets Plutus Health Apart?

• Real-Time Denial Tracking: Advanced dashboard for rejection reasons.
• Orthopedic Coders: Certified experts in musculoskeletal billing.
• RCM KPIs Monitoring: Net collections, AR aging, days in AR, FPR, and more.
• Pre-Billing Scrub Engine: Reduces coding issues by 40% before submission.
• Workers’ Comp & Auto Claims: Specialized handling & follow-up team.

Plutus Health goes beyond simple claim filing—they empower orthopedic practices to analyze, forecast, and optimize every aspect of the revenue cycle. Their denial management engine provides granular insight into which payers, procedures, or providers are leading to payment delays or rejections.

Another strong area? Eligibility Verification. Plutus verifies insurance, authorization, and coverage in real time, reducing front-office workload and back-end corrections. If you're managing complex surgeries, multi-location billing, or high-volume imaging/DME, Plutus helps maintain accuracy and improve profitability.

They also integrate with top orthopedic EMRs like Modernizing Medicine (ModMed), NextGen, and athenahealth, ensuring data integrity from documentation to claim settlement.

While pricing is higher than basic services, the analytics and insight they deliver make them a strong contender for larger or growing orthopedic groups.

MBW RCM — Scalable Ortho RCM for Group Practices

MBW RCM (Medical Billing Whiz) specializes in high-volume orthopedic practices and ASCs that demand scalability, consistency, and enterprise-level customization. Known for white-glove service and custom RCM dashboards, they’re a go-to for orthopedic groups expanding regionally or merging practices.

MBW RCM’s Core Strengths

• AR-Focused Billing Teams: Dedicated to 0–30 day collections.
• Orthopedic-Specific Coding Audits: Daily claim reviews.
• DME & Imaging Billing: The in-house team handles durable medical equipment billing.
• Dashboard Suite: Custom KPIs like surgical CPT profitability, denial by code, etc.
• Credentialing & Payer Contracts: Support for new providers or expansions.

MBW offers flexibility for orthopedic businesses that don’t want a one-size-fits-all RCM partner. Their team takes time to understand the unique payer mix, procedure volumes, and AR challenges of each clinic. Then, they configure workflows around those.

Their strength is not just in claim submission, but data integration and operational alignment. MBW can ingest clinical and financial data to forecast revenue leakage, missed charges, and undercoded services, making them ideal for CFOs or revenue directors seeking deeper control over orthopedic financials.

They also provide custom workflow alerts, notifying physicians or coders when key services (like post-op follow-ups or assistant surgeon modifiers) are missing. Their DME department helps ensure braces, walkers, and implants get billed and reimbursed accurately.

If you’re an orthopedic group seeking precision, data visibility, and rapid scaling, MBW is worth strong consideration.

MBC (Medical Billers and Coders) — Versatile and Affordable

Medical Billers and Coders (MBC) offers a cost-effective orthopedic billing solution without compromising on quality. Their nationwide network of certified coders, flexible pricing models, and multi-specialty expertise make them a reliable partner for independent orthopedic surgeons, rural clinics, and new practices.

Why MBC Appeals to Small and Mid-Sized Ortho Practices

• Flexible Pricing: Pay-per-claim or percentage-based models.
• Certified Coders: Familiar with CPTs like 27447, 29881, 22551, and more.
• Strong Onboarding Process: Includes workflow setup, payer list updates, and EHR integration.
• Appeals Team: Aggressively follows up on denials and underpayments.
• Telehealth & Imaging Billing: Especially useful for orthopedic follow-ups.

MBC’s affordability doesn’t mean low-tech—they use a solid RCM platform that integrates with dozens of EHR systems and offers reporting modules for claim status, collections, and AR analytics. Their onboarding includes a custom billing checklist tailored to each orthopedic clinic, ensuring no CPTs or modifiers are missed.

Another win? Their telehealth billing services, which many orthopedic groups now use for post-op follow-ups and pre-surgical consults. MBC ensures those virtual visits are coded, documented, and billed per CMS telehealth guidelines.

MBC also handles orthopedic trauma cases, dealing with accident claims, hospital billing coordination, and surgical assist reimbursement services often overlooked by general billing companies.

They’re a perfect fit for practices just starting, solo orthopedic specialists, or smaller groups that need reliable billing without breaking the bank.

HIS (HealthInfoService) — Integrated Ortho RCM + Clinical Services

HIS offers more than just billing—it’s a full-service RCM and clinical support company designed for orthopedic and surgical groups looking for deep integration across billing, documentation, and coding compliance.

What Makes HIS Stand Out?

