Orthopedics

Orthopedics is one of the most active Medicare specialties in the United States, with 21K providers billing Medicare nationally. The average Orthopedics provider treats 160 Medicare beneficiaries and receives $102K in total annual Medicare payments, translating to $638 per patient — a figure that signals high-acuity care and complex case management.

Evaluation and Management coding patterns reveal how Orthopedics providers characterize visit complexity. The most frequently billed code is 99213 at 56.9%, suggesting a large share of straightforward follow-up visits. Only 40.7% of encounters are coded as 99214, and 2.3% as 99215 — which may indicate under-coding if the patient population carries significant chronic disease burden.

Care management program adoption presents a significant revenue opportunity for Orthopedics practices. Chronic Care Management (0.1%), Remote Patient Monitoring (0.2%), Behavioral Health Integration (0.0%) remain substantially underutilized relative to the eligible patient population. Annual Wellness Visit adoption sits at just 0.0%, well below the 70% target — meaning a majority of eligible Medicare beneficiaries are not receiving this preventive service, and practices are missing a straightforward billing opportunity. Providers who implement these programs can unlock substantial per-patient monthly revenue while improving chronic disease outcomes — NPIxray can help identify exactly which patients qualify.