Orthopedic CPT codes cover everything from office visits and joint injections to fracture care, arthroscopy, and joint replacement. Because so many codes look alike, however, small errors in joint size, laterality, or global periods quickly turn into denials.
This cheat sheet summarizes the codes orthopedic practices use most, the rules behind them, and the mistakes to avoid. Always confirm current code descriptors in the latest CPT book and payer policies.
Orthopedic CPT Codes Cheat Sheet
| Service | CPT code(s) | Key point |
|---|---|---|
| New patient office visit | 99202–99205 | Level by MDM or total time |
| Established patient visit | 99212–99215 | Level by MDM or total time |
| Small joint injection or aspiration | 20600 / 20604 | 20604 with ultrasound guidance |
| Intermediate joint (wrist, elbow, ankle) | 20605 / 20606 | 20606 with ultrasound guidance |
| Major joint (knee, shoulder, hip) | 20610 / 20611 | 20611 with ultrasound guidance |
| Trigger point injection | 20552 / 20553 | By number of muscles, not points |
| Diagnostic knee arthroscopy | 29870 | Bundles into a therapeutic knee scope |
| Knee arthroscopy, meniscectomy | 29880 / 29881 | 29880 medial and lateral; 29881 one compartment |
| Arthroscopic rotator cuff repair | 29827 | Shoulder |
| Total knee arthroplasty | 27447 | Primary procedure |
| Total hip arthroplasty | 27130 | Primary procedure |
Which Orthopedic CPT Codes Apply to Office Visits and Consults?
Since 2021, providers select office visit levels by medical decision making or total time. New patients use 99202–99205, while established patients use 99211–99215. Note that CPT deleted 99201. For details on low-level new patient visits, see our 99203 guide.
Consultation codes changed as well. Office consultations are now 99242–99245, because CPT deleted 99241 in 2023. However, Medicare does not pay consultation codes, so bill a regular office visit for Medicare patients.
Orthopedic CPT Codes for Joint and Trigger Point Injections
Joint injection codes depend on joint size and whether ultrasound guidance was used. Small joints include fingers and toes, intermediate joints include the wrist, elbow, and ankle, and major joints include the knee, shoulder, and hip. In addition, one code covers aspiration, injection, or both.
Coders report trigger point injections by the number of muscles injected. Specifically, 20552 covers one or two muscles, and 20553 covers three or more. Document the muscles, the drug, and the dose, and bill the drug separately when appropriate.
What Are the Fracture Care Coding Rules?
Fracture codes depend on the bone, the treatment type, and whether the physician performed manipulation. For example, a distal radius fracture can be closed treatment without manipulation (25600), closed with manipulation (25605), or open treatment (25607–25609).
Most fracture care codes carry a 90-day global period. During that time, the global package includes routine follow-up visits and cast changes. However, practices generally bill X-rays separately, and they may bill unrelated problems with the right modifier. Check global days in the CMS Physician Fee Schedule Look-Up Tool.
Arthroscopy and Joint Replacement Codes
A therapeutic arthroscopy on the same joint includes the diagnostic arthroscopy (for example, 29870 for the knee or 29805 for the shoulder). Therefore, bill only the therapeutic code in that case.
For joint replacement, separate primary and revision procedures. Total knee is 27447, while partial (unicompartmental) knee is 27446. Revisions use different codes, such as 27486 for one component and 27487 for all components. Likewise, total hip is 27130.
Modifiers Orthopedic Practices Use Most
- Modifier 25 for a significant, separately identifiable E/M on the same day as a procedure
- Modifier 57 when the visit results in the decision for major surgery
- Modifier 51 for multiple procedures, unless the payer applies reductions automatically
- Modifier 59 or XS only for NCCI-paired services on separate sites or sessions
- RT and LT for laterality, and modifier 50 for bilateral procedures when the payer asks for it
- Modifiers 24, 78, and 79 for services during a global period
For same-day visits and procedures, read our modifier 25 guide.
Common Errors With Orthopedic CPT Codes
- First, choosing the wrong joint size for an injection
- Second, missing or wrong laterality modifiers
- Also, billing routine visits inside a global period
- In addition, billing diagnostic and therapeutic arthroscopy together on the same joint
- Finally, using deleted codes such as 99201 or 99241
Fortunately, claim scrubbing and regular audits prevent these errors. Meanwhile, our orthopedic denial management team recovers payment on claims that have already denied.
How Dr Biller RCM Supports Orthopedic Practices
Our orthopedic billing services include certified orthopedic coders who review procedures, modifiers, and global periods before claims go out. As a result, practices see cleaner claims and fewer write-offs.
Request a free orthopedic coding audit and see where your coding leaves money on the table.
Frequently Asked Questions
What CPT code is used for a knee injection?
Use 20610 for a major joint injection or aspiration without ultrasound, and 20611 with ultrasound guidance. Add RT or LT as required.
Can orthopedists still bill consultation codes?
Commercial payers may accept 99242–99245. However, Medicare does not pay consultation codes, so use office visit codes instead.
Are X-rays included in the fracture care global period?
Generally, no. Fracture care globals include routine follow-up and cast care, while practices usually bill X-rays separately.
Which orthopedic CPT codes are denied most often?
Injections, arthroscopy, and E/M visits with modifier 25 are frequent targets, usually because of joint size, bundling, or documentation issues.
