If you just received a bill for a hip replacement, the number on the first page is almost certainly not what you owe. A hip replacement (CPT code 27130, total hip arthroplasty) carries a chargemaster list price of $32,000 to $65,000 at most U.S. hospitals in 2026, but Medicare pays $12,000 to $14,000 for the same procedure, and insured patients typically end up paying $3,000 to $8,000 out of pocket. The gap between the sticker price and what anyone actually pays is one of the largest in American healthcare, and understanding it can save you thousands.
Quick Answer: The 2026 national median negotiated rate for CPT 27130 is roughly $10,795 across hospitals, but chargemaster rates run as high as $65,000. Medicare pays $12,000 to $14,000 under DRG 470. If you received a hip replacement bill and want to know whether each line item is accurate, the CoveredUSA Bill Analyzer compares your charges to the Medicare reference rate in about 30 seconds.
What CPT 27130 Actually Covers
CPT 27130 is the procedure code for a total hip arthroplasty, meaning the surgical removal and replacement of the hip joint with a prosthetic implant. It covers the surgeon's work during the operation itself.
That single code does not capture everything on your bill. A complete hip replacement encounter typically generates charges under several separate codes:
- CPT 27130: the primary surgical procedure (total hip arthroplasty)
- Facility fees: the hospital or ambulatory surgical center (ASC) charges for the room, staff, and equipment
- Anesthesia codes (commonly 01214 or 01215): billed per time unit
- Implant charges: the prosthetic components, often billed as supply line items
- Post-acute care: physical therapy, skilled nursing if needed, follow-up visits
When people say "hip replacement cost," they usually mean the total episode, not just CPT 27130. The all-in figure is what this article addresses.
Chargemaster Price vs. Medicare Rate: The Real Gap
The chargemaster is the hospital's internal price list, similar to a hotel's rack rate or a car's sticker price. Virtually no one pays the chargemaster amount, not Medicare, not private insurers, not even uninsured cash-pay patients who negotiate.
Here is how the same procedure looks at three different price levels in 2026:
| Price Type | 2026 Range | Who Pays This |
|---|
| Chargemaster (list price) | $32,000 to $65,000 | Almost no one |
| Negotiated (insured rate) | $10,795 median ($3,204 to $16,779) | Private insurance patients |
| Medicare DRG 470 payment | $12,000 to $14,000 | Medicare beneficiaries |
| Cash-pay / self-pay | $15,000 to $25,000 at most facilities | Uninsured patients who negotiate |
| Physician fee (CPT 27130 only) | $1,136 to $2,863 (national median $1,819) | Added on top of facility fee |
Sources: Medicare.gov procedure price lookup for CPT 27130, CMS Hospital Price Transparency FAQ
The physician fee range of $1,136 to $2,863 covers only the surgeon's professional component. The facility fee, the hospital or ASC's charge for the operating room, staff, implants, and supplies, is separate and substantially larger.
What Medicare Pays in 2026
Medicare covers hip replacement surgery under two pathways:
Inpatient (Part A, DRG 470): Most hip replacements are still performed as inpatient procedures billed under MS-DRG 470 (Major Hip and Knee Joint Replacement Without Major Complications or Comorbidities). Medicare pays $12,000 to $14,000 to the hospital, depending on location, teaching status, and whether the facility participates in value-based models. The 2026 Part A inpatient deductible is $1,736. For a standard 1-to-3-day stay, that deductible is usually your primary out-of-pocket cost for the facility portion.
Outpatient/ASC (Part B, CPT 27130): CMS approved hip replacements in the ambulatory surgical center setting. Outpatient procedures at an ASC can cut total costs by 30 to 50 percent. The Medicare facility reference for outpatient CPT 27130 runs closer to $1,275 for the facility fee component, with the full payment varying by setting.
CMS has also proposed nationwide expansion of the Comprehensive Care for Joint Replacement (CJR-X) model in 2026, which bundles all hip and knee replacement payments over 90 days. Per CMS, this model is designed to create accountability for the entire episode rather than individual procedure codes.
What You Actually Owe: Patient Out-of-Pocket by Coverage Type
| Coverage Type | Estimated 2026 Out-of-Pocket | Key Variables |
|---|
| Original Medicare (Part A inpatient) | $1,736 deductible + 20% of Part B charges | Days in hospital, Part B deductible met |
| Medicare Advantage | $1,500 to $4,500 (varies by plan) | Plan's MOOP, network status |
| Private insurance (ACA marketplace) | $3,000 to $8,000 | Deductible, coinsurance, OOPM |
| Medicaid | $0 to $3 copay in most states | State program rules |
| Uninsured / self-pay | $15,000 to $35,000+ | Negotiation, charity care eligibility |
If you have no insurance and face the full chargemaster rate, you are not legally required to pay it. Hospitals must provide charity care programs if they are nonprofit, and most will negotiate a cash-pay discount of 40 to 60 percent below list price.
