# Hip Replacement: Cost, Coverage, and What to Expect

Source: https://ourhealthnetwork.com/procedure-costs/hip-replacement
Last reviewed: 2026-04-18
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays surgeons about $976 for a total hip replacement, but the full hospital bill commonly runs $30,000 to $50,000 on commercial insurance, with the facility fee and implant making up the largest share.

## What it is

A total hip replacement removes the damaged ball-and-socket joint at the top of your thigh bone and replaces it with an artificial one. The surgeon takes out the worn femoral head, reshapes the socket in your pelvis, and installs metal, ceramic, and plastic components that recreate a smooth-moving joint. The artificial hip is designed to last 15 to 25 years for most patients.

Here's what's involved in a typical case:

- **Surgery time:** 1.5 to 3 hours in the operating room
- **Anesthesia:** Usually spinal or epidural with sedation, sometimes general
- **Hospital stay:** Most patients go home the same day or after one night; a decade ago this was a three-to-five-day stay
- **Incision:** 4 to 10 inches on the side, back, or front of the hip, depending on the surgeon's approach
- **Implant:** A metal stem in the thigh bone, a metal or ceramic ball, and a plastic or ceramic liner in the socket

Surgeons use different approaches. The anterior approach goes in from the front and tends to allow faster early recovery. The posterior approach goes in from the back and gives the surgeon better visibility for complex cases. Both have good long-term outcomes. There is only one primary billing code for the standard replacement, so the cost data does not split by approach; the surgeon's choice is driven by your anatomy and their training, not by price.

## When it is done

Hip replacement is almost always elective. It's done for pain and disability that have not responded to everything else, not for an emergency. The most common reason is severe osteoarthritis, where cartilage in the joint has worn away and bone is grinding on bone. Other causes include rheumatoid arthritis, avascular necrosis (loss of blood supply to the femoral head), and post-traumatic arthritis from an old injury.

Your doctor may recommend this when:

1. Hip pain is constant or interrupts your sleep most nights
2. You cannot walk more than a short distance without stopping
3. Climbing stairs, getting out of a chair, or putting on socks has become very difficult
4. X-rays or MRI show advanced joint damage with bone-on-bone contact
5. You've already tried physical therapy, anti-inflammatories, weight loss, and sometimes steroid injections without lasting relief
6. The pain is limiting activities that matter to you, not just the extras

If your joint damage is moderate, alternatives are worth discussing first. These include cortisone or hyaluronic acid injections, regenerative approaches, hip arthroscopy for specific problems, or in younger active patients, hip resurfacing. Surgeons generally want to delay replacement in patients under 55 when possible because the implant's lifespan is finite.

## What you pay

What you actually pay depends heavily on your coverage. Medicare reimburses the surgeon about $976 for the procedure itself, and pays the hospital a separate, much larger amount for the facility side. Commercial insurers pay roughly 2x to 4x what Medicare does overall, which is why total billed charges on a private plan commonly land between $30,000 and $50,000 for the full episode.

**If you're on Medicare:**

- Part A covers the hospital facility charge; if it's inpatient, you'll owe the $1,676 Part A deductible (2025 figure) for your stay
- Part B covers the surgeon and anesthesia fees at 80%, leaving you 20% coinsurance
- Most hip replacements are now outpatient, which shifts some costs from Part A to Part B and can change your share
- Medigap or Medicare Advantage can reduce or cap these out-of-pocket costs substantially

**If you have commercial insurance:**

- Expect to meet your full deductible, commonly $1,500 to $6,000
- After the deductible, coinsurance of 10% to 30% applies until you hit your out-of-pocket maximum (capped at $9,200 for individual ACA plans in 2025)
- Most insured patients end up paying between $3,000 and $8,500 total
- Pre-authorization is almost always required; skip it and the plan can deny the whole claim

**If you're uninsured or paying cash:**

- Bundled cash-pay packages at ambulatory surgery centers run $20,000 to $40,000, covering surgeon, facility, anesthesia, and implant in one price
- Hospital chargemaster prices are several times higher but are almost always negotiable; ask for the self-pay or prompt-pay discount
- Nonprofit hospitals are required by federal rules to offer financial assistance; ask for a charity-care application
- A clear written cash quote that lists what is and isn't included is worth more than a low-sounding estimate with ambiguous exclusions

## Anatomy of the bill

A hip replacement produces multiple bills from multiple parties. Understanding which line comes from whom helps you spot errors and in-network gaps.

