Fracture care is billed using a coding system called the Current Procedural Terminology, or CPT, which identifies the exact fracture and care given.We cannot change these codes.The CPT manual has chosen to list fracture care services in the surgery section.As a result, billing and insurance statements including the Explanation of Benefits (EOB), may use the wordsurgeryto describe your care.
Fracture care codes include aglobal period, usually 90 days.The treatment starts when the orthopedist examines and/or diagnoses the fracture, and forms a treatment plan.Normal follow-up care for the next 90 days is included in the fracture charge.
Global care generally includes
Exam, treatment plan and/or repair of the fracture
The first cast application
Regular follow-up exams for a period of time, usually 90 days
No co-pay is charged for these visits
Global caredoes not include:
Replacement, repair or application of additional casts
Medical equipment such as a brace, sling, walker or crutches
Follow-up exams for unexpected complications or new problems
You will be billed separately for these items.
Your insurance company will review and pay for care based on your coverage.Many plans apply procedures such as globally billed fracture care toward thedeductible, and then cover a percentage of the charge.This is different from the way office visits are paid, which often require just aco-payfrom the patient.
If you have questions about your bill, please call our Billing Officeat 687-4905.