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

Source: https://ourhealthnetwork.com/procedure-costs/knee-replacement
Last reviewed: 2026-04-17
Data: CMS Hospital and Outpatient pricing, CPT/HCPCS code mapping

## Quick answer

Medicare pays orthopedic surgeons about $977 for the knee replacement itself (weighted across 543,732 services), but the total hospital bill commonly lands in the $30,000 to $50,000 range on commercial insurance, driven mostly by the facility fee and the implant.

## What it is

Knee replacement surgery, also called knee arthroplasty, removes worn cartilage and bone from the damaged knee and caps the surfaces with metal and plastic components that work like a new joint. Most people get it because arthritis has eroded the knee to the point where walking, stairs, and sleep are painful, and cortisone shots or physical therapy no longer help.

- **Surgery time:** 60 to 120 minutes for a total replacement, often shorter for a partial
- **Anesthesia:** Usually spinal or regional with sedation; general anesthesia in some cases
- **Hospital stay:** 0 to 2 nights. Many centers now discharge same-day for healthy patients
- **Incision:** A 4 to 8 inch incision down the front of the knee
- **Weight-bearing:** Most people walk with a walker or crutches the same day

There are three versions of the procedure, and the one your surgeon recommends depends on how much of the knee is damaged. A total knee replacement (HCPCS 27447) resurfaces all three compartments of the knee and is by far the most common, making up about 97% of the procedures in this data. A partial or unicompartmental replacement (27446) resurfaces only one side of the joint when the damage is isolated. A revision knee replacement (27487) swaps out components from a prior replacement that has loosened, worn out, or become infected.

## When it is done

Knee replacement is usually a last-resort procedure. Before recommending it, most orthopedic surgeons want to see that you've tried conservative care for at least several months and that imaging and exam findings match your symptoms. The goal is to make sure the pain is actually coming from joint damage a prosthesis can fix, not from something else.

Your doctor may recommend this when:

1. Daily pain limits your walking, stairs, or sleep and has lasted 6 months or more
2. X-rays or MRI show bone-on-bone arthritis or significant cartilage loss
3. Anti-inflammatories, physical therapy, and injections have stopped working
4. Bracing, weight loss, and activity changes haven't given lasting relief
5. A prior knee surgery or implant has failed (for revision cases)
6. The knee has become visibly deformed (bowed in or out) or unstable

Alternatives worth discussing first include high tibial osteotomy in younger active patients, hyaluronic acid or platelet-rich plasma injections (mixed evidence and often not covered), and structured weight-loss programs. A second opinion is especially worth getting if you're under 60 or if only one compartment of your knee is involved, since a partial replacement may be an option.

## What you pay

What you actually owe depends less on Medicare's surgeon fee and more on the facility side of the bill, because knee replacement is an inpatient or outpatient hospital procedure with a large facility charge. Medicare pays surgeons a weighted average of about $977 across the three variants, but the hospital separately bills Medicare (or your commercial insurer) for the stay, the operating room, and the implant. On commercial insurance, the total hospital and physician package commonly runs $30,000 to $60,000 billed, which translates to roughly 2x to 4x Medicare's allowed amount.

**If you're on Medicare:**

- Part A covers the hospital stay if you're admitted as inpatient. The inpatient deductible is $1,676 per benefit period (2025 figure).
- Part B covers the surgeon, anesthesiologist, and any outpatient visits at 80% after the $257 annual deductible (2025 figure).
- If the surgery is done as hospital outpatient or at an ASC, Part B (not Part A) covers the facility fee.
- A Medigap or Medicare Advantage plan usually covers most of the remaining 20% coinsurance.

**If you have commercial insurance:**

- You'll hit your deductible fast; expect to pay the full deductible plus coinsurance up to your out-of-pocket maximum.
- Typical patient responsibility after insurance is $2,500 to $7,500 for an in-network case.
- Prior authorization is almost always required and can take 2 to 4 weeks.
- Ask specifically whether your plan uses a bundled or case-rate payment, since that changes how surprise bills can show up.