Why Your Hospital Bill May Contain Errors
An estimated 80 percent of hospital bills contain at least one error, according to an often-cited University of Minnesota analysis reported by CMS. The average error costs patients $1,300. Hip replacement bills are particularly error-prone because they involve multiple departments, implant vendors, anesthesia groups, and post-acute care providers, all billing separately.
The most common billing errors on hip replacement claims:
- Duplicate charges: the same supply item or service billed twice
- Upcoding: billing CPT 27132 (revision arthroplasty, higher-paying) when a primary 27130 was performed
- Unbundling: splitting procedure components that Medicare requires to be billed together
- Incorrect implant codes: using a code for a more expensive prosthesis than was actually implanted
- Phantom charges: items listed on the bill that never reached the patient (an extra IV bag, a physical therapy session that did not happen)
- Room-and-board miscounts: an extra day of inpatient charges if the discharge date was recorded incorrectly
To check whether each line item on your bill matches the Medicare reference rate, upload the itemized statement to the CoveredUSA Bill Analyzer. It flags charges above the Medicare benchmark, spots duplicate codes, and identifies line items that do not match standard bundling rules, all in under 30 seconds.
How to Read a Hip Replacement Itemized Bill
Before you dispute anything, you need the itemized statement. The summary bill you receive first is not the itemized bill. Call the hospital billing department and specifically request the itemized statement with CPT and revenue codes.
What to look for on each line:
- CPT code: does it match the procedure you actually had?
- Revenue code: the 3- or 4-digit code classifying the department (e.g., 360 for operating room)
- Quantity: are the units correct? One surgery should not show 2 units on the main procedure code.
- Charge amount: compare each line to the Medicare published rate
- Date of service: does every line fall within the date range of your actual stay?
How to Dispute an Overcharge: Step-by-Step
- Request your itemized bill in writing. You have a federal right to this document. If the billing office refuses, escalate to the patient advocate or hospital administrator.
- Pull your Explanation of Benefits (EOB) from your insurer. The EOB shows what the insurer was billed, what it paid, and what you owe. Discrepancies between the EOB and the bill you received signal an error.
- Compare charges to Medicare rates. Use the Medicare procedure price lookup at medicare.gov or upload your bill to the CoveredUSA Bill Analyzer to run the comparison automatically.
- Document every discrepancy. Write down the CPT code, the charged amount, and the Medicare reference amount for each error you find.
- Submit a formal written dispute. Send a letter by certified mail to the billing department. Include copies of the itemized bill, EOB, and your documented discrepancies. Keep the original.
- Escalate if needed. If the hospital does not respond within 30 days, file a complaint with your state insurance commissioner (for insured patients) or your state attorney general's consumer protection office.
- Ask about financial assistance. Even after disputing errors, if the remaining balance is unaffordable, ask for a charity care application. Nonprofit hospitals are required by IRS rules to offer financial assistance programs.
Documents you will need:
- Itemized hospital bill with CPT and revenue codes
- Explanation of Benefits from your insurer
- Operative report from your surgeon
- Anesthesia record
- Discharge summary
- Any pre-authorization letters from your insurer
- Your insurance card and policy number
Common reasons disputes are denied:
- The dispute was submitted verbally, not in writing
- You disputed the wrong billing party (hospital vs. separate physician group)
- The time limit for disputes passed (typically 60 to 180 days)
- Missing documentation to support the claim
Regional Cost Variation for CPT 27130 in 2026
The same total hip arthroplasty can cost dramatically different amounts depending on where you have the surgery. Per MyCareCost and state transparency data:
| Region / Setting | 2026 Negotiated Rate Range |
|---|
| Ambulatory Surgical Center (national) | $8,000 to $18,000 |
| Community hospital (non-urban) | $10,000 to $20,000 |
| Major academic medical center | $20,000 to $45,000+ |
| Texas (214 reporting hospitals median) | $2,648 cash price |
| Maine (state transparency data) | Widely variable by facility |
The case for getting a total hip at an ASC rather than a hospital inpatient setting is financial as well as clinical. CMS added hip replacement to the ASC-covered procedures list specifically because outcomes data showed equivalent safety at substantially lower cost.
