The common material of bearing rings is GCr15 bearing steel which is a typical difficult-to-machine material. As an important working surface of the bearing, the inner surface of the raceway plays a vital role in the performance of the bearing. As an important means to solve the high-performance manufacturing of difficult-to-machine materials, longitudinal–torsional ultrasonic processing is widely used in various types of processing. In the presented work, the basic size of the horn is obtained from the wave equation of the forced vibration, and the modal analysis and amplitude test are carried out to verify the rationality of the LUTG structure. Then, according to the probability density function of cutting thickness and the overlapping effect of adjacent abrasive trajectories, the LUTG surface topography prediction model is established by using the height formula of the surface residual material, and the model reliability is verified by using the orthogonal test. The error between the test results and the prediction model is within 13.2%. Finally, based on the response surface method, the optimal process parameters that can meet the requirements of low roughness (Ra) and high material removal rate (MRR) are screened, and the optimal combination of process parameters is obtained as follows: A = 4.5 μm, n = 6493.3 r/min, ap = 28.4 μm, and vf = 21.1 mm/min.