Total hip arthroplasty replaces the damaged ball and socket of the hip joint with a metal, ceramic, or plastic prosthesis. More than 500,000 total hip replacements are performed in the United States each year, most often to treat osteoarthritis, hip fracture, or avascular necrosis. The surgery reliably relieves pain and restores mobility, but the bill a patient receives can differ by $40,000 or more depending on where the surgery happens, even when the surgeon, implant, and clinical outcome are identical.
Medicare removed total hip arthroplasty from its inpatient-only list effective January 1, 2020, opening the door to same-day outpatient and ambulatory surgery center (ASC) surgery for healthy, lower-risk patients. That regulatory shift, combined with improved anesthesia and pain-control protocols, means a growing share of hip replacements now happen outside the traditional overnight hospital stay. Patients who qualify for outpatient or ASC-based surgery can often save $15,000 to $30,000 compared to a hospital inpatient admission for the same procedure. Patients preparing for surgery often need a pre-operative hip x-ray or MRI to confirm the diagnosis, and those imaging costs are billed separately.
The guide below covers what a hip replacement costs without insurance in 2026, what Medicare pays under DRG 470 and CPT 27130, how site of service and implant choice change the bill, how to request a Good Faith Estimate under the No Surprises Act, self-pay and cash discount programs, and the billing errors most likely to inflate a hip replacement bill after surgery.
Hip Replacement Cost by Site of Service in 2026
The biggest cost driver of Hip Replacement is the site of service: where the procedure is performed. 2026 CMS price transparency data confirms a 2-3x billing differential between independent centers and hospital outpatient departments.
Hip Replacement prices without insurance vs. 2026 Medicare rates| Site of Service | Range Without Insurance | 2026 Medicare Rate |
|---|
| Ambulatory surgery center (ASC) | $22,000 to $32,000 | ~$9,600 (ASC APC 5115) |
| Hospital outpatient department | $28,000 to $42,000 | ~$13,100 (OPPS Comprehensive APC 5115) |
| Hospital inpatient (DRG 470) | $38,000 to $65,000 | ~$13,500 (DRG 470) |
| Premium hospital / specialty orthopedic center | $65,000 to $80,000+ | ~$13,500 (DRG 470) |
Without-insurance ranges include facility fee, implant, surgeon fee, and anesthesia. 2026 Medicare rates are national approximations before local wage-index adjustment. The surgeon fee (~$1,162, CPT 27130) is billed separately under Part B in every setting.
Source: CMS FY 2026 IPPS Final Rule, CMS CY 2026 OPPS/ASC Final Rule, CMS Medicare Physician Fee Schedule 2026, FAIR Health Consumer
Why the Same Procedure Is So Much More at a Hospital
The 2026 hip replacement cost picture is dominated by facility billing, not surgeon skill. A hospital inpatient admission bundles room and board, nursing, operating room overhead, the implant, anesthesia, and post-acute care coordination into the facility charge. An ambulatory surgery center strips out the overnight stay entirely; the patient goes home the same day or within 23 hours, and the facility overhead is a fraction of a hospital's. The surgeon, the implant brand, and the clinical outcome are frequently identical across both settings.
Medicare's own payment schedule shows the spread clearly. CMS pays an ambulatory surgery center approximately $9,600 (ASC Payment System, APC 5115) for a total hip replacement in 2026, versus approximately $13,100 to a hospital outpatient department under OPPS for the same comprehensive APC, and approximately $13,500 to a hospital inpatient facility under DRG 470 (Major Hip and Knee Joint Replacement without Major Complications). In cash-pay markets that Medicare gap of roughly $4,000 typically widens to $15,000 to $30,000, since hospitals apply a much higher markup over their chargemaster than ASCs do.
Implant cost is a second variable that the site-of-service comparison alone does not fully capture. Hip prostheses typically add $4,000 to $10,000 to the total bill, and ceramic-on-ceramic or custom implants sit at the top of that range. Hospitals generally mark up implants more aggressively than ASCs. If you are paying cash, ask the facility in writing whether the implant is included in the quoted total price, and which implant manufacturer and material will be used.
Hip Replacement Cost by Procedure Type in 2026
Not every hip replacement is a standard primary total hip arthroplasty. Hip resurfacing preserves more of the femoral bone and is generally reserved for younger, active patients. Bilateral simultaneous replacement, done in one operating room session, costs substantially more than staging the two hips weeks apart. Revision surgery to replace a worn or failed implant is the most expensive category because of longer operating time, higher complication risk, and specialized revision implants.