• Integrated Clinical + RCM Workflow: Aligns EHR documentation with claim logic.
• Coding Support: On-demand orthopedic coder reviews.
• Pre-Authorization Team: Dedicated prior auth specialists for ortho procedures.
• Documentation Alerts: Helps ensure surgical notes match billing logic.
• KPI Dashboards: Includes denial reasons, CPT trends, and cash-to-net ratio.

HIS is ideal for orthopedic practices seeking both clinical documentation integrity (CDI) and revenue optimization. Their team works closely with providers to make sure what’s documented gets properly billed. For example, if a surgeon documents a spinal decompression, but the op note is missing the level detail, HIS flags it before claim submission, preventing denials or recoupments.

Their pre-authorization team ensures approvals for injections, surgeries, MRIs, and PT before the patient even steps in. And their coders? Trained specifically in orthopedic surgical CPTs and modifiers.

By syncing billing and documentation, HIS helps minimize compliance risks, boosts collections, and keeps your AR in check. It’s an ideal fit for large, documentation-heavy orthopedic practices that want airtight coding compliance and full-service support.

CGM ARIA — Cloud-Based Ortho Billing With RCM Insights

CGM ARIA, part of the global CompuGroup Medical network, brings tech-forward billing solutions to the orthopedic space. Known for its cloud-native architecture and strong analytics tools, CGM ARIA is ideal for orthopedic clinics looking for transparency, efficiency, and self-service reporting.

Why Choose CGM ARIA?

• Cloud-Based Billing System: Accessible anytime, anywhere.
• Client Dashboards: Real-time insights on claim status, AR, and rejections.
• EMR Compatibility: Seamless with CGM EMR, athenahealth, and more.
• Automated Claim Scrubbing: Reduces coding issues by 35%.
• Integrated RCM + Scheduling + Patient Pay: A unified front-office + back-office experience.

CGM ARIA excels in bringing orthopedic billing into the modern age. Their system allows providers, office managers, and even patients to track claim status, understand balances, and receive updates—all without playing phone tag. Their platform features automated alerts for missing modifiers, duplicate CPT codes, and surgical bundling errors.

For orthopedic practices with multiple locations, CGM ARIA’s cloud-based architecture allows seamless management of claims across sites and providers. Its reporting suite can show AR trends, payer breakdowns, top denied CPTs, and even forecast revenue based on surgical bookings.

Another advantage is its integrated patient pay system—patients can view bills, ask questions, and pay online, reducing front-desk friction and increasing collections.

While not the cheapest option on the list, CGM ARIA delivers significant ROI through time saved, claims paid faster, and insights that can guide practice growth. Ideal for orthopedic groups who value data transparency and digital-first workflows.

Conclusion: Choose Expertise, Not Just a Billing Vendor

Orthopedic billing is a high-stakes arena where the right partner can add hundreds of thousands in recovered revenue—or cost you just as much through underbilling, compliance errors, or ignored denials.

Whether you’re a solo orthopedic surgeon, a multi-site practice, or a growing ASC network, choosing the right billing company comes down to one key principle: do they truly understand orthopedic revenue cycle management?

From sprypt.com’s AI-driven automation and clean-claim dominance to CGM ARIA’s cloud-native reporting and Plutus Health’s real-time denial analytics, each company in this list has its unique edge. The best billing partner is the one that aligns with your volume, specialty, tech stack, and future growth goals.

So don’t settle for a generalist. Invest in a billing company that speaks your language, knows your procedures, and keeps you ahead of CMS changes, payer requirements, and patient payment trends.

It’s not just billing. It’s your livelihood.

Frequently Asked Questions (FAQs)

1. What makes orthopedic billing companies different from general medical billing firms?

Orthopedic billing companies specialize in surgical CPT codes, modifier usage, and bundled payments common in orthopedics. They handle high-value procedures, DME billing, workers' comp claims, and strict documentation requirements—areas that general billing firms often mishandle.

2. How much do orthopedic billing companies typically charge?

Most charge between 4% to 8% of monthly collections, depending on services offered. Flat-fee models exist but are rare. Premium firms with AI and analytics, like sprypt.com or MBW RCM, may sit at the higher end due to added value.

3. Do orthopedic RCM companies handle prior authorizations?

Yes, top companies like HIS and Plutus Health have dedicated pre-auth teams for surgeries, imaging, joint injections, and more, ensuring procedures aren’t delayed due to missing approvals.

4. How long does it take to switch orthopedic billing companies?

The transition can take 2 to 6 weeks, depending on your EHR, payer contracts, and documentation systems. Most companies include onboarding, training, and workflow optimization in their implementation plans.

5. Is orthopedic telehealth billing still reimbursable in 2025?

Yes, CMS has extended coverage for orthopedic consults, post-op checkups, and follow-ups, though documentation requirements are tighter. Leading billing firms ensure compliant coding to avoid denials.