- **Surgeon's professional fee:** Billed by the orthopedic surgeon or their group. Medicare pays about $976; commercial fees typically run $2,500 to $6,000.
- **Facility fee:** The hospital or ambulatory surgery center's charge. This is the single largest line and covers the OR, nursing, supplies, and room time. Commercial facility fees commonly run $15,000 to $35,000; hospital-based care is higher than a surgery center.
- **Anesthesia:** Billed by a separate anesthesia group. Commercial total usually $1,200 to $3,000, depending on case length.
- **Implant and hardware:** The prosthesis itself costs the facility $3,000 to $8,000 wholesale and is marked up in the facility bill. Some hospitals itemize it; surgery centers often bundle it.
- **Pre-op imaging and labs:** X-rays, bloodwork, EKG, and sometimes a pre-op medical clearance visit. $200 to $1,500 depending on what's ordered.
- **Post-op physical therapy:** Commonly 8 to 20 sessions at $75 to $250 each depending on setting and insurance.
- **Durable medical equipment:** Walker, raised toilet seat, grabber, sometimes a CPM machine. $50 to $400.
- **Pathology:** Rare for a routine replacement but can appear if any tissue is sent.

## Cost by state

Medicare's surgeon payment varies across the country because the program applies a geographic adjustment that accounts for local practice costs and wages. Utah pays the least at about $424 per case, while Hawaii pays the most at roughly $919. Florida runs the highest total volume with more than 60,000 services, followed by California, Pennsylvania, Illinois, and Texas. These figures are only the surgeon's fee; facility payments, which are the bigger number, track a different geographic formula.

Why costs vary by state:

- **Medicare GPCI:** The Geographic Practice Cost Index scales physician pay to local wages and rent; urban coastal states run higher
- **Commercial negotiation power:** Hospital systems with strong market share negotiate higher private rates, and those rates vary wildly by metro area
- **Cost of living and nursing wages:** Facility fees rise with local labor costs
- **State billing laws:** Some states have tighter balance-billing protections and price transparency rules, which can reduce surprise charges

## Office vs facility

Hip replacement is essentially always performed in a facility setting. Medicare data shows 273,714 services in facilities versus just 1,087 in office-based settings, so the office number is noise (often billing cleanup) rather than a real alternative. The real setting choice for patients is between a hospital outpatient department and a freestanding ambulatory surgery center (ASC).

For a growing share of healthy patients, outpatient hip replacement at an ASC is now the default. It's cheaper, shorter, and the published safety data is strong for carefully selected candidates.

Where each setting fits:

- **Hospital makes more sense when:** You have significant heart, lung, or kidney disease; your BMI is very high; you're on blood thinners or have a clotting disorder; you need overnight observation; or your surgeon operates almost exclusively at that hospital
- **Ambulatory surgery center makes more sense when:** You're generally healthy, mobile, have good home support, and your surgeon has a strong ASC volume; ASCs typically run 30% to 50% less in total commercial billing and often offer transparent bundled cash prices

## Who performs the procedure

Hip replacement is a specialist procedure. Orthopedic surgeons, especially those fellowship-trained in adult reconstruction (joint replacement), perform the overwhelming majority of cases. In the Medicare data, about 4,500 orthopedic surgeons account for the core surgical volume. Physician assistants and nurse practitioners appear in the billing data too, but their reimbursement is a fraction of the surgeon's because they are billing as first assistants, not as the primary operator.