Charity Care and Financial Assistance Options
If you are uninsured or underinsured, you may qualify for financial assistance that reduces your bill before you dispute any errors. Nonprofit hospitals must have charity care policies under IRS 501(c)(3) rules and the Affordable Care Act.
Typical thresholds for free or reduced-cost care:
| Household Size | Common Charity Care Income Limit (2026) | Coverage Level |
|---|
| 1 | Up to $39,900 (250% FPL) | Often free |
| 2 | Up to $54,100 (250% FPL) | Often free |
| 3 | Up to $68,300 (250% FPL) | Often free |
| 4 | Up to $82,500 (250% FPL) | Often free |
| 5 | Up to $96,700 (250% FPL) | Often free |
| 6 | Up to $110,900 (250% FPL) | Often free |
| 7 | Up to $125,100 (250% FPL) | Often free |
| 8 | Up to $139,300 (250% FPL) | Often free |
| Each additional | + $14,200 | Varies by hospital |
These thresholds are based on 250% of the 2026 Federal Poverty Level, per ASPE/HHS guidelines. Individual hospitals may use 200%, 300%, or higher. Always apply. The hospital determines your eligibility, not you.
Beyond charity care, patients with Medicare may qualify for Medicare Savings Programs that cover the Part A deductible, reducing out-of-pocket cost on a hip replacement to near zero. Learn more about your eligibility at the Medicare eligibility guide at coveredusa.org.
Frequently Asked Questions
What is CPT 27130?
CPT 27130 is the Current Procedural Terminology code for total hip arthroplasty, the surgical procedure that replaces a damaged hip joint with an artificial implant. It is the primary procedure code used by surgeons when billing for a full hip replacement. The hospital facility fee is typically billed separately under a different revenue code structure, not under CPT 27130 alone.
How much does a hip replacement cost in 2026 without insurance?
Without insurance, the chargemaster list price ranges from $32,000 to $65,000. Uninsured patients who negotiate a cash-pay rate typically pay $15,000 to $35,000. Nonprofit hospitals must offer charity care programs, and patients below 250% of the Federal Poverty Level often qualify for free or heavily discounted care.
What does Medicare pay for a hip replacement in 2026?
Medicare pays $12,000 to $14,000 to the hospital under DRG 470 for an inpatient hip replacement without major complications. The patient owes the 2026 Part A deductible of $1,736. Physician fees are paid separately under Part B. Outpatient hip replacements at an ASC cost Medicare less and result in lower patient cost-sharing in most cases.
What is the chargemaster and why does it not reflect what I owe?
The chargemaster is the hospital's internal master price list. It represents the maximum gross charge before any insurer discount, contractual adjustment, or charity care reduction. Insurance companies negotiate rates that are typically 20 to 60 percent below chargemaster prices. Medicare sets its own payment rates by statute. For most patients, the chargemaster figure is not what they owe.
How do I know if my hip replacement bill has errors?
Request an itemized bill with CPT and revenue codes from the hospital billing department. Compare each line to the Medicare published rate using the Medicare procedure price lookup tool. Look for duplicate charges, quantities greater than 1 on the main procedure code, and any service line dated outside your hospital stay. Upload your itemized bill to the CoveredUSA Bill Analyzer for an automated line-by-line comparison.
What is DRG 470 and how does it relate to CPT 27130?
MS-DRG 470 is the Medicare inpatient diagnosis-related group that covers major hip and knee joint replacements without major complications or comorbidities. When a Medicare patient is admitted to the hospital for a hip replacement, the hospital bills under DRG 470 and receives a fixed bundled payment of $12,000 to $14,000. CPT 27130 is the outpatient or physician-level code for the same procedure, used when billing Medicare Part B for the surgeon's professional fee, or when the procedure is performed in an ASC.
Can I negotiate a lower price if I am paying cash?
Yes. Most hospitals will discount 30 to 50 percent off the chargemaster rate for patients paying cash. Some facilities publish a cash-pay price as part of the 2026 CMS price transparency requirements. Ask the billing department specifically for the "self-pay" or "cash-pay" rate before agreeing to any payment plan at the list price.
What if my insurer paid the wrong rate?
Review your Explanation of Benefits and compare the allowed amount to your plan's contracted rate. If the EOB shows payment at an out-of-network rate for an in-network facility, file a coverage dispute with your insurer. If you were balance-billed (charged the difference between the chargemaster and what your insurer paid), that may violate your state's surprise billing protections under the No Surprises Act.
Upload your hospital bill to the free CoveredUSA Bill Analyzer to find errors, overcharges, and charity care options in 30 seconds.
