Total knee arthroplasty, the medical term for knee replacement, is performed hundreds of thousands of times each year in the United States, mostly for severe osteoarthritis. It can dramatically reduce pain and restore mobility, but the bill can be confusing. Knee replacement surgery cost varies widely depending on where the surgery happens, how you are insured, and what is included in the price. This guide explains the components of the cost, how coverage works, and how to estimate what you will owe.
What goes into the price
A knee replacement involves several separate charges, which may be billed by different providers:
- Facility fee from the hospital or ambulatory surgery center, covering the operating room, nursing, recovery, supplies, and often the implant.
- Surgeon’s fee for the procedure and typically a 90-day global period of routine follow-up.
- Anesthesia fee from the anesthesiologist or nurse anesthetist.
- Implant costs, sometimes itemized separately.
- Pre-operative testing, such as imaging, blood work, and EKG.
- Physical therapy after surgery, often several weeks of outpatient visits.
- Durable medical equipment, such as a walker or cold therapy device.
- Post-acute care, such as a short stay in a skilled nursing or rehabilitation facility, if needed.
Total negotiated prices commonly reach tens of thousands of dollars. Federal hospital price transparency rules require hospitals to publish standard charges, including negotiated rates with insurers, and many publish “shoppable services” tools that show estimated prices for common procedures, including joint replacement. Health plans must also provide price comparison tools for covered services.
Inpatient, outpatient, and surgery centers
Knee replacement used to require several days in the hospital. Today, many healthy patients go home the same day or the next day. Medicare removed total knee replacement from its inpatient-only list in 2018 and added it to the list of procedures payable in ambulatory surgical centers (ASCs) in 2020. Where your surgery takes place affects cost:
- Inpatient hospital: under Medicare Part A, you pay the Part A inpatient deductible per benefit period ($1,676 in 2025), and Part B covers physician services.
- Hospital outpatient department: covered under Part B; you pay the Part B deductible and 20 percent coinsurance, though coinsurance for a single outpatient procedure is capped at the Part A inpatient deductible amount.
- Ambulatory surgery center: often the lowest total price, covered under Part B with 20 percent coinsurance.
Your surgeon decides the appropriate setting based on your health. People with significant heart or lung disease, obesity, or limited support at home are more likely to need inpatient care.
Note that observation status in a hospital is outpatient care, even if you stay overnight. This matters for Medicare because you need a three-day inpatient stay to qualify for skilled nursing facility coverage under Original Medicare. If you may need rehab in a facility afterward, ask whether you are admitted as an inpatient.
Coverage with Original Medicare
Original Medicare covers knee replacement when medically necessary. Your costs typically include the Part A deductible for an inpatient stay or Part B deductible and 20 percent coinsurance for outpatient services, plus 20 percent of the surgeon’s and anesthesia fees and physical therapy. Original Medicare has no out-of-pocket maximum, so a Medigap policy or other supplemental coverage can make a large difference. Plans such as Medigap Plan G cover most of these cost-sharing amounts after the Part B deductible.
Medicare has also tested bundled payment programs for joint replacement, such as the Comprehensive Care for Joint Replacement model, which pay hospitals a single target price for the surgery and 90 days of follow-up care. These programs do not change your cost-sharing directly but encourage care coordination.
Coverage with Medicare Advantage
Medicare Advantage plans cover knee replacement but often require prior authorization and use provider networks. Your costs depend on the plan’s copays for inpatient days, outpatient surgery, specialist visits, and physical therapy, up to the plan’s annual out-of-pocket maximum. Check your plan’s Evidence of Coverage and confirm that the surgeon, facility, and anesthesia group are in network.
Coverage with private insurance
Employer and marketplace plans generally cover medically necessary knee replacement. Expect:
- Prior authorization requirements, often documenting failed conservative treatment such as physical therapy, weight management, medications, and injections.
- Your deductible and coinsurance until you reach the out-of-pocket maximum. ACA-compliant plans have an annual out-of-pocket limit, which for 2025 was $9,200 for an individual and $18,400 for a family.
- Network rules. Out-of-network care can cost far more, although the No Surprises Act protects you from surprise bills from out-of-network anesthesiologists and certain other providers at in-network facilities.
Some large employers offer centers of excellence programs that cover travel and waive cost-sharing if you use selected high-quality hospitals. Ask your HR department.
Paying without insurance
Uninsured patients should ask about cash prices, which some surgery centers publish as package prices that include the surgeon, anesthesia, facility, and implant. Under the No Surprises Act, uninsured and self-pay patients have the right to a good faith estimate before scheduled care, and if the final bill exceeds the estimate by $400 or more, they can dispute it. Nonprofit hospitals must have financial assistance policies, and many offer discounts or free care based on income.
How to estimate your out-of-pocket cost
- Get the procedure codes. Ask the surgeon’s office for the CPT code (27447 for total knee arthroplasty) and the planned setting.
- Call your insurer or use its cost estimator with the codes, facility, and surgeon.
- Confirm network status of the surgeon, facility, anesthesia group, and any assistant surgeon.
- Ask about the implant and whether it is included in the facility fee.
- Check your deductible and out-of-pocket status for the year. If you have met much of your deductible, scheduling surgery in the same plan year can reduce costs.
- Plan for physical therapy copays, which can add up over many visits.
- Ask about payment plans before surgery.
Questions to ask your surgeon
- How many knee replacements do you perform each year?
- Will surgery be inpatient, outpatient, or in a surgery center?
- What type of implant will you use and why?
- What does recovery look like, and how much physical therapy will I need?
- What are the risks, including infection, blood clots, and stiffness?
- Are there nonsurgical options I should try first?
Studies have generally linked higher surgeon and hospital volume with better outcomes for joint replacement, and Medicare’s Care Compare website provides hospital quality information.
Recovery costs and time off work
Many patients return to desk work within several weeks and to more physical jobs after a longer period. If you will be off work, check short-term disability benefits through your employer and whether the Family and Medical Leave Act protects your job. Budget for home modifications, such as a raised toilet seat or shower chair, which are often not covered.
Partial knee replacement and other alternatives
Not everyone with knee arthritis needs a total replacement. When damage is limited to one compartment of the knee, a unicompartmental, or partial, knee replacement may be an option. It typically involves a smaller incision and may allow a faster recovery, though it is suitable only for selected patients and may carry a higher chance of later revision. Nonsurgical treatments that insurers often expect you to try first include supervised physical therapy, weight loss where appropriate, anti-inflammatory medications, bracing, and corticosteroid injections. Insurers vary in whether they cover hyaluronic acid injections, and Medicare coverage for these has been narrowed in some regions through local coverage policies. Ask your doctor which options fit your condition and which your plan covers before committing to surgery.
Revision surgery
Implants can wear out or loosen over time, and some patients eventually need revision surgery. Revision procedures are more complex and more expensive than the first surgery. Keeping records of your implant type and surgeon notes can make future care easier.
Frequently Asked Questions
Does Medicare require a three-day hospital stay for knee replacement?
Not for the surgery itself. The three-day inpatient stay matters only if you need skilled nursing facility care afterward under Original Medicare.
Is outpatient knee replacement safe?
For carefully selected patients, studies suggest outpatient joint replacement can be safe. Your surgeon will evaluate your health and support at home.
Will insurance cover a robotic-assisted knee replacement?
Insurers usually pay for the knee replacement procedure itself; robotic assistance typically does not change coverage, but ask whether any extra fees apply.
This article is for general informational purposes only and is not legal, medical, tax, or financial advice. Rules vary by state and change over time; confirm details with the relevant agency or a licensed professional.
