Orthopaedics has long been centered on surgical intervention. But with increasing pressure to manage costs and improve long-term outcomes, many in the field are asking a new question: Can the system support getting paid for keeping patients off the operating table?
Preventive orthopaedics includes a wide range of early interventions: physical therapy, weight management, regenerative treatments, biomechanics, and guided exercise. These approaches can slow joint degeneration, improve function, and delay or even eliminate the need for procedures. Clinically, the value is clear. Financially, the picture is less straightforward.
Payers are starting to pay attention
Some insurers recognize the cost savings of early nonoperative care, especially in risk-sharing arrangements and value-based contracts. For example, in CMS’s Bundled Payments for Care Improvement initiative, a nonoperative plan that helps a patient avoid a joint replacement can represent savings of tens of thousands of dollars.
Programs like the Comprehensive Care for Joint Replacement model are designed to reward hospitals and physicians for lowering the total cost of care over an entire episode, including nonoperative management.
The American Association of Hip and Knee Surgeons has reported similar strategies being tested in commercial bundling efforts.
But in traditional fee-for-service environments, most preventive strategies are not adequately reimbursed. Fee-for-service still dominates Medicare payments and generally compensates based on volume, not outcome.
This creates a financial gap for surgeons who spend time on nonoperative care but receive no additional payment unless a procedure is performed.
Measuring value without an operation
Data is essential. Some practices already invest in tools to track outcomes over time using wearable devices and app-based platforms that monitor function and pain levels. These approaches align with CMS’s policies around Remote Patient Monitoring (RPM), which allows billing for collecting physiologic data outside of traditional settings.
More recently, CMS introduced Remote Therapeutic Monitoring (RTM) codes for musculoskeletal care, enabling providers to bill for monitoring adherence to exercise and therapy programs.
In 2023, CMS clarified that RTM services can be delivered by physical therapists and other nonphysician providers, significantly expanding access. In its final rule, CMS also reduced certain operational barriers, such as allowing for shorter monitoring durations and eliminating redundant documentation requirements. Proposed 2025 and 2026 rule changes may further increase payment flexibility.
Still, these billing options remain fragmented. There is no unified reimbursement framework that captures the full scope of preventive care in orthopaedics or recognizes the longitudinal value of keeping patients out of the OR.
What needs to happen next
To make preventive orthopaedics sustainable, reimbursement needs to reflect the realities of modern musculoskeletal care. That could mean the development of new CPT codes or incorporation of nonoperative care into widely adopted bundled payment models.
The demand for surgical care continues to rise, along with the opportunity to manage it more effectively. The question is whether the payment model will support that direction.
Sources
Aligning payment and care in value-based practice models
Basics of Orthopaedic Commercial and Government Bundling
Billing for remote patient monitoring
Bundled Payments for Care Improvement (BPCI) Initiative: General Information
CMS Clarifies Coverage and Payment for Remote Therapeutic Monitoring Services
CMS Proposes Reimbursement Changes for Remote Patient Monitoring
