Estimate Your Medicare Cost for Knee Replacement
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Total Knee Replacement (TKA) · 2026 CMS Rates
Generated
March 15, 2026
Based on 2026 CMS Rates
| Surgery Type | Total Knee Replacement (TKA) |
| Surgery Setting | Inpatient Hospital (Part A) |
| Insurance Coverage | Original Medicare (no supplement) |
| Location | CA |
| Estimated Surgery Duration | 90 minutes |
| Assistant Surgeon | No |
| Pre-Op Medical Clearance | Yes (included) |
| Physical Therapy | Yes (included) |
| Part B Deductible ($283) | Not yet met |
| Part A Deductible ($1,736) | Not yet met |
Conservative Low
$2,591
Estimated Total
$2,688.5
Conservative High
$2,816
With Medigap Plan G
$283
With Medigap Plan N
$383
| Cost Item | Medicare Approved | Your Cost | Confidence |
|---|---|---|---|
Hospital Stay (Inpatient) — DRG 470 (Major Joint Replacement, no complications) Covers room, nursing, operating room, implant, supplies, and all in-hospital services. You are NOT billed separately for the implant. Part A | $25,000 | $1,736 | High confidence Part A deductible is fixed at $1,736 for 2026. No variance unless deductible already met. |
Surgeon Fee — 27447 (National Average) Total Knee Replacement (TKA) surgeon fee. Covers the surgery and all related office visits for 90 days (global period). Part B | $1,159 | $458.2 $447–$470 | High confidence National average based on 34.71 total RVU × $33.4009 CF. Select your location above for a locality-specific fee. |
Anesthesiologist Fee (90 min) CPT 01402: 7 base units + 6 time units = 13 total units × $20.5 national CF Part B | $266.5 | $53.3 $48–$61 | Low confidence National average CF used. Actual surgery duration is unpredictable. Range reflects ±30 min variance. If provider does not accept Medicare assignment, add up to 15% (limiting charge). |
Pre-Op Medical Clearance Required if you have conditions like heart disease or diabetes. Covered when medically necessary. Part B | $225 | $45 $41–$54 | Medium confidence Depends on number of specialist visits required. Complex patients may need cardiology + internal medicine clearance. |
Pre-Op Lab Tests Blood tests, EKG, and other tests required before surgery. Covered when medically necessary. Part B | $175 | $35 $30–$42 | Medium confidence Depends on which tests your physician orders. Estimate based on CPT 85025 + 80053 national averages. |
Radiology Reading Fee (estimate) A radiologist reads your X-rays and MRI. This is a separate Part B bill from the radiologist's practice, not the hospital. Part B | $120 | $24 $19–$30 | Medium confidence Based on typical Medicare-approved amounts for CPT 72148 (MRI read). Actual fee depends on which imaging studies are ordered. |
Hospital Lab Tests (estimate) Blood tests ordered during your hospital stay (CBC, metabolic panel, coagulation). Billed separately by the lab under Part B. Part B | $85 | $17 $14–$22 | Medium confidence Based on CPT 85025 + 80053 national averages. Actual fee depends on which tests are ordered. |
Outpatient Physical Therapy Typically 6–8 weeks, 2–3 sessions per week. Covered under Part B. Part B | $1,500 | $300 $240–$375 | Medium confidence Depends on number of sessions and recovery progress. Estimate based on 16 sessions at typical Medicare-approved rates. |
Durable Medical Equipment Walker, crutches, and other approved equipment. Covered under Part B. Part B | $100 | $20 $16–$26 | Medium confidence Depends on which equipment is prescribed. Estimate based on standard walker + crutches. |
| TOTAL | $28,630.5 | $2,688.5 |
Anesthesiologist Excess Charge Risk
If your anesthesiologist does not accept Medicare assignment, they may charge up to 15% above the Medicare-approved amount (the "limiting charge"). This is not covered by Original Medicare. Verify your anesthesiologist's participation status at medicare.gov/care-compare before surgery.
This estimate is based on 2026 Medicare national rates from CMS official publications.
Assumes an uncomplicated procedure with no post-surgical complications.
Implant costs are included in the facility fee (DRG 470 for inpatient; bundled in OPPS/ASC for outpatient).
Surgeon fee uses GPCI-adjusted rate for your selected locality (or national average if no locality selected).
Anesthesia fee uses locality-adjusted 2026 CMS conversion factor (range: $19.42–$23.37/unit by locality).
Anesthesia time units calculated as: surgery minutes ÷ 15 (to one decimal place), per CMS methodology.
Physical therapy estimate ($1,500) is based on a typical 6–8 week outpatient course (2–3 sessions/week).
SNF costs apply only if you have a qualifying 3-day inpatient hospital stay.
This calculator does NOT apply to Medicare Advantage plans — consult your plan's Evidence of Coverage.
Actual costs may vary based on your specific providers, health status, and plan details.
This is not financial or medical advice. Verify all costs with your providers before your procedure.
| Source | Used For |
|---|---|
| CMS 2026 MPFS Final Rule (PPRRVU2026_Jan_QPP) | Surgeon RVU values and national conversion factor ($33.4009) |
| CMS 2026 GPCI File (GPCI2026) | Geographic Practice Cost Index adjustments for surgeon fees |
| CMS 2026 Anesthesia Conversion Factors (ANES2026) | Locality-adjusted anesthesia conversion factors (100+ localities) |
| CMS 2026 OPPS Final Rule (Nov 25, 2025) | Hospital Outpatient Department facility fees ($13,116 for CPT 27447) |
| CMS 2026 ASC Final Rule (Nov 25, 2025) | Ambulatory Surgery Center facility fees ($9,393 for CPT 27447) |
| CMS 2026 SNF PPS Final Rule | Skilled Nursing Facility per-diem rates ($217/day for days 21–100) |
| CMS 2026 Medicare Part A & B Parameters | Deductibles ($1,736 Part A; $283 Part B) and coinsurance rates |
Confirm all providers (surgeon, anesthesiologist, assistant surgeon) accept Medicare assignment at medicare.gov/care-compare
Ask the hospital if you will be admitted as inpatient or under observation status — this significantly affects your bill
If you have Medigap Plan G, your out-of-pocket is capped at the Part B deductible ($283) for covered services
Request an itemized bill from each provider after surgery and compare against your Medicare Summary Notice (MSN)
If you receive a bill from your surgeon for a follow-up visit within 90 days, verify it is not within the global surgical period
Contact your State Health Insurance Assistance Program (SHIP) at shiphelp.org for free, unbiased counseling
This estimate was generated by the Medicare Cost Calculator at mymedicost.com using 2026 CMS official data. This is not financial or medical advice. Always verify costs with your providers and Medicare before your procedure. For questions about Medicare coverage, call 1-800-MEDICARE (1-800-633-4227).