What to look for when choosing a surgeon:

- **Case volume:** Surgeons who do more than 50 hip replacements a year have better outcomes and lower complication rates in published studies
- **Subspecialty focus:** A surgeon whose practice is mostly hips and knees (adult reconstruction) is a stronger choice than a generalist who also does sports medicine and spine
- **Fellowship training:** A one-year fellowship in adult joint reconstruction is the gold-standard credential
- **Board certification:** Confirm current certification through the American Board of Orthopaedic Surgery
- **Hospital affiliation:** A surgeon with privileges at a high-volume orthopedic center usually has a stronger team around them
- **Willingness to give a second opinion:** If a surgeon pressures you to book quickly, that's a flag, not a reassurance

Sports medicine physicians also show up in the data in small numbers; most are sub-specialists who do joint replacements alongside sports cases. Family medicine and internal medicine do not perform this procedure.

## How to shop for the best price

Price-shopping a hip replacement feels awkward, but the dollar difference is large enough to make it worth an afternoon of phone calls.

1. **Request a Good Faith Estimate from every facility you're considering.** Federal law (the No Surprises Act) requires hospitals and surgery centers to provide a written estimate on request for self-pay patients, and insurers must give an Advanced Explanation of Benefits to insured patients on request.
2. **Verify every billing party is in-network.** Surgeon, facility, anesthesia group, pathologist if tissue is sent, and any imaging provider. Get each confirmation in writing or by screenshot of your insurer's directory.
3. **Compare the hospital outpatient price to an ambulatory surgery center.** Ask both for their total bundled case price. ASCs often come in tens of thousands of dollars cheaper on commercial billing.
4. **Ask about bundled pricing.** Many centers offer a 90-day global bundle that includes surgeon, facility, anesthesia, implant, and follow-up visits in one price. Itemized billing usually ends up higher for cash-pay patients.
5. **Ask about payment plans and charity care.** Nonprofit hospitals are required to have financial assistance policies; many waive or reduce bills significantly for patients under 300% to 400% of the federal poverty level.
6. **Get a second opinion on less-invasive alternatives.** If you're on the younger end or your imaging is borderline, another surgeon may recommend holding off, trying injections, or considering hip resurfacing.
7. **Confirm the implant brand and ask for a mid-tier option.** Premium implants can add $2,000 to $5,000 without evidence of better outcomes for most patients.

Red flags: an estimate that won't itemize anesthesia and implant separately, a scheduler who cannot tell you which anesthesia group covers the facility, or a surgeon's office that says "insurance will handle it" instead of giving you a number.

## Surprise billing risks

Hip replacement has a few predictable points where bills go sideways, even for patients who did everything right on the front end. The biggest issue is ancillary providers who work at an in-network hospital but don't participate in your plan themselves.

Most common surprise-billing sources:

- **Anesthesiologist or CRNA** not in your network even though the hospital is
- **Pathologist** billing separately if tissue is sent for review
- **Implant cost pass-through** charged as a separate high-dollar line you weren't told about
- **Post-op home health or physical therapy** that started automatically without network verification
- **Emergency transfer** if an ASC case is converted to inpatient and moves you to a hospital

If you get a surprise bill:

- **Do not pay until it's verified:** Request a fully itemized bill with CPT codes, not a balance summary
- **File a No Surprises Act dispute:** The 2022 law protects you from out-of-network balance billing in most facility-based scenarios; start at cms.gov/nosurprises
- **Escalate to your state insurance commissioner** if the provider refuses to engage with the NSA process
- **Ask for an internal audit** at the hospital billing office; duplicate charges and coding errors are common

## Total recovery cost

Most patients walk the same day with a walker or cane, drive again in 2 to 6 weeks, and return to desk work in 2 to 4 weeks. Physical jobs can take 8 to 12 weeks. Full recovery, meaning you stop thinking about the hip, is usually 3 to 6 months.