Typical cost by variant| Procedure Type | Without-Insurance Range | Medicare Setting |
|---|
| Primary total hip arthroplasty (CPT 27130) | $20,000 to $80,000 | Part A (inpatient, DRG 470) or Part B (outpatient/ASC) |
| Hip resurfacing arthroplasty | $30,000 to $60,000 | Part B outpatient or ASC, typically younger patients |
| Bilateral simultaneous hip replacement | $55,000 to $100,000 | Part A inpatient (higher DRG weight, often DRG 469) |
| Revision total hip arthroplasty (failed implant) | $45,000 to $90,000+ | Part A inpatient typically (DRG 466-468) |
Ranges include implant cost ($4,000-$10,000 primary; higher for revision hardware) and surgeon fee. Bilateral simultaneous and revision cases are rarely performed at ASCs due to complexity and complication risk. Ask your surgeon whether staged bilateral surgery or hip resurfacing is appropriate before committing to a specific approach.
Source: FAIR Health Consumer, CMS FY 2026 IPPS DRG Weight Tables, CMS CY 2026 OPPS/ASC Final Rule
What Medicare Pays for Hip Replacement
When a hip replacement is performed as a hospital inpatient admission, Original Medicare Part B and Part A split the bill. Part A covers the facility cost under DRG 470 (Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without Major Complications), paying the hospital approximately $13,500 in 2026. The beneficiary's cost is the 2026 Part A inpatient deductible of $1,736 for days 1-60 of the benefit period; if the stay extends to days 61-90, a daily coinsurance of $434 applies. The surgeon and anesthesiologist bill separately under Medicare Part B: after the 2026 Part B deductible of $283, you pay 20% coinsurance on the Medicare-approved surgeon fee of approximately $1,162 (CPT 27130), roughly $232 out of pocket for the surgeon alone.
Since CMS removed total hip arthroplasty from the inpatient-only list on January 1, 2020, Medicare Part B also covers hip replacement performed at a hospital outpatient department (approximately $13,100 facility payment, OPPS comprehensive APC 5115) or at an ambulatory surgery center (approximately $9,600, ASC APC 5115). In either outpatient setting, you owe 20% coinsurance on both the facility and surgeon fees after your Part B deductible. Medicare Advantage plans must cover hip replacement on terms at least as generous as Original Medicare, and many waive traditional inpatient-status assumptions in favor of outpatient or ASC-based surgery with prior authorization. Medigap supplemental plans can pay some or all of the 20% Part A and Part B coinsurance, depending on the plan letter.
Uninsured and self-pay patients have federal protections that Medicare beneficiaries do not need, because Medicare and Medicaid are excluded from the No Surprises Act. Under the No Surprises Act, effective January 1, 2022, any patient paying cash or lacking insurance has the right to a written Good Faith Estimate from the hospital, ASC, surgeon, and anesthesiologist before a scheduled hip replacement. For surgery scheduled at least 10 business days out, the provider must furnish the Good Faith Estimate at least 3 business days before service. For surgery scheduled 3 to 9 business days out, the estimate must arrive at least 1 business day before service. The federal consumer portal at cms.gov/nosurprisesact has the full guidance and the dispute-filing process.
To request a Good Faith Estimate for a hip replacement in 2026, follow these steps. First, call the hospital, ASC, or surgeon's billing office and identify yourself as self-pay or uninsured before your surgery is scheduled. Second, ask for a written Good Faith Estimate that itemizes the facility fee, the surgeon's professional fee (CPT 27130), the anesthesiologist's fee, the implant cost, and any pre-operative testing. Third, provide your ZIP code and confirm whether the estimate is for an outpatient, ASC, or inpatient setting, since the price differs sharply by site of service. Fourth, confirm the timing: 3 business days before surgery if scheduled 10 or more business days out, 1 business day before if scheduled 3 to 9 business days out. Fifth, keep the written Good Faith Estimate; if your final bill exceeds it by $400 or more, you have 120 days from the date of the bill to file a patient-provider dispute resolution (PPDR) claim through the federal portal.
A Good Faith Estimate for a hip replacement is not a guaranteed final bill. Common reasons the actual charges exceed the estimate include a longer-than-expected operating room or anesthesia time, conversion from an outpatient plan to an overnight or extended-stay admission because of a complication, additional imaging or labs ordered during the same encounter, a different implant used than originally quoted, and post-operative supplies (braces, walkers, wound-care products) not listed in the original estimate. If the final bill exceeds the Good Faith Estimate by $400 or more, the patient-provider dispute resolution process at cms.gov/nosurprisesact allows the patient to have an independent third party review the charge, and the process is free or low-cost to the patient.
