diff --git a/src/Microsoft.Health.Fhir.Shared.Core/Features/Search/SearchOptionsFactory.cs b/src/Microsoft.Health.Fhir.Shared.Core/Features/Search/SearchOptionsFactory.cs
index 37333370f6..41e695c0c3 100644
--- a/src/Microsoft.Health.Fhir.Shared.Core/Features/Search/SearchOptionsFactory.cs
+++ b/src/Microsoft.Health.Fhir.Shared.Core/Features/Search/SearchOptionsFactory.cs
@@ -411,7 +411,9 @@ public SearchOptions Create(
             searchOptions.UnsupportedSearchParams = unsupportedSearchParameters;
 
             var searchSortErrors = new List<string>();
-            if (searchParams.Sort?.Count > 0)
+
+            // Sort is unneded for summary count
+            if (searchParams.Sort?.Count > 0 && searchParams.Summary != SummaryType.Count)
             {
                 var sortings = new List<(SearchParameterInfo, SortOrder)>(searchParams.Sort.Count);
                 bool sortingsValid = true;
diff --git a/src/Microsoft.Health.Fhir.SqlServer/Features/Search/SqlServerSearchService.cs b/src/Microsoft.Health.Fhir.SqlServer/Features/Search/SqlServerSearchService.cs
index cdc0c4c5b8..3b4bb0d4eb 100644
--- a/src/Microsoft.Health.Fhir.SqlServer/Features/Search/SqlServerSearchService.cs
+++ b/src/Microsoft.Health.Fhir.SqlServer/Features/Search/SqlServerSearchService.cs
@@ -158,7 +158,7 @@ public override async Task<SearchResult> SearchAsync(SearchOptions searchOptions
                 // We seem to have run a sort which has returned less results than what max we can return.
                 // Let's determine whether we need to execute another query or not.
                 if ((sqlSearchOptions.Sort[0].sortOrder == SortOrder.Ascending && sqlSearchOptions.DidWeSearchForSortValue.HasValue && !sqlSearchOptions.DidWeSearchForSortValue.Value) ||
-                    (sqlSearchOptions.Sort[0].sortOrder == SortOrder.Descending && sqlSearchOptions.DidWeSearchForSortValue.HasValue && sqlSearchOptions.DidWeSearchForSortValue.Value && !sqlSearchOptions.SortHasMissingModifier) || (sqlSearchOptions.Sort[0].sortOrder == SortOrder.Descending && resultCount == 0))
+                    (sqlSearchOptions.Sort[0].sortOrder == SortOrder.Descending && sqlSearchOptions.DidWeSearchForSortValue.HasValue && sqlSearchOptions.DidWeSearchForSortValue.Value && !sqlSearchOptions.SortHasMissingModifier) || (sqlSearchOptions.Sort[0].sortOrder == SortOrder.Descending && resultCount == 0 && !sqlSearchOptions.CountOnly))
                 {
                     if (sqlSearchOptions.MaxItemCount - resultCount == 0)
                     {