Total knee arthroplasty (TKA) is one of the most common elective surgeries in the United States. More than 700,000 procedures are performed each year, and that number is rising as the population ages and as outpatient surgery becomes a viable option for healthier patients. The procedure resurfaces the damaged joint with metal and plastic components, eliminating the bone-on-bone friction that causes chronic pain.
Prices vary sharply depending on whether you are admitted to a hospital overnight or treated at an ambulatory surgery center (ASC). CMS has been actively expanding outpatient knee replacement since removing TKA from the inpatient-only list in 2018, and ASC rates have grown significantly since. A healthy patient under 75 who meets clinical criteria may be a candidate for same-day surgery, potentially saving $10,000 to $20,000 compared to an inpatient stay. Patients preparing for knee replacement often need a pre-surgical MRI or knee MRI to confirm the diagnosis — those costs are separate.
This guide covers what a knee replacement costs without insurance in 2026, what Medicare pays under DRG 470, how site of service affects the bill, and the most common billing errors to watch for after surgery. Patients who have reached their out-of-pocket maximum earlier in the year may benefit from scheduling elective surgery before year-end to avoid resetting cost-sharing.
Knee Replacement Cost by Site of Service in 2026
The biggest cost driver of Knee 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.
Knee Replacement prices without insurance vs. 2026 Medicare rates| Site of Service | Range Without Insurance | 2026 Medicare Rate |
|---|
| Ambulatory surgery center (ASC) | $20,000 – $30,000 | ~$10,500 (APC 5115) |
| Hospital outpatient department | $25,000 – $35,000 | ~$10,500 (OPPS) |
| Hospital inpatient (DRG 470) | $35,000 – $60,000 | ~$13,500 (DRG 470) |
| Premium hospital / specialty center | $60,000 – $80,000+ | ~$13,500 (DRG 470) |
Without-insurance ranges include facility fee, implants, surgeon fee, and anesthesia. Medicare rates are approximate 2026 figures. Surgeon fee (~$1,159) is billed separately under Part B in all settings.
Source: CMS FY 2026 IPPS Final Rule, CMS CY 2026 OPPS/ASC Final Rule, FAIR Health Consumer, New Choice Health
Why the Same Procedure Is So Much More at a Hospital
When a knee replacement is performed at a hospital inpatient setting, the bill includes a facility fee that covers room and board, nursing, operating room overhead, implants, anesthesia, and post-acute care coordination. At an ASC, the same surgeon performs the same operation but the patient goes home the same day or within 24 hours, eliminating overnight room charges and reducing facility overhead substantially.
The Medicare rate gap illustrates this clearly. CMS pays approximately $13,500 to an inpatient hospital under DRG 470 (Major Hip and Knee Joint Replacement without Major Complications) vs. approximately $10,500 under the ASC or OPPS rate. In cash prices, that $3,000 Medicare gap typically expands to $15,000 to $25,000 in uninsured charges, since hospitals apply higher facility markup than ASCs do.
Implant cost is a major variable that the site-of-service comparison does not fully capture. Knee implants typically add $6,000 to $12,000 to the total bill. Hospitals mark up implants more than ASCs, partly because ASCs have incentive to control supply costs. If you are paying cash, ask the facility specifically whether implant cost is included in the quoted price.
Knee Replacement Cost by Procedure Type
Not every knee replacement is a full joint replacement. Unicompartmental (partial) knee replacement is performed when only one compartment of the knee is damaged, and it typically costs 15 to 25 percent less than total knee arthroplasty. Revision surgery to replace a failed implant is significantly more expensive due to complexity and longer operating time.
