Surgical denials shouldn't be your billing team's second job.
Joint replacements, spine procedures, and advanced imaging carry some of the highest-value denials in medicine, and some of the most detailed medical necessity requirements. We build appeals that match what orthopedic payers actually require.
Denials we see most in orthopedics.
Every specialty has its own denial patterns. Here's what we typically find in orthopedics practices.
Medical necessity for joint replacement
Hip and knee replacement claims are frequently denied for insufficient conservative-treatment documentation, even after months of physical therapy.
MRI and advanced imaging prior auth
Pre-surgical and diagnostic imaging denials are common when imaging requests don't explicitly document failed conservative care.
Spine procedure denials
Spinal fusion and other spine procedures face some of the strictest medical necessity criteria in orthopedics and the highest denial rates.
Durable medical equipment (DME) denials
Braces, walkers, and post-surgical equipment are often denied separately from the procedure itself, adding a second appeal your staff has to file.
The same done-for-you service, built for your specialty.
We pull your denials
Connected to your billing workflow, reviewed as they come in.
AI drafts, specialists review
Every appeal is cited to payer policy and reviewed by a billing specialist before it's sent.
We handle payer follow-up
Calls and re-submissions your staff doesn't have time for.
You see what's recovered
A simple monthly report on what was appealed and what came back.
See what your orthopedics denials are costing you.
Send us a sample of your recent denials. We'll show you what we'd appeal and what it could recover, free.
Get my free denial audit →Frequently asked questions.
Do you handle DME denials in addition to procedure denials?
Yes, DME denials are appealed alongside the related procedure when they're connected.
Can you help with prior authorization before surgery, not just the appeal after?
Yes, our Prior Authorization service covers pre-surgical imaging and procedure authorization.
How do you handle spine procedure denials, given how strict payer criteria are?
We cite the payer's specific medical necessity policy and the conservative-treatment documentation already in the chart.
Do you work with ambulatory surgery centers as well as hospital-based practices?
Yes, we scope onboarding to however your practice bills, whether that's hospital-based or ASC.