How much does a knee replacement cost in 2021? | finder.com

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How much does a knee replacement cost?

Compare payment options and costs for a knee replacement

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If you're a candidate for a knee replacement, costs vary significantly based on your insurance, where you live and the hospital or doctor you choose. Each procedure is assigned standardized, 5-digit CPT codes that hospitals and insurance companies use for billing purposes. Use the CPT code to compare prices for a knee replacement before scheduling your appointment.

Average cost for a knee replacement

If you have health insurance and use an in-network doctor, you can expect to pay $21,253 for a knee replacement on average. If you don't have insurance or you choose an out-of-network doctor, the cost increases to $51,219.

Average costs are based on the primary cost of a knee replacement in the 90201 ZIP code and don't factor in insurance costs like copays or deductibles, or additional fees often charged by doctors or hospitals — like medical supplies, facility fees and support services.

CPT code Procedure ZIP used Description In-network costs Out-of-network costs
27447 Knee replacement 90201 Major joint replacement or reattachment of lower extremity without major comorbid conditions or complications $21,253 $51,219

Related costs for a knee replacement

CPT code Primary procedure Description In-network costs Out-of-network costs
73560 Radiology X-ray of knee, 1 or 2 views $21 $50
88305 Pathology Pathology examining of tissue using a microscope, intermediate complexity $93 $250
01402 Anesthesia Anesthesia for open or endoscopic total knee joint replacement $2,310 $5,640
27447 Hospital (Outpatient) Hospital Outpatient Facility (HOSPF) estimate for yor procedure code 27447 (in addition to your doctor's fee) $9,138 $20,097
Total related costs $11,562 $26,037

Does health insurance cover a knee replacement?

Most health insurance policies cover a knee replacement if it's medically necessary and you've met your deductible and any coinsurance or copays specified in your policy. If you don't have health insurance, you may need to pay the full cost of a knee replacement out of pocket. The exact amount your insurance pays for a knee replacement comes down to your plan and the doctor or healthcare facility you're going to. For the most accurate idea of how much you'll pay out of pocket, contact your insurance company before booking a knee replacement.

Does Medicare cover a knee replacement?

It depends on your Medicare plan, but generally Medicare covers procedures like a knee replacement that are considered medically necessary by your doctor.

  • Medicare Part A (Hospital Insurance) covers inpatient care in a hospital or skilled nursing facility following a hospital stay, so it typically won't cover a knee replacement.
  • Medicare Part B (Medical Insurance) pays for emergency, urgent and outpatient care and some preventative services, which means Medicare likely covers a knee replacement — but you'll be charged a 20% coinsurance.
  • Medicare Part C (Medicare Advantage) is a comprehensive plan that combines Part A, Part B and often Part D and should pay for a portion of a knee replacement minus any deductible, copay or coinsurance.
  • Medicare Part D (Prescription Drugs) won't cover a knee replacement, but it may help to pay for any medication you need as part of your recovery.

What affects the cost of a knee replacement?

The price you'll pay for a knee replacement varies based on factors like:

  • Your health insurance plan. Your coinsurance, copay and how much of your deductible you've met affects the amount you pay for a knee replacement out of pocket, does as whether your doctor or anyone else involved is outside your network.
  • Your location. Where you live dictates which doctors or healthcare facilities you have access to for a knee replacement. Urban areas are more competitive, which can drive down costs for a knee replacement compared to rural areas.
  • Your doctor. Your doctor's experience and expertise affects how much they charge for a knee replacement. And the cost may increase if complications arise during a knee replacement and your doctor has to call in other medical professionals.
  • Additional fees. Your healthcare provider may charge associated fees that increase the overall cost of a knee replacement.

How to cut your costs for a knee replacement

In the leadup to a knee replacement, confirm your copay, coinsurance and deductible with your insurer so you know how much you'll pay out of pocket.

  • Dip into your HSA, FSA or HRA. These tax-advantaged accounts can help you to cover out-of-pocket costs for a knee replacement.
  • Ask about financial aid. If you can't afford to pay the average cost of $21,253 with or without insurance, most hospitals and clinics offer financial aid programs that include discounts or interest-free payment plans.
  • Explore outpatient centers. Outpatient facilities tend to charge less for medical procedures like a knee replacement, though they're not an option for everyone.
  • Consider medical loans. A medical loan could help pay for anything your health insurance doesn't cover for a knee replacement, like copays or coinsurance.
  • Compare doctors and hospitals. Lower the price of medical services by comparing in-network hospitals before you schedule a knee replacement. The Centers for Medicare and Medicaid Services require hospitals and clinics to publish online price lists for common procedures, which may include costs for a knee replacement.

Bottom line

The price of a knee replacement is a major consideration for treatment whether you have health insurance or not. The amount you'll pay for a knee replacement can vary between doctors, hospitals, locations and insurance plans, which is why it's worth comparing hospital prices.

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