Medicare Cost Snapshot (2025 National Averages)
| Procedure | CPT Code | Medicare Pays (Hospital) | Typical Out-of-Pocket | Medicare Pays (ASC) | Typical Out-of-Pocket |
|---|---|---|---|---|---|
| Total Hip Replacement | 27130 | $11,918 | $1,884 | $8,401 | $2,099 |
| Total Knee Replacement | 27447 | $11,886 | $1,917 | $8,610 | $2,061 |
| Total Shoulder Replacement | 23472 | $11,900 | $1,916 | $9,000 | $3,082 |
ASC = Ambulatory Surgery Center
How to Interpret These Numbers
- Medicare Pays reflects the amount Medicare reimburses the facility and surgeon.
- Out-of-Pocket represents the average coinsurance or deductible responsibility for Original Medicare beneficiaries. Medicare Advantage plans may use flat copays.
- Geographic adjustments, supplemental insurance, and negotiated rates can significantly change your final cost.
Tips for Getting Personalized Estimates
- Use the Medicare Procedure Price Lookup to view location-specific averages.
- Call the hospital or surgery center billing department for your exact CPT code and insurance coverage.
- Ask your orthopedic practice if physician fees and facility fees are billed separately.
Important Reminders
- Final costs depend on your deductible status, supplemental coverage, and whether you stay overnight.
- Medicare Advantage or commercial plans may require prior authorization or network approval.
- Revision surgeries, custom implants, and comorbidities can increase total charges.
Need help interpreting cost data? Contact us and our team will point you toward official Medicare resources.