Does Medicare Cover Knee Replacement Surgery?
Key takeaways:
Original Medicare and Medicare Advantage plans cover knee replacement surgery that is deemed medically necessary.
If your knee replacement surgery is an inpatient procedure, it will be covered by Medicare Part A. Outpatient knee replacement surgery is covered by Medicare Part B.
Medicare also covers costs associated with your recovery, including physical therapy and equipment.
Table of contents
Knee replacement surgery — also known as knee arthroplasty — is one of the most common medical procedures. Arthritis is the predominant reason for most knee replacements. About 790,000 total knee replacements are performed annually in the U.S. These joint replacements typically last for 20 years or more.
Original Medicare and Medicare Advantage plans cover surgeries, including knee replacement, when they are deemed medically necessary. In fact, knee, ankle, and hip replacements are the most common surgeries for people enrolled in Medicare. Medicare will also cover the therapy and equipment you need to recover.
Quiz: Do I need knee replacement surgery?
Does Medicare cover knee replacement surgery?
Yes. Medicare covers knee replacement surgery if your doctor determines that a joint replacement is medically necessary. Knee replacement surgery is typically performed to relieve pain, swelling, and stiffness or to improve or increase mobility.
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Knee replacement surgeries may be:
Partial: Only a portion of the knee is replaced.
Total: The entire joint is replaced; this type of surgery accounts for most knee replacements.
Some people may later need knee replacement revisions. These are surgeries that correct any issues with a knee replacement, such as loose hardware or infection.
The American Joint Replacement Registry (AJRR) Annual Report, produced since 2013 by the American Academy of Orthopaedic Surgeons, provides a snapshot of U.S. knee and hip replacement surgeries covered by Medicare. Among procedures reported by participating surgeons in 2023, most were total knee replacements.
U.S. Knee Replacement or Revision Surgeries in 2023
Type of surgery | Procedures performed* | Percentage |
|---|---|---|
Total knee replacement | 254,345 | 87% |
Partial knee replacement | 10,609 | 4% |
Knee replacement revision | 26,683 | 9% |
Source: American Joint Replacement Registry 2024 Annual Report
*Note: The number of procedures is less than the U.S. total because the chart includes only surgeries covered by Medicare and performed by surgeons who responded to the AJRR survey. According to the AJRR annual report, about 87% of total knee replacements in 2023 included patella (knee cap) resurfacing.
These signs may mean it’s time for a knee replacement. When medications, exercise, and injections aren’t enough — meaning they no longer work for your pain and stiffness — it may be time for knee replacement surgery.
What to expect after knee replacement surgery. Physical therapy is a crucial element of the recovery program after having your knee replaced.
Does knee replacement surgery hurt? Pain is common in the first few weeks after surgery, but this symptom subsides with time, medication, ice packs, and exercise.
If you have original Medicare, the part of your insurance that will cover your knee replacement surgery depends on where you have the procedure performed. If your knee replacement is an inpatient procedure, your care will be covered by Medicare Part A. Outpatient procedures are covered by Medicare Part B.
Medicare Part A
Medicare Part A, which is hospital insurance, will cover your inpatient knee replacement surgery. You will pay a Part A deductible of $1,676 per benefit period in 2025 for days 1 to 60 that you’re in the hospital. If you recover at a skilled nursing facility, you won’t have any coinsurance for days 1 to 20 during your benefit period.
Medicare Part B
The Medicare Part B deductible is $257 in 2025. After you meet your deductible, Medicare pays 80% of allowed charges and you pay 20%.
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How much does knee replacement surgery cost out of pocket?
For surgery alone, you can expect to pay about $2,000 out of pocket for total knee replacement at an ambulatory surgery center. Your costs are capped at $1,676 in 2025 as an inpatient because of the Part A deductible for the benefit period. As discussed in the next section, this deductible also covers any inpatient rehab, such as physical therapy.
According to Centers for Medicare & Medicaid Services (CMS) estimates, the surgery can cost about the same (a roughly $430 difference) whether you have the procedure at a hospital or ambulatory surgery center.
Ambulatory surgical centers | Hospital outpatient departments | |
|---|---|---|
Surgeon fee | $1,257 | N/A |
Facility fee | $9,255 | N/A |
Total | $10,512 | N/A |
What Medicare covers (80%) | $8,410 | N/A |
What you pay (20%) | $2,102 | $1,676 in 2025 |
If you have Medicare Advantage, your out-of-pocket costs may be more or less than the estimates above, depending on your plan. You can find out about your estimated cost-sharing for the procedure by looking for pricing information on your plan’s website or by contacting your plan administrator.
How does Medicare cover rehab after knee replacement surgery?
Knee replacement surgery recovery typically requires rehabilitation. Most people resume everyday activities about 3 to 6 weeks after surgery, but returning to work and lifting heavy items can take several months.
Physical therapy (PT) and inpatient rehabilitation are covered by Medicare as long as your provider determines that these skilled services are medically necessary.
Medicare Part A
If you have Medicare Part A, your inpatient rehab is covered without any additional out-of-pocket costs as long as you have met your Part A deductible.
According to the AJRR 2024 Annual Report, the average length of stay, from admission to discharge, also varies based on the type of knee replacement, according to the report.