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

- Bundled cash-pay prices at specialty orthopedic centers commonly run $18,000 to $35,000, all-inclusive.
- Hospitals are required to publish standard charges and to offer financial assistance; ask for the uninsured discount and charity-care application.
- Medical tourism to Mexico, Costa Rica, or Eastern Europe averages $12,000 to $18,000 but complicates follow-up care if something goes wrong.
- Negotiate aggressively. Sticker charges (averaging $7,033 for just the surgeon component) are almost never what cash payers actually pay.

## Anatomy of the bill

A knee replacement generates bills from at least four or five different parties, even when the surgery goes perfectly. Understanding who bills what helps you spot gaps in your Good Faith Estimate and avoid surprises.

- **Surgeon fee:** Billed by the orthopedic practice. Medicare weighted average is $977; commercial plans pay roughly 2x to 3x that. Covers the operation itself and the 90-day global period for routine follow-up visits.
- **Facility fee:** Billed by the hospital or ambulatory surgery center. This is the single largest line item, often $15,000 to $35,000 commercially, and it covers the operating room, nursing, recovery room, and overnight stay if admitted.
- **Anesthesia:** Billed separately by the anesthesia group. Typically $1,500 to $3,500 commercial, covers the anesthesiologist and any CRNA.
- **Device/implant:** The knee prosthesis itself can cost the hospital $3,000 to $8,000 wholesale, marked up on your bill. Premium implants and custom jigs add more.
- **Pre-op visits and imaging:** X-rays, EKG, labs, medical clearance, and the surgical consult. Usually $500 to $2,000 combined.
- **Post-op physical therapy:** Billed per session, typically $75 to $250 per visit for 10 to 20 sessions. Often the biggest out-of-pocket surprise.
- **Pathology and other ancillary:** Usually minimal for elective knee replacement but can appear if tissue is sent to pathology or if a consultant is called in.

## Cost by state

Medicare surgeon payments vary more by state than most people expect. Utah is the cheapest state in this data at $403 per service weighted across the three variants, while Hawaii sits at $876 and the District of Columbia at $953. The volume leaders look like the population map: Florida performed 103,856 Medicare knee replacements, Texas 86,925, Pennsylvania 86,552, and California 82,847. Commercial prices can swing much more widely than these Medicare figures suggest.

Why costs vary by state:

- **Medicare GPCI:** The Geographic Practice Cost Index adjusts physician payments for local wages, rent, and malpractice, which is why Hawaii and the Northeast pay more than Utah.
- **Commercial negotiation leverage:** In concentrated markets with one or two dominant hospital systems, commercial rates are substantially higher than Medicare.
- **Cost of living and malpractice premiums:** Drive both Medicare GPCI and commercial base rates.
- **State surprise-billing and price-transparency laws:** Some states have stricter enforcement, which pushes facilities to offer better upfront estimates.

## Office vs facility

Knee replacement almost never happens in a physician's office. The Medicare data shows 541,097 services in a facility setting versus just 2,635 in office-based settings, so office-based is barely 0.5% of volume. The small office-based numbers likely reflect post-op management coding, not actual surgeries. For all practical purposes, the real patient choice is between a hospital outpatient department and a freestanding ambulatory surgery center (ASC).

ASCs have been the fastest-growing setting for knee replacement since Medicare started paying for outpatient total knees in 2018, and they're typically 30% to 50% cheaper than hospital outpatient for the same procedure.

- **Hospital makes more sense when:** You have significant heart, lung, or kidney disease, a BMI over 40, a complicated prior surgical history, or you need an overnight stay.
- **ASC makes more sense when:** You're relatively healthy, under 75, have a support person at home, and want lower out-of-pocket cost and a quicker discharge.
- **Either way:** Confirm the facility does 200+ joint replacements per year and has an established same-day-discharge pathway if you're choosing ASC.

## Who performs the procedure

Knee replacement is firmly the domain of orthopedic surgery. Of the roughly 11,400 clinicians who performed these three HCPCS codes in the Medicare data, 6,620 are orthopedic surgeons. They account for about 99% of the case volume by billed services, at an average of $991 per service. A small number of sports medicine physicians (151 providers, all orthopedic-trained) also perform knee replacement, usually fellowship-trained arthroplasty or sports surgeons.