What Factors Affect Cost
- Site of service: ASC vs. hospital outpatient vs. hospital inpatient, the single largest cost driver, with a spread of $15,000 to $40,000 for the same surgery in 2026.
- Implant material and design: standard metal-on-polyethylene implants cost $4,000 to $6,000; ceramic-on-ceramic or custom-fit implants can reach $8,000 to $10,000.
- Insurance status: an uninsured cash-pay patient, an in-network commercial patient with an ACA-compliant plan deductible, and an Original Medicare beneficiary each face very different exposure for the identical procedure.
- Independent ASC cash-pay bundles: many freestanding orthopedic surgery centers publish flat, all-in bundled cash prices for hip replacement, typically 30 to 60 percent below hospital chargemaster cash price for the same surgery.
- Hospital chargemaster self-pay discount: most hospitals maintain a published self-pay or uninsured-discount policy that can cut 20 to 60 percent off the chargemaster rate, but the patient often has to ask for it explicitly and in writing before surgery.
- Nonprofit hospital charity-care and sliding-scale financial assistance: hip replacement is not performed at a Federally Qualified Health Center, but IRC Section 501(r) requires nonprofit hospitals to publish an income-based financial assistance policy that functions similarly to FQHC sliding-scale pricing, tied to the federal poverty level.
- Prior authorization: elective total hip arthroplasty typically requires prior authorization on Medicare Advantage and commercial plans, and denial or delay of authorization can push surgery, and cost exposure, later in the plan year.
- Post-acute rehabilitation: physical therapy for 6 to 12 weeks typically adds $2,000 to $5,000 if providers are out of network; a skilled nursing facility stay or home health visits add $1,000 to $6,000 more.
Common Hip Replacement Billing Errors
Hip replacement bills are among the most complex in orthopedic surgery, with facility, surgeon, anesthesia, implant, and post-acute charges arriving separately. Review your itemized bill or Explanation of Benefits for these common errors before paying:
- Missing or mismatched laterality modifier: claims for right vs. left hip (modifier RT or LT) must match the operative report exactly, or the claim can be denied and resubmitted with the wrong side.
- Inpatient-level billing for an outpatient-appropriate stay: since CMS removed hip replacement from the inpatient-only list, billing an inpatient admission for a healthy patient who did not meet two-midnight rule criteria is a frequent compliance and cost-shifting error.
- Anesthesiologist billed out-of-network when the facility and surgeon are in-network: the No Surprises Act generally bars this kind of surprise bill for scheduled surgery at an in-network facility; do not pay before checking your explanation of benefits.
- Global period violations: routine follow-up visits, wound checks, and standard post-surgical evaluations within 90 days of surgery are included in the surgeon's global fee and should not be billed separately unless a special modifier (24, 78, or 79) applies for an unrelated or complication visit.
- Duplicate implant billing: the hip prosthesis code should appear once per hip on the itemized bill. Review the implant line item carefully and confirm it is not billed twice.
- Unbundled add-on codes: minor debridement, irrigation, or bone-graft preparation performed during the same session as the total hip arthroplasty is generally bundled into the global surgical code and cannot be billed as a separate procedure.
Frequently Asked Questions
How much does a hip replacement cost without insurance in 2026?
Without insurance, a total hip replacement costs $20,000 to $80,000 nationally in 2026, with a typical national average of $40,000 to $45,000. At an ambulatory surgery center the range is $22,000 to $32,000; at a hospital inpatient admission it is $38,000 to $65,000, and premium orthopedic specialty centers can charge $80,000 or more. Implant cost of $4,000 to $10,000 is usually included in quoted ranges, but confirm this in writing before scheduling surgery.
What does Medicare pay for a hip replacement in 2026?
For an inpatient hip replacement, Medicare Part A pays approximately $13,500 to the hospital under DRG 470, and the beneficiary pays the 2026 Part A deductible of $1,736. The surgeon bills separately under Part B: after the $283 Part B deductible, you pay 20% coinsurance on the approved surgeon fee of about $1,162 (CPT 27130), roughly $232. For outpatient or ASC-based hip replacement, Medicare Part B covers the facility at approximately $13,100 (hospital outpatient) or $9,600 (ASC), and you owe 20% coinsurance on both facility and surgeon fees.