Typical cost by variant| Procedure Type | Without-Insurance Range | Medicare Setting |
|---|
| Total knee arthroplasty (both compartments) | $30,000 – $60,000 | Part A (inpatient) or Part B (outpatient) |
| Unicompartmental (partial) knee replacement | $20,000 – $40,000 | Part B outpatient or ASC |
| Bilateral simultaneous knee replacement | $50,000 – $90,000 | Part A inpatient (higher DRG weight) |
| Revision knee arthroplasty (failed implant) | $40,000 – $80,000+ | Part A inpatient typically |
Ranges include implant cost ($6,000-$12,000) and surgeon fee. Bilateral and revision cases are rarely performed at ASCs. Ask your surgeon whether partial replacement is appropriate before committing to total replacement.
Source: FAIR Health Consumer, New Choice Health, CMS DRG Weight Tables 2026
What Medicare Pays for Knee Replacement
When knee replacement is performed as an inpatient hospital admission, Medicare Part A covers the facility cost under DRG 470 (Major Hip and Knee Joint Replacement or Reattachment of Lower Extremity without Major Complications). Medicare pays the hospital approximately $13,500, and the beneficiary's cost is the 2026 Part A 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 Part B: after the $283 Part B deductible, you pay 20% of the Medicare-approved surgeon fee of approximately $1,159, which works out to roughly $232 out of pocket for the surgeon alone.
When knee replacement is performed at a hospital outpatient department or ASC, Medicare Part B covers the facility fee at approximately $10,500 (OPPS or ASC rate). After your $283 Part B deductible, you owe 20% coinsurance on both the facility and surgeon fees. Medicare Advantage plans must cover knee replacement on the same terms as Original Medicare; many waive the traditional three-day inpatient rule and allow ASC-based TKA with prior authorization. Medicaid covers total knee replacement when deemed medically necessary, though coverage terms and cost-sharing vary by state. If you are uninsured, the No Surprises Act requires hospitals and ASCs to provide a Good Faith Estimate before surgery.
What Factors Affect Cost
- Site of service: ASC vs. hospital outpatient vs. hospital inpatient, the single largest cost driver, with a spread of $10,000 to $30,000 for the same procedure.
- Implant brand and design: standard implants cost $3,000 to $6,000; premium or custom implants can reach $10,000 to $12,000.
- Procedure type: total vs. partial (unicompartmental) knee replacement, and whether it is a primary or revision procedure.
- Length of hospital stay: each inpatient day adds $1,500 to $3,000 in facility charges; outpatient or ASC-based surgery eliminates overnight fees.
- Post-operative rehabilitation: physical therapy for 6-12 weeks typically adds $2,000 to $5,000 if providers are out of network; home health visits add $500 to $2,000.
- Geographic region: procedures in high-cost urban markets (New York, Los Angeles, San Francisco) run 20 to 40 percent above the national average.
- Robotic or computer-assisted navigation technology: adds $2,000 to $5,000 in facility charges; rarely reimbursed separately by Medicare or commercial insurers.
Common Knee Replacement Billing Errors
Knee replacement bills are among the most complex in orthopedic surgery. Before paying any invoice, review your Explanation of Benefits (EOB) or itemized bill for these errors:
- Missing or mismatched laterality modifier: claims for right vs. left knee (modifier RT or LT) must match the operative report exactly. A mismatch causes automatic denial and can result in a resubmission coded to the wrong side.
- Unbundled add-on codes: synovectomy, meniscectomy, and debridement performed during the same session as TKA are bundled into the global surgical code and cannot be billed separately.
- Global period violations: all routine follow-up visits, wound care, and post-surgical evaluations within 90 days of surgery are included in the original surgical fee. Charges for these during the global period require special modifiers (24, 78, or 79) only for unrelated or complication visits.
- Robotic/navigation add-on billed separately: most insurers including Medicare treat computer-assisted navigation as integral to the procedure fee. Separate billing for navigation codes is a common audit trigger.
- Inpatient level billed for outpatient-appropriate stay: since CMS removed TKA from the inpatient-only list, billing an inpatient admission for a healthy patient who did not meet two-midnight rule criteria is a top compliance risk.