What to look for when choosing a specialist:

- **Annual volume:** Surgeons doing 50+ knee replacements a year have better outcomes than low-volume surgeons. Ask directly.
- **Subspecialty focus:** Adult reconstruction or arthroplasty fellowship training, not general orthopedics.
- **Board certification:** American Board of Orthopaedic Surgery certification plus any subspecialty credential.
- **Hospital volume:** The hospital or ASC should also do 200+ joint replacements a year.
- **Complication and revision rates:** Many hospitals publish these; ask for theirs.
- **Second-opinion threshold:** If you're under 60, have only one compartment involved, or have had prior knee surgery, get a second opinion before booking.

You'll also see large numbers of physician assistants (4,121 providers, average pay $137) and nurse practitioners (557 providers, average pay $133) in the data. These are assistant-at-surgery and post-op visit roles, not primary surgeons. They bill at roughly 14% of the surgeon's rate when they assist in the operating room.

## How to shop for the best price

Knee replacement is one of the most shoppable surgeries in American medicine. Unlike emergency care, you have weeks or months to compare prices and get the bill in writing.

1. **Get a Good Faith Estimate in writing.** Federal law requires hospitals and surgery centers to provide one to self-pay and uninsured patients, and insurers must provide an Advance Explanation of Benefits on request. Insist on a line-item estimate, not a lump sum.
2. **Verify every billing party is in-network.** The surgeon, facility, anesthesia group, assistant surgeon, pathologist, and any consulting hospitalist can each bill separately. A single out-of-network party can cost you thousands.
3. **Compare hospital outpatient vs. ASC.** Same surgeon, same implant, different facility. The cost gap is often $5,000 to $15,000 on commercial insurance.
4. **Ask about bundled vs. itemized billing.** Many hospitals offer a 90-day bundled price that includes surgery, facility, implant, and routine follow-up. Bundles often save money and eliminate surprise bills.
5. **Explore payment plans and charity care.** Hospital charity-care policies frequently cover patients up to 300% or 400% of the federal poverty level, and most hospitals offer 0% interest payment plans if you ask.
6. **Get a second opinion on less-invasive alternatives.** If you're a candidate for a partial knee replacement or if non-surgical options haven't been exhausted, a second opinion can change the plan and save money.
7. **Confirm the implant brand and cost, and ask for the mid-range option.** Premium implants rarely show better outcomes in randomized trials for the average patient but can add $2,000 to $5,000 to your bill.

Red flags during shopping: a facility that won't put numbers in writing, an estimate that excludes "ancillary services" without naming them, or a surgeon's office that can't tell you which anesthesia group will be billing. All three usually signal a bill that will grow after the fact.

## Surprise billing risks

Knee replacement is a common source of surprise bills because so many different parties are involved. The No Surprises Act of 2022 protects you from most out-of-network surprise bills for emergency care and for out-of-network clinicians at in-network facilities, but there are still ways bills blow up on this procedure specifically.

Most common surprise-billing sources:

- **Anesthesiologist out-of-network:** Even at an in-network hospital. Protected by the No Surprises Act but you still have to dispute the charge.
- **Assistant surgeon:** Sometimes billed separately and sometimes out-of-network, especially at teaching hospitals.
- **Implant pass-through charges:** Some facilities bill the implant separately at marked-up rates outside the surgical bundle.
- **Post-op physical therapy:** PT is almost always billed per session and frequently has different in-network status than the surgical team.
- **Durable medical equipment:** Walker, CPM machine, ice pack systems. Often not fully covered and easy to miss in the estimate.

If you get a surprise bill:

- **Don't pay it until you've verified it against your EOB and the Good Faith Estimate.** Charges over 400% of your GFE can be disputed.
- **Request an itemized bill.** Summary bills often contain duplicate charges that disappear under itemization.
- **File for No Surprises Act arbitration at cms.gov/nosurprises.** Free for patients and usually resolved in 30 to 90 days.
- **Escalate to your state insurance commissioner** if the insurer is slow to process or denies a legitimate claim.

## Total recovery cost

Recovery is the part most patients underestimate, both in time and in money. Expect 2 to 6 weeks before you're driving and back to a desk job, and 3 to 6 months before you're fully back to higher-impact activities. Home exercises start the day of surgery, and formal physical therapy typically runs 6 to 12 weeks.