How do I request a Good Faith Estimate for a hip replacement?
Call the hospital, ASC, or surgeon's office and identify yourself as self-pay or uninsured before scheduling. Ask for a written Good Faith Estimate itemizing the facility fee, surgeon fee (CPT 27130), anesthesiologist fee, implant cost, and pre-operative testing. Provide your ZIP code and confirm the site of service. If your surgery is scheduled 10 or more business days out, the estimate must arrive at least 3 business days before service; for 3 to 9 business days out, at least 1 business day before. Keep the written estimate for potential dispute rights.
What is the No Surprises Act and does it apply to hip replacement surgery?
The No Surprises Act, effective January 1, 2022, requires hospitals, ASCs, surgeons, and anesthesiologists to give uninsured or self-pay patients a written Good Faith Estimate before a scheduled procedure like hip replacement, and it protects insured patients from certain out-of-network surprise bills at in-network facilities. It does not apply to Original Medicare or Medicaid beneficiaries, who have their own coverage protections. If your final hip replacement bill exceeds the Good Faith Estimate by $400 or more, you can file a patient-provider dispute resolution claim within 120 days at cms.gov/nosurprisesact.
How do I get a written cash-pay quote for a hip replacement?
Call independent ambulatory surgery centers and hospital billing offices directly and ask, in these exact words, what is the self-pay cash price for a total hip replacement. Request that the quote be itemized in writing as a Good Faith Estimate, covering the facility fee, surgeon fee, anesthesia, implant, and any pre-operative testing. Ask specifically whether the price is bundled or whether items like physical therapy and follow-up visits are billed separately. Compare at least two or three facilities before committing, since ASC cash bundles typically run 30 to 60 percent below hospital chargemaster rates.
Can I negotiate a hip replacement bill after the fact?
Yes. Even after a bill arrives, call the hospital or surgical center's billing office and ask for a self-pay or prompt-payment discount, which often reduces the bill 30 to 50 percent if you can pay a lump sum. Request an itemized bill and check it against your Good Faith Estimate; if the final charge exceeds the estimate by $400 or more, you have 120 days from the bill date to file a patient-provider dispute resolution claim through cms.gov/nosurprisesact. Nonprofit hospitals must also offer income-based financial assistance under IRC Section 501(r); ask about this even after receiving a bill.
What's the difference between hospital and ASC hip replacement cost?
The exact same surgery, same surgeon, same implant, typically costs $15,000 to $30,000 less at an ambulatory surgery center than at a hospital inpatient admission. Medicare's 2026 payment reflects this: about $9,600 to an ASC versus about $13,500 to an inpatient hospital under DRG 470. The hospital charge includes overnight room and board, higher facility overhead, and broader staffing. Since CMS removed hip replacement from the inpatient-only list in 2020, healthy, lower-risk patients increasingly qualify for same-day ASC surgery.
Will my insurance cover hip replacement surgery?
Hip replacement is not a USPSTF preventive service, so it is not covered at 100 percent the way screening colonoscopy or mammography is. On an ACA-compliant plan, coverage is subject to your deductible, coinsurance, and any prior authorization requirement, since elective total hip arthroplasty is nearly always considered medically necessary but non-emergency surgery. Original Medicare, Medicare Advantage, and Medicaid all cover hip replacement when deemed medically necessary, but cost-sharing and prior authorization rules differ by plan and by state Medicaid program.
What's the difference between hip replacement and knee replacement cost?
Hip and knee replacement share the same Medicare inpatient DRG (DRG 470, Major Hip and Knee Joint Replacement without Major Complications) and similar cash-pay ranges of roughly $20,000 to $80,000 without insurance. Hip implants generally run somewhat higher, $4,000 to $10,000 versus $6,000 to $12,000 for knee implants at the premium end, but the two procedures are close enough in price that site of service, not joint, is the dominant cost driver. See the CoveredUSA knee replacement cost guide for a full breakdown.
Is anterior or posterior approach hip replacement more expensive?
Surgical approach, anterior, posterior, or lateral, does not typically change the Medicare-approved surgeon fee or the facility DRG payment, since CPT 27130 covers total hip arthroplasty regardless of approach. In cash-pay markets, some surgeons and facilities charge a premium for the anterior approach because it often allows a shorter hospital stay and faster recovery, which can lower facility charges overall even though the technique itself is not billed differently. Ask your surgeon which approach they recommend clinically before comparing cost.
