Care Management Software for Orthopedic Practices (2026)

Care management software for an orthopedic practice runs the work between visits: monthly check-ins by call or text with chronic patients (osteoarthritis on a nonoperative plan, osteoporosis after a fragility fracture, chronic back pain) and with surgical patients across the episode, validated outcome surveys such as HOOS Jr and KOOS Jr at the required intervals, escalation of concerning answers to a nurse, and a log of consent, care plan touchpoints, and minutes that the biller can use to bill Medicare's care management codes through the normal process. It does not diagnose, prescribe, or decide who qualifies. It makes sure the reach happens and that every minute of it is documented. In 2026, with mandatory joint bundles live and outcome reporting tied to payment, the same log is also the practice's evidence of patient engagement.

This guide covers what Medicare requires before a care management code can be billed, why orthopedic groups have historically left those programs to primary care, how a monthly check-in cadence maps to chronic and surgical orthopedic patients, and what bundle readiness means for a group with an attached ASC.

Key Takeaways

• Medicare's chronic care management code requires at least 20 minutes of clinical staff time per calendar month, documented patient consent, and a care plan, for patients with two or more chronic conditions expected to last at least 12 months.
• Home exercise adherence after knee replacement is uneven: in one study of 211 patients, 57.4 percent reported high adherence and 8.5 percent low, and the low group is invisible until the six-week visit unless someone asks.
• The TEAM model started January 1, 2026, covers lower extremity joint replacement for 30 days after discharge at about 720 hospitals, and adjusts payment for quality performance.
• Only 3.5 percent of eligible hospitals reported outcome data during the voluntary period, so most orthopedic programs are building their engagement operation now.
• Documentation, not outreach, is the bottleneck: the practice that logs consent, care plan, and minutes from the first contact can bill, and the one that reconstructs them at month end usually cannot.

The Data Behind the Decision

The billing rules are explicit. CPT 99490, Medicare's chronic care management code, requires at least 20 minutes of clinical staff time per calendar month, and only clinical staff time under the billing practitioner's supervision counts. The patient must have two or more chronic conditions expected to last at least 12 months that place them at significant risk of decline, consent must be obtained and documented in the medical record, the service must be initiated at a face-to-face visit, and only one practitioner can bill the code for a given patient in a given month (CMS, 2016). Those conditions are why most orthopedic practices never built a program.

The clinical case for monthly contact is in the adherence data. A 2023 study of 211 patients after total knee arthroplasty found 57.4 percent reporting high adherence to their exercise program (above 75 percent of prescribed exercise), 34.1 percent medium, and 8.5 percent low (Journal of Pain Research, 2023). Two in five patients were doing three quarters or less of their program, and nothing in the chart says which ones.

The payment context changed this year. The CMS Transforming Episode Accountability Model (TEAM) started January 1, 2026, is mandatory for roughly 720 selected hospitals, covers five surgical episodes including lower extremity joint replacement for 30 days after discharge, and adjusts payment for quality performance (CMS, 2026). Hospitals in the model are also subject to the hip and knee patient-reported outcome measure, which requires matched pre- and post-op surveys for at least 50 percent of eligible patients; only 101 of 2,920 eligible hospitals (3.5 percent) participated in the voluntary period (Health Affairs Scholar, 2025). And 82% of patients try to book care outside a practice's regular office hours, which is also when a monthly check-in gets answered.

What does care management software actually do in an orthopedic practice?

Six things, in order. It identifies candidates from the schedule and problem list, in the categories the practice chooses: nonoperative osteoarthritis, bone health after a fragility fracture, chronic spine, and surgical patients in the months around a joint replacement. It captures and stores consent on the first contact. It runs the monthly check-in by call or text in the practice's voice: pain, function, medication questions, exercise adherence, falls, and whether the ordered PT or imaging actually happened. It collects the outcome survey when it is due, which for joint patients means the pre-op baseline and the post-op score in the 300 to 425 day window. It flags concerning answers to the care team with the transcript. And it logs minutes per patient per month, with the care plan touchpoints attached, so billing is a report rather than a reconstruction.

How is care management different in orthopedics?

Ownership of the patient. Because only one practitioner can bill chronic care management for a patient in a given month, an orthopedic group has to coordinate with primary care and choose the patients whose managed condition is orthopedic: the osteoarthritis patient on injections and a home program, the hip fracture patient in a bone health pathway, the total joint patient in the months around surgery. The surgical episode adds a second layer. A total knee patient generates a pre-op baseline, a 30-day bundle window, a six-week and three-month visit, PT adherence questions in between, and a post-op survey a year later.

