Total knee replacement (TKA) is the most common major surgery among Medicare beneficiaries. Medicare covers 80% of approved costs after your Part B deductible — but you still receive 3 to 5 separate bills. Here is what to expect.
Data source: CMS 2026 Medicare Physician Fee Schedule (MPFS) and OPPS Final Rule.
Based on CMS 2026 MPFS & OPPS Final Rules
Surgeon Fee (national average)
CPT 27447 · 34.71 RVU × $33.4009 conversion factor
~$1,159
Hospital Facility Fee (HOPD)
CMS 2026 OPPS APC 5115 — outpatient hospital
~$13,116
Ambulatory Surgery Center (ASC)
CMS 2026 ASC Final Rule — lower-cost setting
~$9,393
Inpatient Hospital (DRG 470)
Major joint replacement, no complications — Medicare pays most
~$25,000
Anesthesia Fee
Varies by locality and time (base 7 units + time units)
~$700–$1,200
Pre-Op Labs & Clearance
EKG, blood work, physician clearance visit
~$400
Your 20% Share (no Medigap)
After Part B deductible; HOPD setting
~$1,700–$2,900
With Medigap Plan G
Only the annual Part B deductible
~$283
Amounts reflect national averages. Actual costs vary by location (GPCI), provider participation status, and insurance coverage.
Medicare Part A covers inpatient hospital stays if you are formally admitted — pays 100% after the $1,736 deductible for days 1–60.
Medicare Part B covers the surgeon fee, anesthesia, and outpatient facility fee — pays 80% after the $283 Part B deductible.
Physical therapy after surgery is covered under Part B, subject to the 2026 KX threshold of $2,480.
Skilled Nursing Facility (SNF) care is covered for up to 100 days if you had a qualifying 3-night inpatient hospital stay.
Medigap Plan G eliminates nearly all out-of-pocket costs beyond the $283 annual Part B deductible.
Costs vary significantly by location and provider
Medicare pays physicians based on Geographic Practice Cost Indices (GPCI) that differ by locality. Your actual out-of-pocket cost depends on your deductible status, supplemental insurance, and whether your providers accept Medicare assignment. Use our free calculator for a personalized estimate.
Enter your location, insurance type, and deductible status for a precise out-of-pocket breakdown — surgeon fee, facility fee, anesthesia, and post-op costs all included.
Open Free CalculatorFree · No sign-up · Based on 2026 CMS official data
Data sources: CMS 2026 Medicare Physician Fee Schedule (MPFS), 2026 Outpatient Prospective Payment System (OPPS) Final Rule, and 2026 Ambulatory Surgical Center (ASC) Payment System. Estimates are for educational purposes only and do not constitute medical or financial advice.