Certifications & Accepted Insurance Networks
ABOS Certified
American Board of Orthopaedic Surgery
ASSH Fellow
American Society for Surgery of the Hand
Blue Cross
In-Network Provider
Aetna
In-Network Provider
Cigna
In-Network Provider
UnitedHealthcare
In-Network Provider
Medicare
Original & Advantage
Workers' Comp
All Major Carriers
Board-Certified Hand Surgery.
Every Major Insurance
Accepted. Zero
Surprise Bills.
We rebuild the architecture of the human hand — reattaching tendons, freeing compressed nerves, pinning shattered metacarpals. Then we fight just as hard to ensure every procedure is covered, coded, and reimbursed correctly.
98%
Claims processed without patient involvement
80%+
Of initial denials overturned on appeal
0
Surprise bills. Ever.
Serving Patients Since 2009
Calm. Deliberate. Certain.
Accepting New Patients — Call (312) 555-0187
Will My Insurance Cover This?
Prior authorization is insurance's way of approving a procedure before it happens. About 40% of hand surgeries require it — but which ones, and how long it takes, depends on your specific plan. Here's exactly what to expect.
Procedure
Authorization Status
Carpal Tunnel Release
PPO plans rarely require it; HMO and Medicare Advantage often do. We check before you schedule.
Trigger Finger Release
Typically covered after conservative treatment (injection, splinting) has been documented.
Dupuytren's Fasciectomy
Most plans require clinical documentation of contracture severity before approving surgery.
Tendon Repair / Reconstruction
Complex reconstruction always requires prior authorization. We initiate the process for you.
Microsurgery / Replantation
Expedited authorization available within 72 hours for urgent cases.
Spasticity Release (Post-Stroke)
Medicare Advantage requires prior auth; Original Medicare does not.
Cortisone Injection
Office-based procedures almost never require pre-authorization.
Fracture Fixation (Metacarpal)
Workers' comp cases have a parallel authorization pathway — we handle both.
Our Team Absorbs the Burden
The average practice spends 12 hours per week on prior authorizations per physician. We handle every submission, follow-up, and escalation on your behalf — you don't make a single call.
2025 CMS Timelines
7 calendar days
Standard Medicare Decision
72 business hours
Expedited / Urgent Request
30 days (standard)
Medicare Advantage Appeal
Original Medicare
Original Medicare does not require prior authorization for covered services. Medicare Advantage plans may — we verify your specific plan before scheduling.
What Will I Owe?
Every hand surgery procedure has a CPT code — a standardized billing number your insurance uses to determine coverage. We publish ours openly, because fluency in your bureaucratic nightmare is how we earn your trust.
CPT Codes
Current Procedural Terminology codes are 5-digit numbers assigned to every medical procedure. Your insurer uses them to look up coverage rates.
Correct Coding = Full Reimbursement
Using the wrong CPT code — even by one digit — causes claim denials or underpayment. Our billers are certified in hand surgery coding.
2026 Code Update
CPT 64728 was added January 1, 2026. We update our billing system same-day with every annual code release.
Carpal Tunnel Release
85–95%
Trigger Finger Release
80–90%
Carpal Tunnel Injection
90–98%
Tenolysis
70–85%
Tenosynovectomy
70–85%
Tendon Transfer
65–80%
Tendon Transfer with Graft
65–80%
Wrist Reconstruction
60–75%
Tendon Transfer (CMC)
65–80%
Nerve Repair (Hand)
70–85%
Major Nerve Repair
70–85%
New 2026 — Nerve Procedure
TBD
How Appeals Work
A denial is not a verdict. It's the beginning of a process that, when navigated correctly, results in approval the vast majority of the time.
~25%
of prior auths receive initial denial
80%+
of Medicare Advantage denials overturned on appeal
$0
out-of-pocket for appeal filing — we handle it
Urgent Cases: 72-Hour Expedited Review
If your surgeon determines you cannot wait for standard review, we file an expedited request. Insurance must respond within 72 business hours.
Procedure Submitted
Suture's billing team submits prior authorization request with full clinical documentation — operative notes, imaging, conservative treatment history.
Initial Denial Received
"Not medically necessary." This is a form letter — about 25% of all prior authorizations receive an initial denial. It is not the end.
First-Level Appeal Filed
We file a formal appeal the same day, attaching a peer-reviewed literature review and a letter from your surgeon explaining why this procedure is medically necessary for your specific case.
Peer-to-Peer Review
Your surgeon speaks directly with the insurance company's reviewing physician. In our experience, 80%+ of cases are resolved at this stage.
External Review (If Needed)
If internal appeals fail, we escalate to an independent external review — a neutral physician of the same specialty. Over 80% of Medicare Advantage denials are overturned at this stage.
Authorization Approved
Surgery is scheduled. You receive a pre-surgery cost estimate. No surprises.
Find My Plan
Every major insurance network accepted. Filter by plan type or carrier to confirm your coverage — then call us or submit a verification request and we'll do the rest.
18 plans found
Blue Cross Blue Shield
PPO Blue
No referral needed
Blue Cross Blue Shield
HMO Blue
PCP referral required
Blue Cross Blue Shield
Blue Advantage (MA)
Prior auth for most surgeries
Aetna
Aetna Choice POS II
No referral needed
Aetna
Aetna HMO
PCP referral required
Aetna
Aetna Medicare Advantage
Prior auth required
Cigna
Cigna Connect (PPO)
Verify deductible status
Cigna
Cigna LocalPlus (HMO)
Referral required
UnitedHealthcare
Choice Plus (PPO)
No referral needed
UnitedHealthcare
Navigate (HMO)
PCP referral required
UnitedHealthcare
AARP Medicare Advantage
Prior auth required
Medicare
Original Medicare (Part B)
No prior auth required
Medicare
Medicare + Medigap Supplement
Secondary coverage applies
Workers' Comp
Illinois State WC
Claim number required
Workers' Comp
Federal FECA
Case manager contact needed
Workers' Comp
Private WC (All Major Carriers)
We verify carrier status
Humana
Humana Gold Plus (HMO)
Prior auth for surgery
Humana
Humana Choice (PPO)
No referral needed
2027 CMS Rule: A CMS rule finalized May 2024 will require electronic prior authorization and faster decision timelines for Medicare Advantage, Medicaid/CHIP, and Marketplace plans, effective January 2027. We are already compliant.
Don't see your plan?
We accept most major insurance plans. Submit a verification request and our billing team will confirm your specific coverage within one business day.