Add-on costs to budget for:

- **Physical therapy:** $75 to $250 per session commercial, 2 to 3 times per week for 6 to 12 weeks (often 15 to 30 sessions total)
- **Pain medications:** $50 to $300 for short-course opioids, anti-inflammatories, and nerve pain medication
- **Blood clot prevention:** Aspirin is free; prescription anticoagulants like enoxaparin can run $200 to $500
- **Assistive equipment:** Walker ($30 to $100), raised toilet seat ($30 to $60), shower chair ($40 to $80), ice therapy machine ($150 to $300)
- **Home modifications:** Grab bars, stair rails, temporary bed on the first floor
- **Time off work:** 2 to 6 weeks for desk jobs, 8 to 12 weeks for physical jobs; factor in lost wages and short-term disability gap
- **Transportation:** You can't drive for 2 to 6 weeks, so budget for rides or family help

When you add these up, the realistic total episode cost typically runs 15% to 25% more than the sticker price of the procedure alone. A surgery quoted at $30,000 commercially can easily come in at $36,000 to $40,000 once PT, equipment, and missed work are counted. Budget for the full episode, not just the operation.

## Variants of this procedure

- Partial (Unicompartmental) Knee Replacement
- Total Knee Replacement
- Revision Knee Replacement

## Frequently asked questions

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

On commercial insurance, the in-network total bill for a knee replacement typically runs $30,000 to $60,000, but your out-of-pocket share is usually $2,500 to $7,500 after your deductible and out-of-pocket maximum. The exact amount depends on your plan's deductible, coinsurance, and whether you've already hit your out-of-pocket max for the year.

### Does Medicare cover knee replacement?

Yes. Medicare Part A covers the hospital stay (after the $1,676 inpatient deductible in 2025), and Part B covers the surgeon and anesthesia at 80% after the $257 Part B deductible. A Medigap or Medicare Advantage plan usually covers most of the 20% coinsurance, and Medicare also pays for outpatient knee replacement at hospitals and ambulatory surgery centers.

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

Most people are walking with a walker the same day, off the walker in 2 to 3 weeks, and driving in 2 to 6 weeks. Formal physical therapy usually runs 6 to 12 weeks. Full recovery and return to higher-impact activities takes 3 to 6 months, though many patients continue to improve gradually for up to a year.

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

Both options exist. Since 2018, Medicare pays for outpatient total knee replacement, and ambulatory surgery centers now handle a growing share of cases with same-day discharge. Hospitals still perform most replacements, with stays of 0 to 2 nights. Healthy patients under 75 are often good ASC candidates; patients with significant heart, lung, or kidney disease generally do better in a hospital setting.

### What's the difference between total, partial, and revision knee replacement?

A total replacement resurfaces all three compartments of the knee and is by far the most common, used when arthritis is widespread. A partial (unicompartmental) replacement resurfaces only one side of the knee and is an option when damage is isolated. A revision replacement swaps out components from a prior knee replacement that has loosened, worn out, or become infected, and is more technically demanding than a first-time procedure.

### How do I avoid a surprise bill on a knee replacement?

Request a Good Faith Estimate in writing, verify that every billing party (surgeon, facility, anesthesia, assistant surgeon, pathologist) is in-network, and ask about a 90-day bundled price that includes everything. The No Surprises Act of 2022 protects you from most out-of-network charges at in-network facilities, but you'll still need to dispute them. If a bill exceeds your Good Faith Estimate by more than 400%, you can file for patient-provider dispute resolution at cms.gov/nosurprises.

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

The cheapest in-network commercial route is usually an ambulatory surgery center using a bundled case rate, which can save $5,000 to $15,000 over a hospital outpatient department for the same surgeon and implant. For cash payers, specialty orthopedic centers advertise bundled prices of $18,000 to $35,000, all-inclusive. Ask the hospital about financial assistance and charity-care qualifications, which often cover patients up to 300% or 400% of the federal poverty level.

### Where does this cost data come from?

The Medicare figures on this page come from the CMS Medicare Physician & Other Practitioners Public Use File, which reports actual payments to 12,089 clinicians across 543,732 knee replacement services. These figures reflect surgeon and physician reimbursement only, not facility fees or implant costs. Commercial and cash price ranges are informed estimates based on published hospital charges, transparency data, and Medicare-to-commercial ratios; your actual price will vary by plan, facility, and market.

## 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)