- Duplicate implant billing: implant cost should appear once per knee on the itemized bill. Review the line items for the implant code and confirm it is not duplicated.
Frequently Asked Questions
How much does a knee replacement cost without insurance in 2026?
Without insurance, a total knee replacement costs $30,000 to $60,000 nationally in 2026. The national average across facility types is approximately $35,000 to $45,000. At an ambulatory surgery center the range is $20,000 to $30,000; at a hospital inpatient setting it is $35,000 to $60,000. Premium hospitals and specialty centers can charge $80,000 or more. Implant costs of $6,000 to $12,000 are typically included in quoted ranges but confirm this before scheduling.
What does Medicare pay for a knee replacement in 2026?
For an inpatient knee replacement, Medicare Part A pays approximately $13,500 to the hospital under DRG 470. The beneficiary pays the 2026 Part A deductible of $1,736. The surgeon bills under Part B: after the $283 Part B deductible, you pay 20% of the approved surgeon fee, roughly $232. For outpatient or ASC-based knee replacement, Medicare Part B covers the facility at approximately $10,500, and you owe 20% coinsurance on both facility and surgeon fees after the Part B deductible.
Is knee replacement covered by Medicare outpatient or does it require hospitalization?
Since 2018, CMS removed total knee arthroplasty from the inpatient-only list, making it payable in outpatient and ASC settings. In 2026, healthy patients who meet clinical criteria may have TKA at an ASC or hospital outpatient department and go home the same day. Whether inpatient admission is medically necessary depends on the patient's health status, and the two-midnight rule applies. Medicare Advantage plans often waive the three-day inpatient requirement for joint replacement.
How much does a partial (unicompartmental) knee replacement cost compared to total knee replacement?
A partial or unicompartmental knee replacement typically costs 15 to 25 percent less than a total knee replacement. Without insurance, expect $20,000 to $40,000 for a partial replacement vs. $30,000 to $60,000 for total knee arthroplasty. Partial replacements are more commonly performed at ASCs, which keeps costs lower. Not every patient qualifies; your surgeon determines whether only one compartment is damaged.
What additional costs come after a knee replacement?
Post-operative costs include physical therapy (6 to 12 weeks, typically $2,000 to $5,000 if out of network), home health aide visits ($500 to $2,000), and any follow-up imaging. Pre-operative costs also apply: X-rays, MRI if ordered, pre-surgical labs, and anesthesia consultation can add $1,000 to $3,000 before the procedure. All routine follow-up within 90 days is bundled into the surgeon's global fee and should not be billed separately.
Does the No Surprises Act apply to knee replacement surgery?
Yes. The No Surprises Act requires hospitals, ASCs, and other facilities to provide a Good Faith Estimate (GFE) to uninsured or self-pay patients before a scheduled procedure. The GFE must include expected costs for the facility, surgeon, anesthesiologist, and other providers. If your final bill exceeds the GFE by more than $400, you can dispute it through the patient-provider dispute resolution process.
What is a Good Faith Estimate and how do I use it for knee replacement?
A Good Faith Estimate is a written cost estimate required under the No Surprises Act for self-pay patients scheduling a non-emergency procedure like knee replacement. You are entitled to request one before scheduling. The GFE must itemize expected charges for all providers involved in the surgery: surgeon, facility, anesthesiologist, and any assistants. Compare the GFE to national benchmarks using CoveredUSA data to determine whether the quoted price is reasonable.
Are robotic-assisted knee replacements more expensive?
Robotic-assisted TKA adds $2,000 to $5,000 in facility overhead versus conventional surgery. Most commercial insurers and Medicare do not reimburse the robotic navigation component as a separate line item, meaning the additional cost is absorbed by the facility or passed to the patient. Studies show comparable clinical outcomes between robotic-assisted and conventional TKA for most patients. If a surgeon recommends robotic surgery, ask whether it is included in the quoted price or billed as an add-on.
