Insurance & Billing

Fracture Care Billing

Fracture care is usually billed as a “packaged service.” Your insurance company requires that we bill our services to you using a coding system known as CPT (Current Procedure Terminology). The codes used to describe the services we provided for you are found in the “surgery” section of the CPT codebook. This does not mean that you had an operation. This is merely the way the CPT codebook is organized for ease of use by both insurance companies and physicians.

According to the CPT guidelines, fracture care is billed as a “packaged service.” This means that at the time of initial care, a bill is generated that includes:

• Treatment of the fracture
• The first cast or splint application
• 90 days of normal, uncomplicated, follow-up care

The procedures and other items NOT included in the package are:

• The initial office visit to evaluate, diagnose, and develop a treatment plan for your injury
• X-rays
• All casting supplies (including those used with the first cast application)
• Any replacement cast application
• The evaluation and management of any additional problems or injuries
• The treatment of complications

There will be a separate charge for these.

Your insurance company may cover the care rendered for fractures differently than for office visits. Therefore, when you receive the explanation of insurance benefits, the services may be paid as a surgical procedure, with deductible and co-insurance guidelines applied. We are using the most appropriate code available to describe the care rendered. As always, we encourage you to check with your insurance company and verify the benefits available. If you have any questions, please do not hesitate to contact us.

Financial Policy & Billing

Insurance & Payment

At Falmouth Orthopaedic Center, we accept Workers’ Compensation, Medicare, and most major insurance plans. Please contact your insurance company or you may call our office at (207) 781-4424 to find out if we accept your insurance plan.

If your insurance plan requires you to pay a co-payment, co-insurance, and/or a deductible, you will need to pay at the time of your visit. For your convenience we accept cash, checks, Visa, MasterCard and Discover. Please download and read our financial policy.