This page is for the owner, administrator or marketing lead of an orthopedic practice who wants to know what one Medicare total knee replacement is worth to the surgeon in 2026, and how much that number moves by location. Every figure below is computed from the CMS 2026 physician fee schedule relative value file (October release) and the 2026 geographic index table that ships with it, using the payment formula CMS publishes in the same file.
I run a marketing agency for surgical practices. Before I plan a campaign for a service line, I look at what a case pays, because that sets a ceiling on what it makes sense to spend to win one. For many joint replacement practices, a large share of total knee patients are on Medicare, so this is the first number I check.
When I reviewed the pages that rank for this procedure’s Medicare reimbursement, nearly all were billing software, coding vendor and revenue cycle pages. The results I read led with one national figure, and none of them showed the payment for a specific locality, which is the number a practice actually receives. Some quoted a percentage change from 2025; I could not check that against a 2025 file, so I have left it out.
The national number
For 2026, CMS assigns this procedure 34.71 total relative value units in the facility setting. Multiplied by the 2026 conversion factor of $33.4009, that is a national surgeon payment of $1,159.35.
The 2026 file also comes in a second version for clinicians who qualify as participants in an advanced alternative payment model. That version uses a conversion factor of $33.5675, which puts the same procedure at $1,165.13, a difference of $5.78 per case.
| Component | RVUs | Dollars at $33.4009 | Share |
|---|---|---|---|
| Physician work | 19.11 | $638.29 | 55.1% |
| Practice expense (facility) | 11.58 | $386.78 | 33.4% |
| Malpractice | 4.02 | $134.27 | 11.6% |
| Total | 34.71 | $1,159.35 | 100% |
The file marks this procedure as facility only. There is no office (non-facility) rate, because the surgery happens in a hospital or surgery center.
What it pays where your practice is
CMS adjusts each of the three components by a geographic index for each of its 109 payment localities. The 2026 work index includes a floor of 1.0, which Congress extended through January 1, 2027. Applying the formula from the CMS file gives these surgeon payments:
| Medicare locality | 2026 surgeon payment |
|---|---|
| Arkansas (lowest in the file) | $1,039.69 |
| Alabama | $1,052.72 |
| Rest of Texas | $1,126.59 |
| National | $1,159.35 |
| Los Angeles and Orange County | $1,211.18 |
| Houston | $1,212.23 |
| Suburban Chicago | $1,277.91 |
| Chicago | $1,339.63 |
| Manhattan | $1,341.54 |
| Miami | $1,380.50 |
| NYC suburbs and Long Island (highest in the lower 48) | $1,388.37 |
| Alaska (work index floor of 1.5) | $1,443.34 |
Across the lower 48, the gap between the lowest and highest locality is $348.68 per case, or 33.5%. In 61 of the 109 localities, the surgeon is paid less than the national figure.
These are the fee schedule amounts. What actually arrives also depends on the patient’s deductible and coinsurance, and on adjustments outside this file. Your billing team’s remittance data is the final word for your own practice.
What the payment covers
This procedure carries a 90-day global period. The CMS file describes that as major surgery with a one-day preoperative period and a 90-day postoperative period included in the fee schedule amount. In plain terms, the surgeon’s routine visits during those 90 days are already paid for inside this one number.
The file also splits the global package into three parts:
| Part of the global package | Share | Dollars at the national rate |
|---|---|---|
| Preoperative | 10% | $115.93 |
| Intraoperative, including in-hospital post-op work | 69% | $799.95 |
| Postoperative care in the office after discharge | 21% | $243.46 |
This split matters when care is shared, for example when a different clinician handles the post-op period.
Payment rules in the file that affect the case value
The same row of the CMS file carries several payment policy indicators. For this procedure:
- Multiple procedures on the same day: standard rules apply. CMS ranks the procedures by fee schedule amount and pays the next ones at 50%. At the national rate, that is $579.67 for a second procedure with this value.
- Bilateral: the 150% adjustment applies. If both knees are reported on the same day, payment is based on the lower of the actual charge or 150% of the single fee, which is $1,739.02 at the national rate.
- Assistant at surgery: the payment restriction does not apply, so an assistant may be paid.
- Co-surgeons: could be paid, but CMS requires supporting documentation of medical necessity.
- Team surgery: not permitted for this procedure.
Where the hospital and surgery center payment fits
The surgeon’s fee is only one of the payments for a Medicare total knee. The hospital or surgery center is paid separately under the outpatient or surgery center payment systems. CMS publishes those rates in addenda that carry an AMA license agreement, so I have kept them off this page.
Two 2026 policy facts from the final rule in the Federal Register are relevant to where these cases happen. CMS wrote that for 2026 it is “phasing out the IPO list over 3 years,” starting with 285 mostly musculoskeletal services (Federal Register, CMS-1834-FC). The same rule adds 276 procedures to the surgery center covered procedures list based on revised criteria, plus 271 codes being removed from the inpatient only list. Total knee replacement itself left the inpatient only list years earlier; the 2026 rule refers back to that removal in the CY 2018 rulemaking.
For the marketing side of that shift, I wrote about marketing total joint replacement in an ASC.
What this means for an owner
Here are facts from this page set side by side:
The national Medicare surgeon payment for a total knee replacement in 2026 is $1,159.35.
The same case pays $1,039.69 in Arkansas and $1,388.37 on Long Island.
That fee includes 90 days of routine post-op visits.
A second same-day procedure with this value is paid at 50%.
In one orthopedic practice I audited, 92% of the Google Ads spend went to a campaign that had produced zero appointments, and the appointment buttons led to a page with no form.
What those mean together for your practice is for you to work out.
If you want to see what a knee case costs you to win in your own market, book a 30-minute call. I will look at your site and your market before we talk.
Related pages
What patients see when they compare prices is covered in knee replacement cost, partial vs total knee replacement cost and robotic vs traditional knee replacement cost. For the marketing side of the math, see orthopedic patient acquisition cost.
How I computed these numbers
- I took the work, facility practice expense and malpractice RVUs for this procedure from the CMS 2026 national physician fee schedule relative value file, October release.
- I took the 2026 work, practice expense and malpractice geographic indices for all 109 localities from Addendum E in the same download.
- I applied the facility pricing formula printed in the CMS file: each RVU times its index, summed, times the conversion factor.
At an index of 1.0 for all three components, the result matches the national amount. You can recheck any locality with the CMS physician fee schedule look-up tool.
Frequently asked questions
How much does Medicare pay a surgeon for a total knee replacement in 2026? The national facility amount is $1,159.35, based on 34.71 total RVUs and a conversion factor of $33.4009. Qualifying alternative payment model participants are paid at a conversion factor of $33.5675, which gives $1,165.13.
Why is the Medicare payment different in my area? CMS adjusts the work, practice expense and malpractice parts of the fee by a geographic index for each of 109 localities. For this procedure, that moves the payment from $1,039.69 in Arkansas to $1,388.37 on Long Island.
Does the Medicare fee include follow-up visits? Yes. The procedure has a 90-day global period, so routine postoperative visits during those 90 days are included in the fee.
Does Medicare pay more if both knees are done on the same day? The bilateral indicator for this procedure allows payment of up to 150% of the single fee, which is $1,739.02 at the national rate.
Does this page include the hospital or surgery center payment? No. It covers the surgeon’s fee under the physician fee schedule only. The facility is paid separately under its own payment system.
