Specialty
Sports Medicine Billing and RCM
Part orthopedics, part therapy, and part services no insurer will ever cover.
Why it’s different
Sports medicine crosses billing rule sets that were never designed to meet: office E/M, in-office procedures, imaging, therapy units, and a steady stream of services that simply are not benefits — pre-participation physicals, clearance exams, performance testing.
The revenue problem here is usually not denials. It is work performed without a payer, and no process for collecting it from the patient.
Common challenges
Where the money goes missing.
- Non-Covered Services
- Sports physicals and clearance exams billed to insurance, denied, then written off.
- Workers' Comp and Leagues
- School, league and workers' compensation claims with entirely separate rules.
- Same-Day Procedures
- Injections and imaging performed alongside an E/M without modifier 25.
- Therapy Under a Physician NPI
- Therapy units billed without a certified plan of care behind them.
- In-Office Globals
- Procedures with global periods performed in the office and followed up inside them.
How we help
We separate non-covered services from billable ones before the claim goes out, set up patient-pay and ABN workflows for the rest, and check same-day procedure and E/M combinations for the modifiers payers require.
We do not provide coders. Your clinical team assigns the codes. We verify and validate them.
Key codes
- CPT 99202–99215
- CPT 20610
- CPT 97110 / 97140
- Modifier 25
- ABN for non-covered services
Indicative, not exhaustive. Code sets and payer policies change.
Get a Sports Medicine Billing Analysis
Send us a sample of your denials. We'll tell you what's actually driving them in your specialty.