Add-on costs to budget for:

- **Physical therapy:** 8 to 20 sessions at $75 to $250 each depending on setting; many plans cover most of this but copays add up
- **Assistive equipment:** Walker $40 to $150, cane $20 to $60, raised toilet seat $40 to $80, reacher/grabber $15 to $30
- **Prescription medications:** Pain meds, blood thinner (often a DOAC for 2 to 6 weeks), stool softeners; $100 to $600 depending on coverage
- **Follow-up visits:** 2 to 4 surgeon visits with X-rays over the first year; copays $25 to $75 each
- **Time off work:** 2 to 12 weeks depending on job; short-term disability may cover 60% to 70% of wages if you have it
- **Home modifications:** Shower grab bar, non-slip mats, sometimes a temporary recliner rental; $50 to $400
- **Transportation and caregiving:** You can't drive for weeks; budget for help with errands and appointments

When you add these up honestly, the real episode cost typically runs 15% to 25% above the sticker price of the surgery itself. Factor that in when comparing surgery center quotes to hospital quotes, because lost wages and PT copays are the same either way.

## Variants of this procedure

- Total Hip Replacement

## Frequently asked questions

### How much does hip replacement cost with insurance?

On a commercial plan, most insured patients pay between $3,000 and $8,500 out of pocket for the full episode. You'll typically meet your deductible and then owe coinsurance until you hit your plan's out-of-pocket maximum, which is capped at $9,200 for individual ACA plans in 2025. The total billed amount to the insurer is usually $30,000 to $50,000.

### Does Medicare cover hip replacement?

Yes. Medicare covers hip replacement when it's medically necessary. Part A covers the hospital facility if you're admitted as inpatient, and you'd owe the $1,676 Part A deductible (2025 figure). Part B covers the surgeon and anesthesia at 80% after your annual deductible, so you're responsible for 20% coinsurance unless you have a Medigap or Medicare Advantage plan that covers it.

### How long is recovery from a hip replacement?

Most patients walk with a walker the day of surgery, switch to a cane at 2 to 4 weeks, and are walking unaided by 4 to 8 weeks. Desk workers return at 2 to 4 weeks; physical jobs at 8 to 12 weeks. Full recovery takes 3 to 6 months for most people.

### Is hip replacement outpatient or does it require a hospital stay?

It depends on your health, your surgeon, and your facility. A decade ago almost every hip replacement was inpatient with a 3-to-5-day stay. Today, for healthy patients, same-day outpatient hip replacement at an ambulatory surgery center is common and is often cheaper. Patients with heart, lung, or kidney conditions still typically stay overnight in a hospital.

### How do I avoid a surprise bill?

Verify in-network status in writing for the surgeon, the facility, and the anesthesia group before surgery. Request a Good Faith Estimate or an Advanced Explanation of Benefits. If a surprise out-of-network bill still arrives, file a No Surprises Act dispute at cms.gov/nosurprises and don't pay until it's reviewed.

### What's the cheapest way to get a hip replacement?

For most people, the cheapest route is an in-network ambulatory surgery center on a commercial plan, or an outpatient hospital procedure on Medicare with a Medigap plan. For cash-pay patients, a bundled surgery-center package quoted in writing is usually $20,000 to $40,000, and nonprofit hospital charity-care programs can reduce bills further for those who qualify.

### Where does this cost data come from?

The Medicare figures come from the CMS Medicare Physician and Other Practitioners data set, covering more than 274,000 hip replacements performed by about 8,000 surgeons. Commercial and cash ranges are sourced from published industry benchmarks and transparent hospital price files, which is why those are given as ranges rather than a single number.

## Related

- [All procedure cost concepts](https://ourhealthnetwork.com/procedure-costs)
- [Find specialists who perform this procedure](https://ourhealthnetwork.com/find-doctors)
- [Insurance plans that cover this procedure](https://ourhealthnetwork.com/tools/insurance-matcher)