Systems. The clinic runs Epic, athenahealth, ModMed, or NextGen; the ASC runs HST or a comparable center system; the software has to read the schedule and problem list from the practice system and the case date from the ASC system, and it has to recognize the patient across both. Payers: chronic care management is a Medicare fee-for-service benefit with its own documentation rules, and TEAM hospitals now share episode risk with the surgeons who operate there. Outcome capture is covered in orthopedic patient engagement software.

What should care management software connect to, and what does it cost?

It should connect to the practice schedule, the problem list for enrollment criteria, the ASC schedule for surgical episodes, and the patient's contact preferences, and it should produce a monthly export per patient of consent status, care plan touchpoints, and minutes for the biller. Pricing is usually per provider or per location rather than per patient. Test the economics in one quarter: enrolled patients, months with 20 or more logged minutes, and claims submitted, against staff time otherwise spent on unstructured phone calls.

How to launch care management in an orthopedic practice: 6 steps

1. Pick two patient categories to start. Nonoperative osteoarthritis and the total joint episode are the usual choices; add bone health after fracture once the first two run cleanly.
2. Write the eligibility rule and the care plan template with the physician. The physician decides who qualifies and what the plan says; the software applies the rule.
3. Capture consent on the first contact. Verbal or written, documented in the record, before the first month is billed.
4. Run the monthly check-in by call or text. Pain, function, exercise adherence, medication questions, falls, and whether ordered care happened, with concerning answers escalated to a nurse the same day.
5. Fold in the outcome surveys. HOOS Jr or KOOS Jr at baseline and at the post-op window, collected in the same conversation thread.
6. Hand the biller a monthly report. Per patient: consent, care plan touchpoints, and minutes. The biller decides what is billable and submits it.

What Should Still Go to a Human?

Enrollment and the care plan are physician decisions. A patient who reports new pain, a fall, instability, or a medication problem during a check-in gets a nurse call, not a survey score. Whether a month qualifies for a care management code, which code applies, and how it interacts with a surgical global period are billing judgments that stay with the revenue cycle team.

Where Clinekt Fits

Clinekt is not a scheduling tool and not an AI receptionist company. Clinekt is the patient activation platform for specialty practices: four AI agents that share one memory of every patient and cover the whole journey, from first click to the care between visits. The Care Management Agent runs monthly check-ins between visits by call or text, collects validated outcome surveys such as HOOS Jr and KOOS Jr, flags concerning answers to staff, and logs consent, care plans, and minutes so the biller can bill from the audit trail through the normal process. It was built for the care programs Medicare already pays for and for bundle-era engagement scoring. The Recall Agent finds the ordered-but-never-scheduled PT and the lapsed care plan and books the patient back in, and because all four agents share one memory through Clinekt OS, the patient who arrived through the website in spring is recognized when they answer a check-in in winter. That is the difference between a tool that only coordinates care the practice already ordered and a platform that runs care operations. The orthopedics page shows the full episode.

Deployment is live the same day, with no IT project and no new staff workflow, and it syncs to the EHR. The platform is HIPAA compliant and SOC 2 Type II. Baldwin Bone & Joint, an orthopedic group, generated 263 qualified surgical leads and 159 booked appointments, a 60% booking rate, in a single quarter (detail in orthopedic patient activation results), and more than one million patient interactions have been completed across the platform. Estimate what unmanaged patients cost your group with the leakage calculator, or book a demo.

Frequently Asked Questions

Can an orthopedic practice bill Medicare for chronic care management?
Yes, if the requirements are met: two or more qualifying chronic conditions, documented consent, a care plan, an initiating face-to-face visit, and at least 20 minutes of clinical staff time in the calendar month. Only one practitioner can bill for a patient in a given month, so the practice has to coordinate with primary care.

What has to be documented for a care management claim?
Consent in the medical record, the care plan, and the minutes of qualifying clinical staff time in the month, along with the check-in content that supports them. Care management software produces that log automatically as the work happens..

How often should check-ins happen?
Monthly is the floor because the codes are billed per calendar month. Surgical patients get more frequent contact in the weeks after surgery, then settle into the monthly cadence.

What does bundle readiness mean for an orthopedic group?
Being able to show, for every joint replacement patient, a pre-op outcome baseline, a matched post-op score in the required window, and a record of engagement across the 30-day episode. Hospitals in the TEAM model carry the financial risk, and surgeons who operate there are asked to supply that evidence.

Does the software decide who is eligible?
No. The physician defines the eligibility rule and the care plan, and the software applies the rule to the schedule and problem list to surface candidates. Enrollment, clinical judgment, and billing decisions stay with people.

Use the leakage calculator to see what lapsed care plans and unscheduled orders cost across your patient panel, then book a demo to see a month of check-ins, escalations, and minutes land on one report.