Medical billing can be tricky to understand, especially when it comes to fracture care. If you receive treatment for a fracture at Seaview Orthopaedics, including casting, bracing, or splinting, we are required by your insurance company to bill our services using specific CPT Codes. Current Procedural Terminology (CPT) codes are numeric codes created by the American Medical Association in order to identify medical services and procedures, and are essential to the billing process.

The CPT code for fracture care is found under the “surgery” section of the code book. This does not imply that you had an operation; it is simply how the AMA has organized the code book to facilitate ease of use for both physicians and insurance companies.

Billed as a “packaged service”, the initial bill will include:

• Initial treatment of the fracture, including first cast or splint application
• X-ray interpretation of the fracture
• 90 days of follow up care, including any necessary cast or splint adjustments
• Cast or splint removal

Items NOT included in this pack include:

• X-rays
• Casting and splinting supplies
• Replacement cast or splint application

You will see a separate charge for these items.

When you receive your explanation of benefits, you may see the service listed as surgery due to the CPT code. This means the deductible and co-insurance guidelines for that service will apply. Please know we are using the most appropriate code available and are legally required to bill this way. We encourage patients to contact their insurance company to verify their benefits and address any billing concerns.