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Fracture Billing
 
 

Fracture Billing

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 word surgery to describe your care.

Fracture care codes include a global 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 care does not include:

  • Xrays
  • Cast materials
  • 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 the deductible, and then cover a percentage of the charge.  This is different from the way office visits are paid, which often require just a co-pay from the patient. 

If you have questions about your bill, please call our Billing Office at 687-4905.

Go back to Orthopedics Education