Average Length of Stay by Knee Replacement Surgery Type in 2023
Surgery type | Length of stay |
|---|---|
Total knee replacement | 1.1 days |
Partial knee replacement | 0.5 days |
Knee replacement revision | 3.3 days |
Medicare Part B
If you have Medicare Part B and have met your deductible, original Medicare covers 80% of covered outpatient therapy services and you pay 20%. Once charges for your outpatient physical therapy (PT) services reach $2,410 in 2025, your provider is required to confirm that the PT remains medically necessary for your care in order for it to continue to be covered. Outpatient occupational therapy, which may be provided at a skilled nursing facility, has its own $2,410 limit in 2025 before your provider is required to confirm that these services are still medically necessary in order for them to continue to be covered.
What equipment does Medicare cover for knee replacement surgery?
After knee replacement surgery, you also may need durable medical equipment (DME). Medicare covers certain items, including:
Continuous passive motion (CPM) machine, a device that gently moves a joint while a patient is in bed, which you may be able to rent or buy. To qualify for coverage, you must start using the device within 2 days following total knee replacement. Medicare covers up to 21 days of use in your home.
Heating pad
Medicare typically pays 80% of the approved charges for these items after you meet your Part B deductible.
Does Medicare cover home care after knee replacement?
Yes. Medicare covers certain home care after knee replacement, including a CPM machine and other DME. Covered home health care includes:
Part-time skilled nursing care
Physical therapy
Occupational therapy
Your home care services may be covered in full. Before your home care begins, the care agency should explain verbally and in writing what’s covered, what’s not covered, and how much you’ll be responsible for paying.
How can you tell if a knee replacement is medically necessary?
CMS considers total knee replacement medically necessary when three or more of these five criteria are met:
Advanced joint disease confirmed by imaging, such as MRI
History of unsuccessful therapies, such as pain relievers, anti-inflammatory medications, and exercises
Pain because of arthritis or injury that impacts daily activities despite assistive devices, weight loss, or injections
Distinct structural abnormalities
Needed revision because of previous failed joint replacement
Frequently asked questions
Yes. Medicare typically covers alternative treatments before and after knee surgery, including:
Injections, such as viscosupplementation — or hyaluronic knee injections for osteoarthritis — before knee replacement when conservative treatments such as physical therapy, pain medication, and/or a knee brace failed or no longer work
Nerve therapy known as transcutaneous electrical nerve stimulation (TENS) under Part A, if furnished while you are in the hospital, or under Part B as a medical supply when you have an outpatient procedure
Your Medicare plan may deny your knee surgery for reasons including a determination that the procedure is not medically necessary. You can file an appeal if you disagree with a Medicare coverage decision. The process is different depending on whether you’re covered by original Medicare or a Medicare Advantage plan.
The bottom line
Original Medicare and Medicare Advantage plans cover knee replacement surgery if the procedure is determined to be medically necessary. With original Medicare, knee replacement as an inpatient procedure is covered by Part A and outpatient surgery is covered by Part B. Medicare also covers costs associated with your recovery, including physical therapy and medical equipment such as a continuous passive motion machine.
For total knee replacement surgery alone, your costs are capped at $1,676 in 2025 — the Part A deductible — for both inpatient hospital surgery and inpatient rehab. For outpatient total knee replacement, you can expect to pay about $2,000 out of pocket for the surgery after meeting your Part B deductible, which is $257 in 2025. For outpatient rehab and other recovery services and equipment, expect to pay about 20% of allowed charges after meeting your deductible, though some care may be covered in full.
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References
American Academy of Orthopaedic Surgeons. (n.d.). American Joint Replacement Registry Annual Report.
American College of Rheumatology. (2024). Joint replacement surgery.
American Joint Replacement Registry. (2024). Annual Report 2024. American Academy of Orthopaedic Surgeons.
Centers for Medicare & Medicaid Services. (2012). Transcutaneous electrical nerve stimulation (TENS) for acute post-operative pain.
Centers for Medicare & Medicaid Services. (2019). Lower extremity major joint replacement (hip and knee).
Centers for Medicare & Medicaid Services. (2021). Comprehensive Care for Joint Replacement Model.
Centers for Medicare & Medicaid Services. (2022). Hyaluronic acid injections for knee osteoarthritis.
Centers for Medicare & Medicaid Services. (2023). Durable medical equipment reference list.
Centers for Medicare & Medicaid Services. (2024). Transparency in coverage.
Centers for Medicare & Medicaid Services. (2025). Medicare & Home Health Care.
Ignite Healthwise. (2024). Total knee replacement: What to expect at home. Kaiser Permanente.
Medicare.gov. (n.d.). Arthroplasty, knee, condyle and plateau; medial and lateral compartments with or without patella resurfacing (total knee arthroplasty).
Medicare.gov. (n.d.). Braces (arm, leg, back, & neck).
Medicare.gov. (n.d.). Continuous passive motion (CPM) machines.
Medicare.gov. (n.d.). Filing an appeal.
Medicare.gov. (n.d.). Inpatient rehabilitation care.
Medicare.gov. (n.d.). Occupational therapy services.
Medicare.gov. (n.d.). Physical therapy services.
Medicare.gov. (n.d.). Surgery.
Medicare Interactive. (n.d.). Outpatient therapy costs.
